Inspection on 27/04/06 for St Laurence

This inspection was carried out on 27th April 2006.

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Laurence 07/06/07

St Laurence 06/09/05

St Laurence 04/05/05

St Laurence 04/10/04

St Laurence 24/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 St Laurence 33 Tower Road West St Leonards-on-sea East Sussex TN38 0RJ Lead Inspector Jason Denny Unannounced Inspection 27th April 2006 09:30 St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 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 Laurence DS0000021222.V288710.R01.S.doc Version 5.1 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 Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Laurence Address 33 Tower Road West St Leonards-on-sea East Sussex TN38 0RJ 01424 438262 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) st.lawrence@btconnect.com Communitas Limited Miss Kelly-Jane Godden Care Home 7 Category(ies) of Learning disability (7) registration, with number of places St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Residents must be aged between eighteen (18) and sixty-five (65) years on admission The maximum number of Residents to be accommodated is seven (7) Residents with a learning disability only to be accommodated Date of last inspection 6th September 2005 Brief Description of the Service: St Laurence is one of three Communitas homes based in East Sussex and is located in a Residential area of St Leonards-on-Sea. The home is close to local transport and amenities. The seafront is within two miles of the home. The home is large detached property with spacious grounds. The garden has undergone redevelopment over the last 2 years and is spacious and well equipped. The home currently provides services for four people with high dependency needs. The home is registered to provide services for seven people in line with its statement of purpose. All Residents have a single bedroom some of which are double-sized; one bedroom not currently used is undersized with one of the lounges recently converted to a bedroom, which is now used instead. There is range of spacious communal areas and sufficient bathroom and toilet facilities throughout. The home has its own mini-bus type vehicle. The Organisations day centre used by some Residents for activities, and staff for training and interviews closed In July 2005 with no current plans for a replacement venue. Information on the range of fees charged is not within the homes current statement of purpose/service user guide but on the last occasion of inspection was approximately ranging from around £1100 to £2500 per week. Inspection reports are not routinely sent out to families and advocates after each publication although a copy is kept on display in the reception area of the home and can be obtained via the manager. At the time of the inspection the managing company- Communitas was undergoing a proposed name change to Evesleigh [East Sussex] with the current ownership remaining unchanged since July 1st, 2005. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced key Inspection, which included a visit to the home which took place between 9.30am and 3pm on 27 April 06. This inspection focused on the key major areas such as the compatibility of the Resident group and who the home intends to provides care for in the future, how care is planned and delivered, activities and lifestyles, the environment and staffing of the home, along with how the home is managed and how concerns are dealt with. During this inspection process, which covers the period since the last inspection 6 September 05 and the week of the home visit, a number of relatives and social workers have been spoken with along with the overseeing organisation. Two inspectors carried out the inspection visit due to concerns about the stability of the home since the last inspection, which has affected the previous Good rating and performance of the home. A monitoring visit by the same two Inspectors on 22 March 06, reassured the Commission that there were signs of improvement. Two outcome areas are Good, three Adequate [ok] and three areas Poor, in need of major improvement. The focus of the inspection was looking at three Resident’s [one new] all of whom who have struggled to have their needs met since the last Inspection with concerns about activities and their welfare following the disruptive behavior of another Resident and issues with the staffing and management of the home. Some diversity and equality areas were explored in relation to lifestyles to test what opportunities are provided for Residents. The inspector’s spoke with and observed 6 of the 7 Residents and looked at the care records for three Residents along with health and medication needs. Discussions with management looked at the future purpose of the home such as the admittance process and staff training plans. The inspector toured all communal areas of the home along with bedrooms. Meal arrangements were examined. A record of complaints was inspected. Staffing was looked at in detail along with the homes management, including measures to ensure quality for Residents. What the service does well: The home benefits from an experienced manager who has specialist skills suited to the needs of Residents. Induction training into the basics of the job is good. The home has maintained effective, links with advocacy projects to enable Residents to have someone outside the home speaking on their behalf. Some Leisure activities for Residents continue to be organised including holidays and marathons. Regular meetings are held with staff and with Residents. Staff are closely supervised. Record keeping especially with regard to Residents is of a good standard. Most staff have worked in the home for over a year. Staff are well supported by the manager with opportunities to learn and improve. Relatives and social services persons all commented that St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 6 the basic care was good, the manager is skilful and responds quickly to concerns, and that staff work hard. 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. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 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 Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,and 3. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. The home needs to have a clear statement of purpose and admissions criteria which reflects service provision and registration category, so protecting the right of existing service users to live with people who have similar needs The last three people to be admitted into the home had needs outside the homes purpose and provision causing a negative effect on the home. The home is not currently meeting assessed needs, due to the effect of not having a compatible group, making it difficult to create the right type of service, and so causing some Resident’s needs to be marginalised, and others too complex too meet. EVIDENCE: The inspector looked at the home’s [service user/ Resident’s] guide, which also contains the statement of purpose. The Statement of Purpose needs to be tightened and clarified to confirm what needs it can meet and what type of Resident it would consider accommodating in line with the homes category of registration. The current statement of purpose is confusing such as the statement that “we will work with anyone” without closely defining the needs it will meet and lists a number of mental illness and disorders it can support St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 9 future Residents with. The manager was advised to rewrite this document and be specific that the home is registered for learning disabilities with the home specific about what level of learning disability it will attempt to provide a services for. The document in its introduction refers to the overall purpose of Communitas ltd and will benefit at the outset from being more specific to the actual home and future admissions to ensure clarity for the reader This clarity is needed as the last two people to be admitted have turned out to have mental health issues, as their prime needs causing disruption to the home and needs of others. Another resident has mental health illness, which the home struggles to meet. Overall the home has been attempting to offer two services with one group of residents taking precedence over the other. The manager intends that the service is for those on the autistic spectrum which describes those Residents who have lived in the home for a number of years [9] and who been marginalised. Staff, the manager social services, and relatives who spoke with the inspector all confirmed that the service was struggling to meet needs. Staff at all levels both on this visit and a monitoring visit on 22/03/06 confirmed that they have not been sure how to meet some needs and hope for a period of stability once a current resident moves on to the right service. It was evident how the behaviour of the more vocal Residents has affected the behaviour of other Residents with some copying behaviour such as throwing chairs and drinking high amounts of coca cola. The manager indicated that a range of re-assessment’s are taking place for all three other Residents who were focused on by the inspectors. The social worker for two of these Residents indicated that they are looking at a new placement due in one care to “a loss of confidence” and in the view of a family of the other due for the need for “long term stability and need for the person to reach their potential and develop life long skills” The manager indicated that a period of stability was needed to refocus the home and ensure that staff can meet present and future needs. The manager was required to send the Commission a copy of this revised admittance criteria inclusive of a new statement of purpose. A statement of purpose including a admissions policy was sent to the Commission following the inspection at the point of publishing the report. Both documents were non-specific to the home and did not specifically describe the purpose of the home and what type of needs would be met. A relative expressed confusion about how to view and obtain copies of inspection reports carried out by the Commission. The person was directed towards the home manager who makes copies available on request with one kept in the reception area of the home [possibility of Residents moving such items]. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, and 9. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Care-Plans though containing a good range of information are not understood by most staff and lack clear, updated, and realistic goals based on individual’s diverse aspirations and potential. Resident’s benefit from a good amount of independent advocacy, which operates effectively, and regularly, on their behalf. EVIDENCE: The Inspector’s examined 3 Care plans, which were found to be accessible, clear and frequently reviewed. Plans had a range of behavioural support and other, guidelines rewritten and revised within the last year. The plans showed clear evidence of key worker involvement. On the day of the inspection as was the case on 22/03/06 monitoring visit that staff at all levels had varying knowledge of these plans. A team leader stated that due to time constraints and crisis management involving other Resident that he did not know the needs of two Residents who have lived in the home for the last 6 months. A St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 11 key worker for one Resident case-tracked stated that they are frustrated that other staff do not understand the particular Residents needs The goals in the plans looked at lacked clarity for instance one stated “develop a fair programme of activities”. In relation to this it was evident from talking to staff, observing the Resident, looking at Records and talking to his social worker that this goal linked to a full range of activities is not occurring. Another Resident who is more able than the other Residents and has worked previously and attended college courses was found to have goals linked to behaviour such as drinking less cocoa cola as opposed to goals based on aspirations and achievement. A senior staff member agreed that his goals were not really goals individual to him or ones that he had chosen. It was also evident that these behaviours, which the goals were intended to control where, in part based on the relief of boredom and partly influenced by the service along with mental health issues. The manager showed evidence that this Residents is shortly to undergo a reassessment of his autism by a specialist to enable the service to best understand and meet his needs in order to promote a improved lifestyle. All Residents were found to have fortnightly visits from their designated external advocate. In addition two Residents continue to benefit from weekly counselling sessions. Residents confirmed how the advocate was helping them apply for either jobs or college placements. Risk assessments were found to be clear and regularly updated. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15,16,and 17. Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Regular Meaningful and wide ranging Activities are not taking place for Resident’s restricting opportunities to develop skills and an active and rewarding lifestyle. Residents lack structured daily routines and skilled and focused staff to assist them to fulfil their individual choices and aspirations. Meal arrangements and leisure opportunities are satisfactory. EVIDENCE: Throughout the morning of the inspection, one Resident left for day centre, one went out for a 10-minute walk returning with a snack and along with 5 Residents remained in the house. One resident was not seen by the inspector’s as they spent the morning in bed and then went out whilst the inspectors looked at office information. A weekly programme of leisure activities was on display although staff confirmed as they did on 22/03/06 that this is not St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 13 usually followed in practice due to shortages of staff, Resident’s mood’s, crisis management needed for 1 to 2 Residents, and confusion about whether some of these activities were actually liked by Resident’s . It was also evident that the activities lacked sufficient variety and were not always as evidenced in discussions with staff, Residents, and records meeting Residents aspirations. The lack of educational and occupational based activities was most noticeable in relation to the 3 Residents locked at in most detail. A social worker for one of these Residents commented that more creativity is needed as activities consist “mainly of Walks” and that staff too easily assume that this is an informed choice. One resident who has recently stopped attending a day centre [March 06] was found not have a regular alternative programme in a place and was seen copying the behaviour of another Resident who has an addiction to drinking coke during the day and largely remaining in the home. One staff member stated that they did not see any value in a routine for one Resident who spent the morning in bed. The team- leader on duty in feedback with the manager stated that routines needed to be devised once the home settled down and once the right staffing and training was in place. A number of staff described the current situation as based on “crisis management” where no plans for Residents can be arrived at until the shift starts depending on who is on duty and the atmosphere of the home. This therefore means that Residents do not know in advance what is planned. The manager agreed that for a home based around autism that regular and predictable routines need to be introduced and consistently adhered too. The manager stated that college course for three Residents are due to start in September 06. All the relatives and social workers spoken with in relation to the 3 residents looked at [Case tracked] agreed that more activities need to take place to create meaningful lifestyles although in one case they pointed out that one particular Resident has had opportunities but is affected by motivational issues. Two Residents indicate dhow they were recently supported to do the London Marathon which showed good evidence of fulfilling activity once the motivator had been found they attributed much of their success to the manager who also works as their key-worker. Meal arrangements were again found to be good and based on choice within these recorded and additional alternatives offered. The diverse ethnic needs of one Resident were found to be supported by him being supported to cook a West Indian dish every Wednesday. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, and 20. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Resident’s basic health needs are closely monitored and met, although more success with health eating and exercise is needed. Medication arrangements are with one exception, soundly managed. The home regularly reviews medication with appropriate Specialists with positive outcomes. EVIDENCE: The medication cabinet was examined along with all records. All aspects of storage and administration was found to meet the standard and best practice. All homely remedies were labelled and accounted for on recording sheets. Staff interviewed were found to be knowledgeable about all aspects of medication including what each drug is for. All staff receive appropriate training before being assessed to be able to dispense medication. The overall awareness of staff and management towards medication procedures has improved following a unique incident in January 2006 where a staff member incorrectly discontinued a medication for a Resident, with this mistake not spotted for several days. No direct harm was caused to the person’s welfare as a result of the mistake. It was therefore surprising in light of improved St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 15 awareness and protocols that on the day of the inspection there was a gap on one of the recording sheets where medication had been given and not signed for. It was recommended that the sheet be signed once medication has been absorbed. It was observed and confirmed in records and discussions with relatives that one resident who has the goal of more exercise to decrease weight has since the last inspection put on weight and is less inclined towards exercise. The key-worker spoken with explained that reasons for the persons looking to avoid walks unless they are short ones for preferred activities or snacks, was still being explored. On the morning of the inspection there was a plan for the person to go for a walk of approximately 2miles with the person instead returning within 10 minutes after purchasing a snack. It was explained by the shift-leader that the person supporting him did not realise the planned walking route, which is based on initially avoiding nearby shops. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 manager of the home responds to concerns and complaints in an open and effective manner. The service responds quickly when people are at risk of being harmed. The way in which the home reports and responds to incidents has improved. EVIDENCE: Those relatives and social workers spoken with stated that they found the manager to be approachable and helpful with any concerns or questions. One relative stated that following their Son coming out their home for Easter with an untidy appearance and not enough clothes that the manager promptly dealt with the concern with the relative confirming that on the following trip [270406] that the person was immaculate and well equipped. Since the last inspection there has been one formal complaint made against the service by a relative concerned about how their Son has been affected by the behaviour of another Resident. This situation was found to be taken seriously by both the manager and the organisation who are currently dealing with the concerns with the aim of making improvements one of which is for the other Resident to move to a more suitable home within the organisation. A number of concerns [some anonymous] have been sent directly to the Commission since the last inspection some of which relate to the management style of the new organisation which oversees the home and the period when the registered manager was away from the home with different arrangements in place. By the time of the inspection and following a monitoring visit on St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 17 22/03/06 these concerns had been resolved with agreements reached. Some of these concerns were also covered with an adult protection investigation which started in January 06 following a violent incident The overall conclusion of all these concerns has been some positive outcomes for the service with clear learning taking place such improvements in how staff record and report incidents. The manager also now develops clear action-plan after each serious incident, which is then sent to the Commission and social services. The responsibility of staff to manage challenging situations has also improved although it was recognised on this visit as was the case on 22/03/06 that some staff lacked confidence in following guidelines with a particular Resident and were unclear how to protect others safety in a particular situation. This has been recognised with arrangements in place for more training and the moving on of the resident concerned due in May 06. This Resident’s behaviour was found to have stabilised over the month before the inspection and presented themselves in a particularly positive and settled manner when compared to previous visits by the Inspector. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The building continues to benefit from investment as evidenced over the last 3 years creating a modern feel in line with Resident’s needs and the manager’s specialist input. Cleanliness has improved with ongoing redecoration continuing take place. EVIDENCE: The inspector’s toured all communal parts of the home and looked in two bedrooms of some of those residents focused on [.case-tracking]. The foyer entrance to the home was found to be clean on this inspection with a greater attempt to make this area more homely. One relative spoken with confirmed that the home is working harder at maintaining cleanliness involving Residents. Since the last inspection the home has installed a good quality laminate flooring across the Ground floor and purchased modern dining- room furniture, fitted a new kitchen, creating a positive impression .The Conservatory was found to be used with music centres, 8 seats and a television. The lounge is large and well-equipped one, had 4 leather sofas and was decorated and St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 19 appointed in accordance with the needs of Residents. The other previous lounge area has become a large bedroom, replacing an undersized room which will no longer be used for Residents. All toilets were found to be in good order and were well-equipped including suitable drying facilities. One bathroom had a range of disabled adaptations All Residents had lockable storage space in their rooms unless they expressly decline this. The home was found to be clean. The kitchen door was found to be locked. The home is again advised to review their system of locking the kitchen door to ensure that this measure is necessary and based on ongoing risk assessment [Standard 16] Relatives are impressed by the garden, which has been transformed in the last 3 years based on resident involvement. The rear garden is well maintained but not wheelchair accessible. The entrance area is the one area that is less impressive. No obvious maintenance jobs were spotted with the overall home well maintained. Bedrooms were reasonably clean taking into account the nature of the Residents concerned and that one was being prepared for redecoration. Current Residents benefit from well-equipped and good-sized rooms. Staff confirmed that during a period of the registered managers absence that some decorating plans were put into practice in the dinning room leading to problems with Residents as the colour and pattern schemes were not based on autism advice or preferences of Residents. The manager has addressed this on her return to the home. The current decoration of a particular bedroom for someone with autism has been carefully planned. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35, and 36. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home needs to ensure that there is sufficient number of experienced staff on duty to meet assessed needs. Staff training needs to improve further to ensure staff are sufficiently aware of how to meet needs with training specific to the home’s needs. Staff are closely and regularly supervised and are generally committed but performance is variable. Tight recruitment procedures are followed. EVIDENCE: On the morning of the inspection there was 4 staff on duty instead of the intended 5 to meet the assessed needs of 7 people. There was a new staff person to support the 4 staff but due to the persons inexperience [second shift] was shadowing, and under staff supervision. The shift/team leader stated that due to variations in staffing levels on any given day along with varying levels of experience and ability that plans for Residents were difficult to follow in practice. This situation was confirmed on earlier monitoring visit on 22/03/06. Relatives spoken with along with a social St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 21 worker who funds one Resident for 2:1 support especially when in the community confirmed that staffing levels were often insufficient with some staff lacking an understanding about Residents informed choices. A recent monthly section26 report undertaken by the area manager and an earlier investigation into an incident indicated that staffing levels needed to match assessed needs to promote activities and protect Residents. No new staff have been employed since the last inspection. The manager was found to be aware of all necessary checks, which would need to be carried out prior to employment including Protection of Vulnerable Persons Register checks [POVA]. The organisation was found to be currently carrying out fresh Police checks on all their staff to update their records. The manager confirmed after the inspection that the overall organisation has carried out checks on a bank flexi person working in the home. A senior staff person in agreement with the manager indicated that most staff had not received autism focused training and that the last company training was 2 years ago consisting of a day workshop. It was evident from talking to and observing staff that some staff lack awareness, have difficulty understanding the value of predictable and structured routines, and reading residents various forms of communication sometimes leading to incidents. Staff including a key worker, and records confirmed that some staff were reluctant to take out a certain resident to his favourite destination of Eastbourne as they lacked confidence and awareness around how to best to communicate. The manager identified plans for priority autism and other training for staff. Less than 50 of the full care staff team have at least National Vocational Qualification level 2 although most staff were found to have started these courses with one person spoken with confirming that they on a NVQ 3. All staff employed during the last 2 years have experienced 3 week Induction’ covering TOPSS, all mandatory training such as Moving and handling, food hygiene and First aid, and the foundational course level 2 in Care Practice, which leads to an NVQ 2. A basic introduction to the company’s philosophy of care is also included, leading to the in-house structured written induction found in each home. A regular round of general training is now organised by the organisation’s training officer following a delay at the last inspection. Records and discussions with the manager indicated that all staff receive regular written supervision. Staff on the visit of 22/03/06 who had transferred from another home stated that the supervision they received was more helpful and detailed that they had previously experienced. The manager also indicated that she intends to spend more time on the shop floor observing staff and role modelling to them as had had recognised some inconsistencies in staffing approach and the need for job coaching. This has also been identified in a study carried out by the overseeing organisation. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39, and 42. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home benefits from an experienced and suitable manager with specialist skills suited to the needs of Residents. The overall management and running of the home has suffered since the last inspection due to some decision making by the overall organisation although more recent improvements are positively contributing to stability. The overall organisation needs to demonstrate how it is measuring and contributing to the quality of service to the Residents. EVIDENCE: The home’s manager has 10 years experience in managing services for learning disabled people has specialist skills within the field of autism which suits her to the stated purpose of the home. All Staff spoken with on both recent visits indicated they feel well supported by the manager and benefit St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 23 from her guidance. Relatives and social service departments who have known the manager for a number of years identified her as the key strength of the service. The manager was found to be attending college in order to complete her necessary management qualifications National Vocational Qualification level 4 in management and care. The lines of communication between the home and the new organisation who own and manage the home are gradually improving. Some Staff on this and previous visits have expressed some confusion and concern about the way the organisation is being managed however by the time of the inspection this situation was improving. Staff and some Residents spoken with explained various ways in which the management and running of the home suffered during the enforced six week absence of the registered manager when the overall organisation were undertaking an investigation and where different management arrangements were in place. The return of the registered manager has coincided with an improvement in the stability of the home as evidenced in discussions and records, and new plans to improve the service with some input from the overseeing organisation who are involved with the home Section 26 monthly reports of inspections of the home by the organisation are sent to the Commission on a monthly basis within two weeks of the actual visit date. These reports need to be more comprehensive and make reference to the views of Residents and staff in relation to the overall quality of care being provided. Some attempt should be made to measure the quality of care to those who lack verbal skills to express this. Subsequent discussions with the new area manager have indicated clear plans to address this in line with effective quality assurance. Some views of Residents have been placed in the home’s guide The home has introduced a quality assurance system based on Residents or their representative’s views. The manager ensured that all Residents filled out the Commission’s comment/survey cards along with relatives. All comments were positive especially about the care being provided. One resident was particularly praiseworthy of the manager describing her as his “motivator” and describing on 22/03/06 how he has spent most of her absence in bed. A relative who spoke to the inspector stated “staff do their very best, are caring and polite” another described a resident as “always appearing happy” when they visit The Inspector found all food correctly stored and labelled. The managers stated that all equipment in the home was within its servicing schedules. Previous inspections of such records have showed everything to be in order. All current staff have the necessary health and safety training such as First Aid, food hygiene and safe Moving and Handling. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 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 1 2 2 3 2 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 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 2 34 3 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 X 15 3 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 2 2 X X 3 X St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 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 Standard YA1 Regulation 6 Requirement That the homes statement of purpose is revised to ensure that it is clearly in line with the home’s Registration category. That this statement is specific and indicates intended service provision to ensure that a compatible group of service users are accommodated in the home. That this statement indicates what type of training will be necessary to fulfil its aims. That a copy of an appropriate statement of purpose service user guide is sent to the Commission within the timescale indicated. That a clear admissions criteria and policy is developed with a clear statement that only those with a learning disability as their prime need are accommodated. That this admissions criteria is consistent with the intended autistic focus of the home. That this admissions policy is sent to the commission within the timescale indicated. That the Registered person must DS0000021222.V288710.R01.S.doc Timescale for action 27/07/06 2 YA1 4[1][c] Schedule 1:8 27/07/06 3 YA6 15[2] 27/08/06 Page 26 St Laurence Version 5.1 4 YA12 undertake a review of service user care-plans in respect of goal planning to ensure clarity and that they meet the individual’s aspirations and long term plans 16[m]&[n] That the Registered person must 27/08/06 develop a holistic range of meaningful and regular activities for all service users based on individual needs and aspirations and which allow opportunities for skill development. That any such individual programmes are regularly adhered too. 12 [1][2][3] That the Registered person must ensure that clear and predictable routines are developed in line with service user needs and aspirations and that staff are aware of these and adhere to them. That the Registered person must ensure that any restrictions around the home such as service user access to the kitchen area is reviewed to ensure that any restriction is subject to continuous risk assessment and the ability of the individual. That the Registered person must ensure that sufficient numbers of experienced Staff are on duty at all times. That the Registered Provider/person organises staff training specific to the autistic needs of service users in line with the homes statement of purpose. That such training is comprehensive and regular and supports Person Centred Planning. That the Registered Provider must ensure that monthly section 26 reports show sufficient evidence of Service DS0000021222.V288710.R01.S.doc 5 YA16 27/08/06 6 YA16 12 [1][2][3] 27/08/06 7 YA33 18[1][a] 27/05/06 8 YA35 18[1][c] 27/08/06 9 YA39 26 27/05/06 St Laurence Version 5.1 Page 27 10 YA39 24 users experiences in order to arrive at a opinion as to the quality of the care. That sufficient numbers of service users and their advocates regardless of disability and diverse needs are included in these reports in relation to their care. That such reports are also agreed with the registered Manager before publishing, to ensure factual accuracy. That such reports are sent to the commission on a timely basis. That the Registered person must undertake a review of the service quality, involving Service Users and staff in order to produce an annual development plan for the home with clear and achievable goals 27/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA20 YA35 YA37 YA38 Good Practice Recommendations That Medication recording sheets are signed once dispensing has taken place. That at least 50 of Care staff are trained to at least National Vocational Qualification Level 2. That the manager completes the necessary management qualification National Vocational Qualification level-4 CARE and Management, as soon as possible [by 2008] That any investigation carried out by the organisation is timely in the best interests of service users, with propionate decision-making. St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Laurence DS0000021222.V288710.R01.S.doc Version 5.1 Page 29 - 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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