Inspection on 20/05/08 for St Judes House

This inspection was carried out on 20th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Judes House 21/06/07

St Judes House 05/10/06

St Judes House 24/02/06

St Judes House 10/10/05

St Judes House 02/03/05

St Judes House 11/08/04

St Judes House 26/03/04

Similar services:

Ashlong House

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Spring Lane Care Home

Avenues (The) (Neave Crescent)

Delrose House Ltd

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 St Judes House 14 Canadian Avenue Catford London SE6 3AS Lead Inspector Claire Taylor Key Unannounced Inspection 20 & 22nd May 2008 10:15a th St Judes House DS0000025643.V361649.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 Judes House DS0000025643.V361649.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 Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Judes House Address 14 Canadian Avenue Catford London SE6 3AS 0208 6904493 0208 690 4501 stjudes@hotmail.com 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) Elizabeth Peters Care Home Limited Mrs Priscilla Kagijo Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0), Physical disability (0), Physical disability over 65 years of age (0) St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 10 persons aged 40 years and above with a past or present mental disorder, 2 of whom can have a physical disability service users can be over 65 years To include one named person aged 39 years, until May 2006 2. Date of last inspection Brief Description of the Service: St Judes is a large Victorian property offering care and accommodation to ten adults with past or present mental health problems, some of who may be over 65 years of age. The home is one of four owned and managed by a local provider, Elizabeth Peters Care Homes Ltd. The home is on a main road and is a short walking distance of shops and facilities of Catford town centre. This provides the home with good transport links as the town centre has two train stations and is well served by buses. The house is unobtrusive and blends in with the surrounding properties. The home offers single bedroom accommodation and communal space including a large rear garden. There were no vacancies on the day of the inspection. The weekly fees for a place at the home range from £650.00 to £690.00 and were correct at the time of this inspection. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection report is based on findings from two visits made to the home. Various records were looked at in relation to people’s care, staffing and the way the home was being run. We returned to the home on the 22nd May to look at some records that were not available during our first visit. Prior to the visit, the home returned its Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment that the provider (owner) must complete every year. It is used to tell the Commission about the services provided, how the home makes sure of good outcomes for the people using it and any planned developments. The completed AQAA provided us with useful information about what the service does well and where it needs to improve. Some details from the AQAA are included in this report. ‘Have your say’ comment cards were sent to all people living in the home, a selection of staff and relatives. Five people, four staff and one relative responded to our questionnaires. We met with nine people who live in the home and spoke with the manager and some of the staff. We also had a look around the house. All those who took part are thanked for their time and contribution to this inspection. What the service does well: The home supports people to make decisions about their lives and share their views. Each person is fully supported to access relevant mental health services and the home maintains good working relationships with other relevant professionals. People are treated with respect and dignity that promotes their individuality and values their rights. The staff team remains well established and stable and individuals were all very positive in their comments about the overall standard of care they receive. “Happy about the meals the home provides.” said one person. Other comments included, “I like it, the staff are very nice.” “It’s a good place, they look after you”. Additionally, the people we met seemed comfortable and relaxed in their home. One staff wrote, “Listen to service users’ views and opinions and act on them.” A relative said, “They provide a caring and secure living environment for my…” The environment provides homely and comfortable surroundings for the people who live there. People responded on their comment cards that the home was “always” fresh and clean. Information from the AQAA also told us that the home has a good awareness of where it could improve and how it plans to develop its services over the next 12 months. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: We found that many of the improvements relate to the home’s standard of record keeping. This also applies to some aspects of record keeping required by law. General improvements will ensure that the rights and best interests of people living in the home are more fully safeguarded. Each person must have an up to date and relevant contract so that they have accurate information about how much they will pay and what the home provides for the money. It will also help each individual and/ or their representative have a better understanding of the care that is promised to them. This issue remains outstanding from our last two inspections. We have therefore extended this requirement for a final time and may consider taking enforcement action if there is another failure to comply. Care plans and risk assessments require expansion, updating and review, as they do not give assurance that people’s needs are being fully met. The home needs to keep better records to show that the people using the service get the individual care they need and are safe. Training records for staff did not give assurance that staff were up to date with their training and consequently that they have the necessary skills and knowledge to meet the needs of the people living in the home. Similarly, the lack of routine staff supervision may affect the quality of care provided. Records must show that staff are adequately trained to meet people’s needs and that they are supported to do their work. Staff now require refresher training on safeguarding issues and local authority procedures. This is to enhance and update their knowledge and skills in reporting and detecting abusive situations. In addition staff require training on diabetes, as it is specific to the needs of some people in the home. A planned maintenance and redecoration programme is needed to demonstrate how the premises are kept in a good state of repair and where any necessary and planned improvements are made to the upkeep of the building. A new medicine cabinet is needed to store medication safely and in line with revised Pharmacy guidance. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 7 Risk assessments concerning the premises and safe working practices need improving. These must show that all hazards have been identified and minimised wherever possible to ensure the safety and well being of all those living and working in the home. As well as the Regulations and National Minimum Standards for Care Homes for Younger Adults, attention is drawn to various guidance and information documents that are available to service providers on our website. (www.csci.org.uk). 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 Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 8 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 Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 9 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 and 5 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place for assessing people’s needs so that staff are aware of how to support them. Up to date contracts are needed so that people know how much they will pay and what the home provides for the money. EVIDENCE: Two people have been admitted to the home since the last inspection. Including these, we looked at three other files for people using the service. The Manager explained that staff carry out their own needs assessment process and that this includes an assessment that identifies a person’s ability to take positive risks. The completed needs assessments were based on information supplied by the referring professionals, usually care managers, and by the staff’s own assessment of each person’s needs. The assessment covers the person’s social care needs, health, personal care, mobility, communication and dietary needs. Needs assessments also identified any physical and psychological needs and in all cases each individual had signed and dated their assessment in agreement. Some equality and diversity issues are also explored through assessment. Examples seen included details about people’s ethnicity, preferred faith and culture. For most people, the home had received copies of St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 10 the summary and care plans from the assessments carried out through care management arrangements. However, not all the files had up to date Care Programme Approach (CPA) documentation. The manager explained that this was due to some of the clinical teams that support people not carrying out their annual reviews. The home should therefore contact the relevant local authorities to obtain this information from their colleagues in the clinical mental health teams. Contracts sampled at both this inspection and the last key inspection on 21st June 2007 had not been reviewed or amended to include the necessary information. The contract must specify what the person is expected to pay and include accurate information about the facilities and services that people can expect to receive. Any arrangements for charging people additional costs must also be fully reflected in their terms and conditions. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 11 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 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments require expansion, updating and review, as they do not give assurance that people’s needs are being fully met. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. EVIDENCE: We looked at care plans for five people who use the service and found that some improvements are needed. Although reviewed on a monthly basis, recordings were very brief in their detail and did not accurately reflect the work being done with the person to follow their care plan objectives. The plan included basic information necessary to deliver the person’s care but lacked detail and did not address any needs identified in a person centred way. The wishes and aspirations of each person were not stated and apart from a signature there was little evidence of the person’s involvement in the creation of the plan. Individual daily records were basic and did not give an indication of each person’s experience of their day. Full care plan reviews need to be held St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 12 every six months as objectives may be changed where it becomes apparent that they are unrealistic and unachievable. There were three files for each person that contained different sources of information. These files contained a lot of old information that was not relevant to people’s current assessed needs and lifestyles. It would therefore be better if the necessary documents were archived so that only relevant and up to date records are held on each person’s file. In addition, one care plan should be used as a working document that consistently reflects the care being delivered. Once this work has been completed it will mean that people can be assured that their assessed and changing needs will be reflected in their individual plans and that staff always know the person’s current needs and wishes. A more person centred planning approach would ensure that people are offered improved opportunities to make their wishes known regarding their care and lives. All residents confirmed that they have a key worker and that they have regular opportunity to discuss issues with them. Through regular house meetings, relevant issues are discussed concerning all aspects of life in the home and in relation to individual needs. We sampled some records of meetings. Recent discussions centred on people’s choices for outings, meals, holidays and general house issues. We saw that risk assessments had been undertaken as a part of the initial assessment and care planning process. These assessments aim to support each person to take acceptable risks in order to maximise their independence wherever possible. However the risk assessments seen on the five sampled files had not been updated since the people were placed at St Jude’s House. Risk assessments therefore require updating and review or this has the potential to affect the quality of care if staff do not have accurate information to support people’s needs. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16 and 17 People using 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 People are part of their local community and are supported to follow their personal interests and activities. Relationships with family and friends are well supported and daily routines ensure that people’s individual rights’ and responsibilities are recognised. People who use the service are offered a healthy diet and enjoy their meals at times that suit them. EVIDENCE: Staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. Care records sampled showed that individuals are provided with regular opportunities to experience their local community such as local cafes, restaurants and places of interest. During this inspection, two people were supported to shop locally for their chosen items and one person visited their local GP practice for a routine appointment. There is indoor entertainment St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 14 including a widescreen television, DVD player and music system. The AQAA stated, “Service users requested to have more TV channels and it was done for them.” We looked at care records that included details about people’s lifestyles. Some individuals like to go out regularly whilst others prefer to stay in their home surroundings. Individuals spoken to said that staff were helpful and supportive. This was also reflected in the five returned comment cards from people living in the home. Five people were due to go on a holiday to Hastings and there had been a recent trip to a museum. It is suggested that a summary of weekly activities be drawn up for each person that links in with the care plan objectives and helps staff to ensure they are being actioned appropriately. People are supported to follow their chosen religion or faith. One person advised that they were a Jehovah’s Witness and regularly attended services. Records showed that individuals are involved in the domestic routines of the home. They are encouraged to take responsibility for their own room, menu planning and cooking meals. One person said that they enjoyed a weekly cookery session. Care records include details about each person’s social network and who is important in their lives. Families are involved and the staff support people to visit and to keep contact with those that are close to them. Rules on smoking, alcohol and drugs are made clear in the home’s service user guide. Each person has a key to their room and people confirmed that staff respect their privacy and enter their bedrooms only with permission. The manager advised that there is no set menu in place as people plan their meals every week. We saw records kept of the food provided which reflected a healthy and varied diet. Improvements noted on the AQAA said, “Part of our menu has been revised from service users comments. One service user requested to have his main meal in the evening and it has been done.” Staff consulted each person about their meal choice during the visit. There was a choice of beef stew with vegetables or a salad. The meals were well presented and individuals spoken to said they liked the food. We saw staff interact positively with people, taking time to listen to what they were saying and respect their choices. In the dining room, there is an area for people to make their own drinks. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 15 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 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Promotion of health is well observed. Welfare is closely monitored to ensure that the physical and emotional needs of people living in the home are met. The home’s medication practices are generally well managed although some improvements will ensure better safety and consistent treatment for each person. EVIDENCE: People spoken to said that they do choose when to go to bed, when to have a bath, what they wish to wear and what activities they do during the day. The manager advised that each person is supported to keep well through accessing appropriate healthcare services. Healthcare records gave a good overview of a person’s health and emotional care needs. They showed that people have regular input from their GPs; consultants; opticians; dentists and chiropodists. Each person accesses one of the local GP surgeries and some are registered with a local dentist. People confirmed that they go to see their GPs as and when necessary. People at St.Judes House continue to receive regular support from their Community Psychiatric Nurses (CPN) and other mental health St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 16 professionals. This was confirmed by staff and by the health check records that we saw. This record itemises each contact that the person has with health care professionals and any planned actions or outcomes. Examples seen highlighted that one person had been recently diagnosed with “type 2 Diabetes”; a condition that is controlled by diet. A suitable support plan was in place to meet this person’s changed needs. The dietician had also provided menu guidelines and advice for both the individual and the staff team. Each person is offered an annual health check that is usually undertaken by his or her GP. This shows that the staff team monitors healthcare needs closely and takes action to address any changes. Staff make sure that those who are fit and well enough are encouraged to be independent, have regular appointments and visit local health care services. Records confirmed that each person is fully supported to access relevant mental health services and that the home maintains good communication links with other relevant professionals such as community psychiatric nurses. The Manager reported that none of the current people living in the home manage their own medication but if required, they would be given the support they need. Medication is supplied from a local chemist and records were accurate for the receipt, disposal and return of medication. The administration charts were signed and accounted for. As good practice, guidelines should be written up for any as required medication. They should specify the reasons for its use and guide staff on what action to take before it can be given. This will help to protect the person’s welfare and ensure that as required medications are given appropriately. The medicine cabinet does not meet the current requirements and now needs to be replaced with a metal cabinet that is bolted to the wall with a facility inside it to store controlled drugs. The manager advised that all staff had completed a medication training course in October 2007. The home’s Pharmacist provided the training but no certificated evidence was available at the time of the inspection. Two staff spoken to confirmed that they had attended the training. Records must be kept to show that staff are appropriately trained to administer medication. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 17 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 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or those close to them, know how to complain. Their concern is looked into and action taken to put things right. The home’s practices and procedures help protect people from abuse although staff now need to update their training in safeguarding issues. EVIDENCE: There is a complaints procedure although it is only available in one format. Given that one person uses English as their second language, the home should provide a copy that the person can understand more fully. The AQAA stated, “We have displayed a complaints procedure on the notice board. This information is also in the service user guide and every service users has a copy of it.” Five comment cards from people using the service confirmed that they knew who to speak to if they had a concern or complaint. A complaints book is available and we saw that since the last inspection, one informal complaint had been made by a person living in the home. Records showed that the home acted upon the concerns raised and that the individual was satisfied with the outcome. Since the last inspection in June 2007, we have received no complaints in relation to this service. Records showed that staff had received training in safeguarding over three years ago. Suitable training must be provided for staff to enhance and update their knowledge and skills in reporting and detecting abusive situations. A policy from Lewisham local authority was available but on discussion with some staff, they were not clear about its purpose. Training should therefore include St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 18 information about any local authority procedures on safeguarding vulnerable adults. This will provide staff with the correct guidance on how to refer concerns of this nature to the local social services department. We looked at some financial records for people living in the home. People are supported to be as independent with their finances as possible and for the small number who require support; robust systems are in operation to protect their financial interests. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 19 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, 26 and 30 People using 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. Redecoration of the home has meant that people live in more welcoming and comfortable surroundings that also meets their needs and lifestyles. Bedrooms are designed and furnished to meet individual needs and reflect personal preferences and interests. The premises is clean, hygienic and generally kept in a good state of repair. EVIDENCE: The home is well placed to access local transport links, community facilities and shops. Since our last inspection, there have been various home improvements within the premises. The ground floor has been replaced with a new wood floor cladding, window restrictors have been installed following risk assessments. The kitchen has been refurbished and redecorated. Eight bedrooms, the downstairs bathroom and laundry room have also been redecorated. People were consulted about their choice of room décor. The home was clean and tidy with good hygiene practices in place. People St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 20 responded on their comment cards that the home was “always” fresh and clean. Protective clothing is available to staff and appropriate arrangements were in place for the safe storage and disposal of clinical waste. All the bedrooms were viewed with people’s permission. Each one clearly reflected the person’s individuality, interests, leisure needs and preferences. Some individuals have their own TV and music systems. Rooms were also furnished with photographs and chosen possessions that were meaningful to each person. Some people smoke in their bedrooms and appropriate risk assessments and practice reflected a safe environment. We saw that the local fire authority carried out an inspection of the premises in August 2007. The fire safety report identified three areas that needed attention. Records showed that the manager had taken action to address them. The home should arrange a follow up visit however to confirm that the premises now meet with fire regulations. We saw records to show that staff carry out a monthly check around the home to identify if any repairs or improvements are needed. A repairs/ maintenance report form is used to highlight any areas within the premises that need attention. Improvements noted on the AQAA said, “To completely redecorate the home externally.” A planned maintenance and redecoration programme for the year is needed. This will show how the organisation keeps the home in a good state of repair and makes any necessary improvements to the upkeep of the building. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 21 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, 33, 34, 35 and 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people are supported by a stable staff team who have a range of skills and experience to meet their needs. Staff training and development must improve however as it does not give full assurance that staff are able to meet people’s needs. The lack of routine staff supervision means that individual job performance is not regularly monitored which may affect the quality of care provided. EVIDENCE: The manager and majority of the staff team have worked in the home for many years. This enables consistency and familiarity for the people who live there. Feedback from people spoken to showed that they have confidence in their key staff who support them. All written comment cards confirmed that the staff treat people well. We looked at staff rotas which on the whole, show that the home is staffed efficiently. There are always between two and three staff each day and staff allocation is planned around people’s routines, lifestyles and assessed needs. Two staff live in at the home and provide night time support with one awake and one staff sleeping in. Regular staff team meetings are held; minutes were clear and focused on people’s needs as well St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 22 as the day-to-day running of the home. The AQAA informed that eight of the nine staff had achieved the NVQ level 2 in care qualification. We saw only one certificate to evidence this. Since our last inspection, the home has improved upon its recruitment practices. There are good procedures which ensure that staff are vetted correctly before they begin work. This means that people using the service are protected from unsuitable workers. We looked at records for three staff and these contained all the required legal checks and documentation. Staff training records however showed that they were not up to date with their training. Certificates for one employee were dated 2005. All staff must complete training in key health and safety issues and this has been discussed in “Conduct and Management of the home”. Provision of training was therefore not up to date although the home had developed an organisational training programme for the year. This offers a variety of courses for staff to update their skills and knowledge along with recognition of mandatory training that they must attend. The home has produced an induction pack that is based upon the required Skills for Care standards. Sampled files included a completed induction for each staff. Given that three people in the home have a diabetic condition, suitable training must be given to the staff. This will ensure that staff have the specialist knowledge and skills and are up to date with current ways of working with people who have such specific needs. The AQAA informed that eight of the nine staff had achieved the NVQ level 2 in care qualification. We saw only one certificate to evidence this. Again, records must be kept in the home to show that staff are adequately trained to meet people’s needs. The manager advised that she has responsibility for all staff supervision. Records showed that yearly job appraisals for one staff were up to date but some staff had not received supervision for several months. Record keeping must therefore improve to show that the staff have received the necessary training and support to do their jobs effectively and meet people’s needs. Formal supervision also ensures that each worker’s job performance is regularly monitored and recorded. The manager and deputy acknowledged that improvements are needed. In addition the AQAA said, “Increase regularity of staff supervision.” St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 23 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, 41 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an established manager who has a good leadership approach to run the home in the best interests of the people. Although people’s opinions are central to how the home develops and reviews its practice, some improvements are still needed for monitoring the quality and delivery of the services provided. Overall record keeping needs to improve to ensure that the rights and best interests of people using the service are fully safeguarded. Some health and safety practices need improving to ensure that the environment is safe for people and staff. EVIDENCE: Priscilla Kagijo, the manager, has worked in the home for several years and registered with the Commission over two years ago. She is also the responsible individual for other homes owned by Elizabeth Peters Care Ltd. Discussions and St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 24 observation confirmed that she is knowledgeable about each person’s specific needs and how to support them. She has previous experience in working with people who have mental health needs. The manager reported that she has yet to complete the NVQ level 4 qualification and Registered Managers Award. She advised that she had yet to complete her studies due to some difficulties with her assessor finalising her work. Progress will be checked at the next inspection. There were some quality assurance systems in place to measure the success of how the home is achieving its aims and serve the best interests of the people who live there. Examples include regular meetings and satisfaction questionnaires. In response to our last inspection, the responsible individual or appointed representative visits the home once a month and completes an audit of the service. We sampled these reports which showed that the owners monitor the conduct of the home and identify areas that need attention. The home has some systems in place that aim to promote the health, safety and welfare of the people using the service, staff and visitors. In addition, there is policy guidance for staff to follow regarding a range of health and safety activities. We saw a general risk assessment for the workplace environment although further details are needed that are specific to hazards and health and safety practices. Actions to lessen the risk of each hazard need to be clearer so as to ensure the safety and well being of all those living and working in the home. As discussed earlier not all staff were up to date with key health and safety training. Staff must be appropriately trained and familiar with current legislation in order that people’s health and welfare is better safeguarded. During the visit, an in house fire training session was held for staff. Staff gave feedback that the training was useful and relevant. Records are maintained of all accidents and incidents at the home. The completed AQAA stated that all relevant safety checks were up-to-date. We looked at some of the servicing and maintenance records for the home. Fire drills, fire equipment and hot water temperature checks are carried out at regular intervals. The gas and electrical safety checks could not be located during our first visit but were available when we returned to the home two days later. Both were up to date. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 25 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 2 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 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X 2 2 X St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 YA5 Regulation 5(b to c) Requirement The Registered Manager should ensure that all required details are completed in service users’ contracts. Repeated. Timescales of 30/11/06 and 31/07/07 not met- Failure to address this on going issue within the new timescale for action, which has been extended for a final time, will result in the Commission considering taking enforcement action to ensure future compliance. Care plans must include more information about how intended outcomes will be achieved. This is to ensure that staff are aware of how people prefer to be supported and that their personal needs and goals are met. Risk assessments for each person must be up to date. This is to ensure that staff have clear guidance on what action to take to support people’s needs and minimise the risk of injury or DS0000025643.V361649.R01.S.doc Timescale for action 31/08/08 2. YA6 15(1)(2) 31/08/08 3. YA9 13(4b)(5) 31/08/08 St Judes House Version 5.2 Page 27 harm. 4. YA20 13(2) An appropriate medicine cabinet is needed to ensure that all medication is stored safely and in accordance with revised Pharmaceutical guidelines. Training records must be available to show that staff are competent to administer medication safely. The Registered Manager must ensure that there is a list kept of all staff trained and deemed competent to administer medication along with a sample of the signature they use to sign medication administration charts. Previous timescale of 31/07/07 not met- extended The Registered Individuals must ensure that an appropriate policy and procedure is drawn up regarding the mental capacity act, that staff are aware of the effect of this and that effective assessments of capacity are conducted when necessary. Previous timescale of 30/09/07 not met- extended The manager and staff require training in Safeguarding issues. This is to enhance their knowledge and skill in reporting and detecting abusive situations. A planned maintenance and redecoration programme is needed to demonstrate how the premises are kept in a good state of repair and where any necessary and planned improvements are made to the DS0000025643.V361649.R01.S.doc 30/09/08 5. YA20 17(2) 19(5)(b) 31/07/08 6. YA20 13 (2) 31/07/08 7. YA23 18 (1) (c) (i) 31/08/08 8. YA23 18(1)(c i) 19(5)(b) 30/09/08 9. YA24 23(2)(b) (d) 30/09/08 St Judes House Version 5.2 Page 28 upkeep of the building. 10. YA32 18(1)(c i) 19(5)(b) Training records must be available to show that staff have completed the required NVQ level 2 in care qualification. All staff must receive training on diabetes, as it is specific to the needs of people living in the home. This will ensure that staff have the specialist knowledge and skills to meet individual needs in a safe and competent manner. Training records must be available to show that staff have the skills and experience to meet the needs of the people living in the home. Each staff member needs an individual training and development profile. Each staff must have routine formal supervision so that their job performance is regularly monitored and any training needs can be identified and actioned. The Registered Manager must ensure that notifications of incidents are sent as required to the Commission. Previous timescale of 31/07/07 not met- extended The Registered Manager must ensure that all records required to be maintained in the home are so maintained. Previous timescale of 31/07/07 not met- extended Records must show that staff are up to date with key health and safety training to ensure that DS0000025643.V361649.R01.S.doc 31/08/08 11. YA35 18(1)(c i) 19(5)(b) 17(2) 30/09/08 12. YA35 19(5 b) 17(2) 31/08/08 13. YA36 18(2) 31/07/08 14. YA37 37 30/06/08 15. YA41 17 31/08/08 16. YA42 17(2) 18(1)(a) 19(5)(b) 30/09/08 St Judes House Version 5.2 Page 29 people’s needs can be fully met and health and safety practices are correctly followed. 17. YA42 13(4) 15(1) Sch.3 (3 q) Risk assessments concerning the premises and specific safe working practices must be reviewed. This will show that all hazards have been identified and wherever possible minimised to ensure the safety and well being of all those living and working in the home. 31/07/08 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 YA2 Good Practice Recommendations To contact the relevant local authorities and obtain up to date Care Programme Approach assessments for each person. The home considers streamlining the individual plans, while still keeping all the necessary information available. Some records should be archived that are not relevant to the person’s current needs or plan of care. Person centred plans should be developed with each person using the service. This will enhance people’s involvement and contribution to their plan of care. A summary of weekly activities be drawn up for each person that links in with the care plan objectives and helps staff to ensure they are being actioned appropriately. The complaints procedure should be adapted so that it is accessible to all people using the service. i.e. Available to people in their preferred language. The home arranges a follow up visit with the local fire authority to confirm that the premises now meet with the DS0000025643.V361649.R01.S.doc Version 5.2 Page 30 2 YA6 3 YA6 4 YA14 5 YA22 6 YA24 St Judes House required fire regulations. 7 YA35 The Registered Manager should consider ways in which inhouse training can be offered to staff around mental health issues and should look into accessing more external training for staff in this area. Repeated from last inspection. St Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Judes House DS0000025643.V361649.R01.S.doc Version 5.2 Page 32 - 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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