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Inspection on 06/10/08 for St Mark`s Road Care Home - Block B

Also see our care home review for St Mark`s Road Care Home - Block B for more information

This inspection was carried out on 6th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Mark`s Road Care Home - Block B 26 St Mark`s Road Derby DE21 6AH The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jo Wright Date: 0 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 29 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: St Mark`s Road Care Home - Block B 26 St Mark`s Road Derby DE21 6AH 01332294466 01332242449 26stmarksroad@robinia.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Robinia Group PLC care home 8 Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: Date of last inspection A bit about the care home Robinia Care Group is the responsible provider for 26 St Marks Road. The home is located on the same site as another home owned by this organisation. The home was purpose built to a high standard in 2005, to provide personal care and accommodation for up to 8 people in the category of learning disability, aged between 18 and 65 years of age. The home is situated in Chaddesden, just outside Derby City centre, and is close to local amenities. A car park is available at the front of the premises and a garden at the rear. The home provides a Care Homes for Adults (18-65 years) Page 4 of 29 spacious environment with all rooms being single with en-suite shower facilities. The home has a vehicle to help promote activities outside of the home. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 29 How we did our inspection: This is what the inspector did when they were at the care home We arrived at the home without an appointment. We looked at some of the policies and procedures in the office. Policies are rules about how to do things. Procedures tell people how to follow the rules. We talked to people living at the home and watched what people did each day. We also met some of the staff working at the home. We have written down what was said in a report we did in October 2007. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well Staff give out medication properly so people are safe and receive their medication when they need to. People are offered a healthy diet, which takes into account their likes and dislikes and any allergies they may have. All of the required checks are done before people start work at the home, so that people who live there are safe. Care Homes for Adults (18-65 years) Page 8 of 29 People who live at the home are supported to make their own decisions and can choose to go on different activities. What has got better from the last inspection What the care home could do better A manager needs to be appointed and register with the Commission for Social Care Inspection. This person will have to tell the inspectors how they will make things better at the home. Care Homes for Adults (18-65 years) Page 9 of 29 A secure controlled medication cupboard and secure refrigerator needs to be provided. Staff must listen to what people say about things they do not like and write these things down. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jo Wright CPC1 Capital Park Fulbourn Cambridge CB21 5XE Care Homes for Adults (18-65 years) Page 10 of 29 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 11 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Detailed assessments of needs covering all aspects of a service users life help to ensure that the needs of the service users are met. Evidence: Three service users files were examined. Each of the files were well organised. Each had a detailed assessment of need in place and from that a very detailed service users plan has been developed. The plan developed covers all aspects of the service users life. The person in charge stated that service users are offered a visit to the home before deciding to move in. Care Homes for Adults (18-65 years) Page 13 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Detailed service users plans and risk assessments help to ensure that needs are met, helping to improve quality of living. Evidence: Each of the files held a detailed service users plans. The information held detailed all aspects of the service users life and addressed all needs highlighted within the assessments of need. There was evidence of input from other professionals and although relatives visit regularly 3 of the files did not have evidence of input from them. Each of the files are written in a user friendly manner and easily accessible for staff and service users. Evidence of the home contacting relatives via letter to ensure that they are kept informed of appointments, accidents, incidents and any changes to needs. Cultural details are addressed including employing a person who speaks a service users native language. It was evident that staff support service users to take risks and risk assessments along with action plans were available within each file. There is a missing persons procedure in place. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: The person in charge stated that service users are supported to attend staff meetings and have input if they wish to but they often chose not to become involved although they may sit in on them. Care Homes for Adults (18-65 years) Page 15 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A detailed service user plan with activities to meet needs, input from relatives and suitably trained staff, all help to ensure that service users needs are met and they are able to develop new skills. Evidence: Each of the files examined held a detailed activity plan which ensured that they had activities throughout the week, supporting them to access the local college and supermarkets. A number of service users were out on activities on the day of the visit. There was evidence of risk assessments to cover activities. The person in charge stated that they try to involve the service users as much as possible when choosing group activities and holidays. Staff duty rotas are planned around the activities of the service users to ensure that suitably trained staff are on duty to cover the activities safely. Families are involved with the service users and are able to visit unrestricted. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Staff work with the families closely and open mail with the service users to ensure that appointments are documented and support is available. It was evident that staff are aware of the needs of the service users, being aware of when they prefer to be alone and when they want company. Their preferred form of address is documented. Service users have full access to all parts of the home, there is a key pad at the front door to ensure their safety. There is a menu prepared to accommodate the likes and dislikes of the service users and also to ensure that a balanced diet is offered. Mealtimes are not rushed and service users needing support are offered it ensuring their privacy and dignity is respected at all times. Care Homes for Adults (18-65 years) Page 17 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Appropriate information within the care files and access to a range of professionals helps to ensure that the health needs of the service users are met. Evidence: The service users files held information to ensure that the privacy and dignity of service users is respected at all times. Each of the service users have their own hoist in their room which goes into their own en-suite facility. Although there are no specific times for getting out of bed in the morning, staff do have to ensure that service users are up in time for the activities of the day. There are no specific bed times. Service users are supported to choose appropriate clothing for the weather. There was evidence of input from a range of professionals; epilepsy nurse, chiropodist, neurologist, dentist. Medication is stored in a secure area and audited appropriately. There is no secure controlled medication cupboard and no secure medication fridge at the home. One service user has her medication later than detailed on the prescription sheet, however the Operations Manager stated that this has been agreed by the GP, to enable her to Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: have a lie in in the morning. Care Homes for Adults (18-65 years) Page 19 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Detailed policies and procedures to deal with complaints and safeguarding adults helps to ensure that they are listened to and safe, however staff without training and failure to record complaints potentially puts service users at risk. Evidence: The organisation has a detailed complaints procedure and Safeguarding Adults procedure. Some of the staff team have completed training in Safeguarding Adults, however there are still 5 staff to complete. The organisation provides training in managing behaviours; Team Teach, however there are 5 staff to complete this. 2 staff files were examined one held all the relevant information, the second file had an out of date UK entry clearance. This was discussed with the person in charge who contacted the Human Resources department during the visit, it was confirmed that they had the relevant information and would forward copies to the home. A copy of the complaints procedure is available in the home for visitors and relatives. A record of complaints is kept by the home, however there was nothing documented since the last inspection. This was discussed with the person in charge and the Operations Manager. There have been complaints made and have been dealt with but they had not been recorded appropriately. Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A clean home providing necessary equipment ensures that service users are safe. Evidence: The home is well decorated with modern furniture. Each of the bedrooms has an ensuite facility. All bedrooms seen had the necessary equipment to ensure that service users are safe. The rooms are personalised and clean. There were no malodours apparent in the home. The home has a utility room with the necessary equipment. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Poor staffing levels, staff without suitable training and lack of relevant information within the staffing files potentially puts service users at risk of serious harm. Evidence: There were only 2 regular staff and 2 agency staff on duty in the home on the day of the visit. One member of staff had phoned in sick and the person in charge had failed to cover the shift. This clearly limited the time staff were able to spend with service users and also limited their choice. On the day of the visit this had clearly impacted on people using the service, as one person was unable to go to college as planned, and no activities were taking place. In addition, people did not have a choice of when they got that morning, as they had to get up when staff were available. Staff on duty did appear to have a good, positive relationship with service users. The organisation offers a range of training for staff, however there are still staff who have yet to complete mandatory training. This was discussed with the Operations Manager. Six staff files were examined. Three of the files held on 1 written reference. One file had no POVAFirst check and a CRB check dated 3rd June 2008, however the member of staff concerned started to work at the home before the return of the CRB. There were other concerns evident within this file and these were discussed with the Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: Operations Manager. Staff spoken with stated that they did receive 1:1 supervision on a regular basis. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Although the home is working relatively well there is clearly a need for a suitably qualified Registered Manager to ensure changing needs are met. Evidence: There have been a number of managers in this home and they are currently without a manager. Although the person in charge at the time of the visit appeared to be competent, there is a need to ensure that a suitably qualified Registered Manager. The person in charge has developed a training matrix giving a clear view of who has completed what training. The environment has a quarterly Health & Safety audit. The landlords certificate was in date. Fire alarm tests had been held regularly up to 27.08.08. The system was serviced 24.04.08 and fire drills had been held three monthly. The organisation has clearly looked in to moving and handling, ensuring that dignity is respected. In addition to the provision of staff training, service users have the use of hoists within large bedrooms with en-suite facilities. Care Homes for Adults (18-65 years) Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 29 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 Controlled medication must 31/03/2009 be stored in a cupboard that meets the legal requirements for controlled drugs - metal cupboard of specified gauge, specified double locking mechanism, fixed to a solid wall or a wall that has a steel plate mounted behind it, and fixed with either rawl or rag bolts. This is to ensure that controlled drugs are stored securely and safely. 2 22 22 All complaints must be fully recorded, investigated and feedback given to the complainant. 31/12/2008 To ensure that those making a complaint feel listened to and appropriate action is taken. Care Homes for Adults (18-65 years) Page 26 of 29 3 23 18 Staff must receive training on how to manage behaviours safely. 31/01/2009 To ensure that both people using the service and staff are safe. 4 23 13 Staff must receive training on how to prevent people using the service being placed at risk of harm. 31/01/2009 To ensure that people using the service are safe. 5 32 18 Staff must receive training appropriate to the needs of the people who use the service. 31/01/2009 To ensure that staff have the skills and knowledge to meet the needs and preferences of the people who use the service. 6 33 18 Staffing levels must be 31/12/2008 reviewed to ensure that sufficient staff are on duty at all times. To meet the needs and preferences of the people who use the service. 7 35 18 Staff must receive all mandatory training. 31/01/2009 To ensure that staff have the skills and knowledge to meet the needs of the people use the service and keep people Care Homes for Adults (18-65 years) Page 27 of 29 safe. 7 37 9 A manager must be appointed and make an application to be registered with the Commission for Social Care Inspection 31/12/2008 To ensure there is a fit and competent person running the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 A secure medication refrigerator should be provided. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 29 of 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!