Inspection on 07/06/07 for St Laurence

This inspection was carried out on 7th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Laurence 27/04/06

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 Key Unannounced Inspection 7th June 2007 10:10 St Laurence DS0000021222.V339129.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 Laurence DS0000021222.V339129.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 Laurence DS0000021222.V339129.R01.S.doc Version 5.2 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) stlawrence@evesleighcaregroup.co.uk Evesleigh (East Sussex) Ltd Miss Kelly-Jane Godden Care Home 7 Category(ies) of Learning disability (7) registration, with number of places St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 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 19th December 2006 Brief Description of the Service: St Laurence is one of three Evesleigh 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 two years and is spacious and well equipped. The home currently provides services for three 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. There is arange of spacious communal areas and sufficient bathroom and toilet facilities throughout. Information on the range of fees charged is within the homes current statement of purpose/service user guide 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. Minster Pathways managed the service from July 1, 2005 on behalf of the new purchasers of Communitas Ltd. The company then underwent a name change to Evesleigh [East Sussex] in mid 2006. Shares in the company were then transferred in December 2006 to Hermes Equity with a new board of directors including the existing operations director appointed. The overall Regional management team in the organisation is unchanged with some switches of Responsible Individual and Area manager in January 2007. The home has its own MPV type vehicle. St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 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 10.10am and 2.20pm on 7th June 2007. The focus of the inspection was twofold, which involved looking at how the home is meeting outstanding requirements such as those linked to staffing levels activities, and the compatibility of Residents. Secondly, speaking with advocates of Residents such as relatives and social services. 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 all 3 Residents, the 3 staff on duty, and looked at records. This inspection looked at management, who the home intends to provide care for, how care is planned and delivered, activities, lifestyles, the environment, staffing of the home, along with how concerns are dealt with. Discussions with management looked at the future purpose of the home, the admittance process, and 2007 Business plan. All communal areas were toured. Meal’s, along with quality measures for Residents, was looked at. The inspector, following the home visit, spoke with some relatives, advocates, and social services care managers involved with the home The planning of this visit was unable to take account of the homes Annual Quality Assurance Assessment [AQAA]. This was received on the day of the inspection visit and has been used to inform the report. The AQAA was found to be comprehensive and helpful. This report also takes into account a shorter Random inspection visit of 19 December 2006 which was based on following up requirements from the last key Inspection of April 27 2006. That visit indicated steady progress, maintenance of some good practice, along with some delays in addressing other shortfalls such as activity provision. Six [6] outcome areas are assessed as Good, and the other two [2] Adequate [ok] and in need of some improvement to improve outcomes. What the service does well: The home benefits from a dedicated hard core of good staff which ensures stability provides each Resident with an effective key worker who understands their needs. The manager has good experience and the skills needed for current Residents. Resident’s benefit from a modern and spacious environment, which meets their needs and preferences. The home maintains good and effective links with outside professionals, which ensures that all Residents receive a wide range of specialised input based on improving their quality of life. A good amount of consideration is given to the views of Residents with action plans developed to show how improvements will be made. The home is responsive and open to the views of Resident’s advocates St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 6 such as relatives. The quality of care-plans and overall information on Residents is exceptional. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 5. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home has finally resolved incompatibility issues and established a clear purpose for the home. This means that current Residents now benefit from living with people similar to them and can have more confidence that this will continue. Contracts will benefit from fine- tuning to enable the home to be clear about expectations. EVIDENCE: The inspector looked at the home’s [service user/ Resident’s] guide, which also contains the statement of purpose, which is on display in the home’s reception area. The Statement of Purpose has been written several times since the last key inspection and then the random inspection of December 2006, with the Commission requested to offer advice. On the day of the visit the homes Statement of Purpose was found to be clear and had fully answered outstanding questions. The key are being the range of needs section was found to be clear and accurately reflected current Residents by stating that the home is suited to those with a moderate to severe learning disability and who St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 9 experience a range of autism or related traits. This clarity has been necessary to resolve compatibility issues and confusion about service provision. The Statement of Purpose has a range of useful information such as good detail on the staff that work in the home. The home has developed a more user-friendly Service User guide for Residents which uses symbols to convey key information. The home is currently looking at a range of different ways of communicating key information such as by the use of photographs. The manager confirmed that inspection reports are communicated to Residents in a summarised form via their regular Residents meetings given difficulty with reading the written word. The home has supported Social Services decision to move out 3 Residents since the last key Inspection. Relatives spoken with indicated how this has improved the meeting of current Residents needs. The inspector noted how calm and relaxed the atmosphere of the home was and how Residents which previously had to compete with more powerful personalities approached staff more confidently. One specialist who works with the home on their behavioural programmes commented in survey cards sent to the Commission how the home is becoming more person centred in the meeting of Residents needs No new Residents have moved into the home since the last inspection with the home having four vacancies. Current Residents / users of the service who were observed to get on well together with no-one interfering with the meeting of individual needs. The manager and staff confirmed that following a recent referral to the service that a prospective new Resident had recently visited the service and is awaiting funding agreement before moving in. staff described this new residents needs and clearly indicated how this person would fit in well with current Residents. All current Residents were fully assessed before moving in as confirmed in records. The manager and records confirmed some variations in the files of each Resident in relation to contracts/ terms and conditions. All contracts listed the fee either in the homes documentation, such as weekly fee of £1600 for one Resident and £2560 for another ,in Social Services information. One of these Residents had an user agreement the other did not. More confusing were generic contracts written by the organisation which did not relate specifically to any individual and listed the West Sussex CSCI office [which closed in 2006]. The manager indicated how she wants to get new contracts written out and agreed for the Resident on the higher fee. The manager is aware that this Resident requires 2 staff when going out which is reflected in the high fees staffing is the main cost. The manager explained how she currently interprets this to mean trying to provide [not always possible due to staffing levels and choice of other Residents ]6 hours community activity per day. Social Services confirmed to the inspector that the funding is for 2 staff when out and one staff when in the home as was the case with the persons St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 10 previous placement which the same inspector had also inspected before its closure. Relatives expressed some queries to the inspector in relation to some financial matters. One relative questioned why they are sent petrol receipts for them to pay from the Residents own allowance. They indicated confusion about what the basic high fee was for, due to their concern that the Residents allowance is being overused. The inspector was not clear whether this petrol contribution is from their mobility allowance or should be covered in the fee. Similarly another relative indicated that they have been asked to contribute financially for areas such as a holiday but were not clear what percentage and what basic costs the home should cover such as food and staffing, and some of the basic cost of the holiday. Neither relative was unhappy with the service and felt it was improving. The home is therefore advised to clarify contractual terms and conditions for the home and advocates, and Residents. St Laurence DS0000021222.V339129.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, & 9. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Care planning has improved to an exceptional standard, which benefits the meeting of Residents needs. Residents benefit from good advocacy arrangements, which enable them to have people speaking on their behalf. EVIDENCE: The Inspector’s examined Care plans of all 3 current Residents, which were found to be accessible, clear and frequently reviewed. The plans showed clear evidence of key worker involvement and staff were found to have excellent working knowledge of these plans. The inspector met with 2 of the 3 key workers who each demonstrated a clear sense of purpose for their Resident along with clear goals, and an excellent awareness of their needs and preferences. Relatives spoken with identified the quality of the key workers as the key strength of the home. Residents were observed to relate well to their St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 12 key-workers. It was evident how the key worker plays a key role in advocating the needs of Residents to the wider staff team to promote consistency, as seen in the minutes of team and Residents meetings. Care-plans also demonstrated regular review with a range of specialist to ensure that all specialist support was in place to support complex needs. One of these specialists indicated to the inspector through a survey card the way in which the home responds well to advice. Each Resident was found to have thorough Guidelines and written routines based on needs and preferences. Relatives confirmed the commitment of key workers to gather a full family history and Residents profile to ensure full information. Each resident was found to have a range of long-term goals, which had also been broken down in to achievable short-term goals. It was evident that each Resident had a variety of diverse goals based on their needs such as greater community presence and college, and preparing meals Plans showed evidence of monthly and six monthly review with the latter well detailed such as a reviews of the 10thand 19th of March 2007 of 2 Residents one of which was attended by social services who confirmed in records and in discussion with the inspector that needs were being met with the exception of activities and a need for a medication review. Daily recording notes are complete and informative and linked to care-planning goals and guidance as well as activity schedules All Residents were found to be well-presented and wearing clean new clothes with clear time allocated to meeting basic care needs. All Residents have fortnightly visits from their designated external advocate with all having written records of the outcome of these visits. Risk assessments were found to be comprehensive, updated and which covered up to 20 different activities for each Resident. These assessments were found to be working in practice with them showing a range of measures over the last year to improve safety practice. St Laurence DS0000021222.V339129.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): 11, 12, 13, 15, 16, & 17. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The home continues to make some improvements to activity schedules but Residents will benefit in order to achieve their potential, from a more diverse range of stimulating activity and educational opportunities which are regular and based on their need and preferences and which are not affected by staffing levels. Meal and visitor arrangements suit Residents needs. Resident’s views are sought and routines are flexible. EVIDENCE: The inspector purposefully arrived at around 10am on the basis of the visit coinciding with planned activities. One of the Residents was having breakfast that joined slightly later by another peer. The other Resident was in their St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 14 room. There was also just 2 staff on shift until a third staff person arrived at 10.30am. The support needs of each Resident therefore meant that opportunities for staff to support activities was limited during most of the morning. Two of these Residents subsequently went out for lunch and the other Resident went out for shorter period due to foot pain. It was evident that staff have a commitment to provide activities and explained how current schedules need review especially since the departure of a resident who joined in with some activities enjoyed by others and so helped to balance out staffing. Activity schedules and records of activities did not show any significant improvement over the 3 inspections where a requirement has been made to improve activity provision. At the last key inspection of May 2006 the inspector was informed that college opportunities would be accessed for Residents. During this inspection the inspector was again told that no progress had been made other than ordering prospectus appoint supported by relatives spoken with Relatives and Social Services spoken indicated that activity provision and opportunities for stimulating activities such education which could increase Residents skills by accessing college, continues to be the main weakness of the home. This was evidenced in the review report of one Resident in March 2007 where increasing activity provision was agreed as action point/ goal. In light of the significantly high funding paid for this Resident it was not possible to evidence that value for money was being achieved. This Resident is funded as confirmed by staff and Social Services for 2 staff when out in the community. It was evident that this cannot occur regularly or when the Resident wants to go out as his programme is dependent on other Residents who are requiring some of the existing staff support. The staff and the manager confirmed that at present due to staffing that the activities programmes is a “juggling act” and is dependent on Residents choosing similar activities or waiting on each other. The manager explained how they attempted to provide at least one car ride per day for the Resident referred too. The relatives raised a query about being confused about whey they are invoiced for petrol receipts as thought this might be covered in the fee especially given that it is £2560 per week. The home is advised to resolve this with all stakeholders. The home have faced the difficulty of accommodating a Residents activity needs which has been mainly met by regular attendance at a day centre. The home and relatives agreed that this day centre was no longer benefiting the Resident and that since it stopped that behaviours and wellbeing had improved. An more appropriate day centre has been researched but the cost is seen as prohibitive. This persons activity programme can expand further due to it be being mainly leisure based. More positively an afternoon slot has been found on a Monday at another day centre along with aromatherapy. The home also showed that for another Resident that activities have needed a lot of review due to behavioural issues and that some previous ones such as the gym may be resumed. Relatives of this Resident indicating how the home could St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 15 explore some other options such as cycling. It is noted that a social club has been accessed more recently by the Resident and the home may be more successful in develop regular activities now that the Resident is more settled.. Care-plans have a range of goals, which are linked, to greater community presence and educational inputs which now require activity schedules and staffing resources to match these. The homes Annual Quality Assurance Assessment completed by the manager identified that the home intends to keep activities under review over the next year Visitors confirmed that they are treated with courtesy and respect. The advocate and records show that Residents are playing a greater role in the running of the home as seen in regular Residents meetings. A relative indicated that although there are some queires around costs that they were pleased that the home is looking to organise an individually tailored holiday for one particular Resident and that due to the carefully chosen location they will be able to also visit the resort. Meal arrangements were again found to be good and based on choice with these recorded and additional alternatives offered. The home was found to have good supply of fresh food including fruit and vegetables. The manager indicated the diverse way in which Residents are offered choices of meal such as showing one Resident the ingredients. The manager plans according to their Annual Quality Assurance Assessment to introduce photo cards over the next year to communicate choices. St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents receive a good level of care, which is constantly reviewed with positive attention to medication needs. EVIDENCE: The medication cabinet was examined along with all records. All aspects of storage and administration were found to meet the standard and best practice. All homely remedies were labelled and accounted for on recording sheets. Staff interviewed was 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 home undertakes a series of its own regular checks, which involves both the home and the visiting area, manager. It is positively noted that full explanation is given for each medication drug being given to individuals along with what side effects to monitor. Records and discussion with social services indicated how the home has supported some positive medication changes for 2 Residents with a St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 17 commitment to reduce medication where safe to do so to give Residents as much control as possible. One particular Resident has had some complex health needs prior to admittance into the service, which have interrupted their progress and quality of life. Staff and records showed how following some intensive support including a range of specialist input that some progress has been made over the last 2 months to the benefit of the residents mood, behaviour, and well being following medication adjustment. A relative of this Residents indicated to the inspector how this current home is the best one the Resident has lived in Another Resident has been on significant medication on admission to the service for behavioural support. Following a sustained period of stability the home has agreed in conjunction with a recent socials services review to undertake some medication changes to reduce dependency and control Health needs such as medication reviews, and dental check ups are recorded and regularly reviewed Accident records showed a low rate. Admittances to accident and emergency are low with none reported over the last year. Overall staff support to Residents was seen to be unhurried, warm, and respectful with all Residents exhibiting good evidence of well-being and no anxiety. St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The home operates in an open manner for the benefit of Residents and continues to have a low number of concerns made against it. Residents benefit from well- trained staff and now with live with others who do not threaten them. EVIDENCE: There has been no formal complaints or concerns made against the home over the last year as confirmed by the manager and by the Annual Quality Assurance Assessment completed by the manager. A Residents who has recently left the service had raised a concern several times which had been recorded in the monthly regulation 26 reports of the home. This was around frustration that the front door was locked following a serious incident to another Resident when they had left the door open. This was resolved by eventually supporting the Resident to move to independent service where such liberties could be safely exercised without affecting others. Relatives and social services spoken with indicated the open nature of the home and how the service welcomes their views and suggestions. Visitors described the home as open and approachable with a clear complaints procedure in place with some attempt to make this accessible to some of the Residents with the use of symbols. Monthly service user meetings have started where the manager hopes that service users will develop skills and St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 19 confidence in airing any views. These meetings along with key worker reviews are attended by the independent advocate who indicated the open way in which the home acts on suggestions in the best interest of Residents. The manager indicated in the Commissions completed Annual Quality Assurance Assessment that she intends to introduce photographs to the Residents complaints procedure to aid understanding. All staff have received adult protection and again confirmed through discussions how to both identify and report suspected abuse. The home’s policy in this respect is regularly updated. Some adult protections have been raised since the last key inspection in 2006. There was confusion at the last [follow up Random] inspection visit of December 2006 in respect of delays with positively resolving a particular issue which affected Residents rights. It is positively noted that by this inspection that these issues and risks no longer existed due to particular a Resident moving on to more appropriate services. Furthermore the management of the service have since the last inspection demonstrated a stronger willingness to protect Residents welfare needs. Current Residents were observed to be compatible without anyone interfering with the meeting of their needs. Relatives commented to the inspector how much calmer the home had become which allows current Residents to play a more leading role. Some queries around financial management on behalf of Residents in terms of petrol and holiday costs have been raised elsewhere in this report by relatives. In the absence of clear evidence that the home is acting against Residents interests no recommendation has been made in this section in the expectation that the home clarifies these matters in written policy form to the satisfaction of all stakeholders. St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 20 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, & 30. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a modern, clean and spacious environment, which creates a good impression and which, is personalised to Residents tastes and preferences. EVIDENCE: The inspector toured communal parts of the home. Resident’s bedrooms were inspected on the previous visit and were found to be highly personalised with new furniture including comfortable chairs, new wardrobes, and audio/visual equipment, with decoration according to resident’s preferences. One bedroom on the ground floor was looked at during observations of a Resident and staff. This person has recently opted to move back downstairs. Some flooring in this room was found to need attention with the manager indicating that it was in the process of being sorted out. The person has chosen to have their laminated floor replaced with carpet. The manager and staff with reference to written records indicated how a behavioural specialist has made recommendations, St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 21 which have been implemented in relation to making the environment more sympathetic to the autistics needs of some Residents The home was found to benefit from a range of modern touches including lighting and well-maintained and attractive furniture. The home is airy spacious and well designed with Residents having a range of communal areas such as the main lounge, dining room, conservatory, and large rear garden which is fully furnished. It was also pleasant to see the kitchen door unlocked with Residents having full access with staff present. Relatives commented positively on the suitability of the environment to meet Residents needs. The home was found to be clean, bright, warm, and free from offensive odours. St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 22 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. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from well-trained and experienced staff some of who are exceptional. Residents will fully benefit once staffing numbers increase to meet activity interests and needs. EVIDENCE: On arrival at the home at 10am there was found to be 2 staff on shift one of whom was the manager. Staffing levels increased to 3 at around 10.30am.It is repeated feature of the last 3 inspections that the home is not providing enough staff to fully meet assessed needs particularly activities. Whilst this is not seriously affecting outcomes it does place some unfair restrictions on Residents who are funded for higher levels of staff than which is provided at present. One of these Residents is funded for 2 staff when going out into the community. As staffing does not go above 3 staff according to the rota and observations and that each of the other 2 Residents need 1 staff each when going out then this persons options and opportunities are unreasonably limited. During this inspection this Resident did go out with 2 staff but also one of the other Residents to balance this out which meant he did not have 2 staff. St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 23 It was therefore evident that in order to properly carry out activities that 4 staff are currently needed on shift. The manager was again found to be working half of their hours on shift[20] but stated that this was manageable in relation to their mangemt duties. The service is advised to urgently review this particular as the service grows to fill vacancies. Additionally freeing up the manager to be the occasional fourth staff member on shift could support activities. There was no evidence that insufficient staffing was putting Residents at risk other than creating some compromises with activity provision in terms of choice and risk assessments agreed with Social Services in the case of one Residents who requires 2:1 staffing in the community but often goes out with 2 staff and another Resident who needs staff support . The manager indicated that there continues to be staffing shortages and is actively recruiting. More than 50 of the full care staff team as confirmed by the manager now have at least National Vocational Qualification level 2. Two of the senior staff have achieved level 4 which has helps assist them to run the home especially in the managers absence. Both these staff were interviewed during the inspection visit and found to have exceptional knowledge and skills. Relatives spoken with singled out both these staff as crucial to Resident welfare. Other staff are also long serving and make a positive contribution. Staff were observed to work well with Residents this also included the manager Tight recruitment procedures are followed with the manager fully aware of what is required. Only one part time staff person staff has been employed since the last Key inspection when they were last checked [May 2006] and so staffing files were not looked at as there was no issues last time. The manager confirmed that all checks continue to be carried out as confirmed by the Annual Quality Assurance Assessment and recent regulation 26 reports. The manager confirmed that all staff receives regular written supervision. Staff themselves also confirmed this. All staff employed have experienced a thorough Induction’. The manager confirmed awareness of the new Common Induction standards effective from September 2006 for any new staff joining the home. Staff spoken with confirmed how the more comprehensive autism training they had since the last inspection had aided their understanding. Staff work very closely with behavioural specialists who support the home from the local Social Services department. St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, & 42. Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The management of the home has improved and is clearer about what is required in the best interests of Residents. Measures taken to improve quality are improved which is providing a closer and more effective focus on Residents needs. EVIDENCE: This manager is experienced and was described in the last report as working towards the required qualification. The manager achieved registration in 2005 on the basis of ensuring that they commence and complete the necessary qualification as soon as possible. On the day of the visit the manager confirmed that they hoped to complete all the necessary work by the end of St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 25 the week in order to submit the necessary work to achieve the Registered managers Award which incorporates both the National Vocational Qualification in Care level 4 in management and in Care. The manager has a management qualification from the leisure industry and has been involved in the management of care services for the last 10 years , 4 of these being at St Laurence . The home is clearly benefiting from having a stable manager who also has a good awareness of the needs of current Residents due to her background in autism. Social services consistently comment how they find the manager knowledgeable, helpful and easy to work with. The manager has more recently developed an independent ability to recognise what a compatible service look like s along with how to develop a clear purpose in Residents best interest to avoid the incompatibility issues which have affected the home in the last 2 years. The manager no longer needs advice from the Commission in relation to these matters. It is also of benefit to the Residents that the managing organisation is now allowing the manager of the home more freedom despite a concern about how many hours she is currently expected to work on shift. The Annual Quality Assurance Assessment sent to the home by the Commission and completed by the manager was found to be comprehensive, reflective, realistic and indicated a clear direction for the home over the next 12 months. This paper indicated what the obstacles had been to progress. Allied to this the manager has developed a written business plan for the home over 2007 which, highlights objectives such as widening access to community participation for Residents by improving activity planners and their communication skills along with that of staff. Some aspects of this business Plan were found to be general and non- specific such as references to staff having specialist training without outlining what this is. Similarly how Residents weekly planners will be improved was unclear. Overall this document represents a useful benchmark to assess service quality over the year. Regulation 26 monthly reports of inspections of the home by the organisation are sent to the Commission although these could be timelier. The most recent report received at the time of writing dated April 26, 2007 represented a significant improvement on previous versions by being more in depth they making reference to Residents and staff in observations of activities and identifying clear action plans as to where the service could improve. Such as in relation to Residents meetings. In depth checks included reference to training records, and Residents behavioural and health issues. Reference was made to the number of staff on shift but not whether this was sufficient or not. The last annual survey for Residents views was in June 2006 with another planned shortly and which will involve the independent advocate to help Residents answer questions. Daily entries in to Residents daily records are in bound books with staff away of not leaving spaces. St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 26 All staff were found to have all the basic health and safety training such as first aid and moving and handling. Fire training recently took place for staff. Fire drill occurs six monthly with an evacuation carried out. No hazards were observed during the visit. The homes Annual Quality Assurance Assessment confirmed that all health and safety checks continue to take place. The Commission’s local office moved location in February 2007 with a senior staff member explaining that a minor incident report of that same month may not have found its way to the Commission’s new office location, due to possible confusion in the home over this advertised move. It was social services, which alerted the Commission on March 10, 2007 to this incident with no further action necessary. The inspector decided, as this was a minor incident and given the homes good track records of open and transparent reporting, that no further action is necessary. No response to this report was received at the point [deadline date] of publishing. St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 3 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 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 4 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 28 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA12 Regulation Requirement Timescale for action 07/09/07 16[m]&[n] That the Registered person must ensure that it fully develops a holistic range of meaningful and regular activities for all Residents based on individual needs and aspirations and which allow opportunities for skill development. That any such individual programmes are regularly adhered too. That necessary resources are provided such as appropriate staffing levels to ensure that routines can be followed and that flexibility and choice for Residents is fully maintained. Requirement of the last 3 Inspections. Requirement first made April 27, 2006 2 YA33 18[1][a] That the Registered person must conduct a review of staffing levels to demonstrate it is meeting assessed needs. That the organisation provides any additional staffing resources in line with assessed needs and funding expectations, such as activities and set staffing ratios, DS0000021222.V339129.R01.S.doc 07/09/07 St Laurence Version 5.2 Page 29 and ensures that the manager only works on shift as supernumerary to existing staffing ratios and not in order to balance minimum staffing levels on a regular and substantial basis Requirement of the last 3 Inspections. Requirement first made April 27, 2006 3 YA37 18[1][c] That the Registered person must ensure that the registered manager confirms to the Commission by the date shown. That they have achieved the necessary management qualification 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA5 Good Practice Recommendations That the home ensures that it has clear contracts with the funders of particular Residents which detail expected service provision such as staffing ratios and holidays. That goal plans are actioned in respect of educational needs such as accessing college and other further education opportunities. That the home clarifies in policy form the responsibility for transport [petrol] costs. Detailing what the homes contribution is from the basic fee and what is reasonable for the Resident to fund. That this policy is agreed with funders and, advocates such as relatives YA11 YA13 St Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Laurence DS0000021222.V339129.R01.S.doc Version 5.2 Page 31 - 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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