CARE HOME ADULTS 18-65
St Marks 23 Collier Road Hastings East Sussex TN34 3JR Lead Inspector
Caroline Johnson Unannounced Inspection 9th February 2006 16:00 St Marks DS0000021225.V267131.R01.S.doc Version 5.0 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 Marks DS0000021225.V267131.R01.S.doc Version 5.0 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 Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service St Marks Address 23 Collier Road Hastings East Sussex TN34 3JR 01424 200854 01424 200854 23collierroad@tiscali.co.uk 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) A S D Unique Services Limited Miss Fiona Macartney Care Home 6 Category(ies) of Learning disability (6) registration, with number of places St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The maximum number of residents to be accommodated is six Residents will be over the age of eighteen on admission and below the age of sixty five Residents will on admission be diagnosed as suffering from autism Date of last inspection 3 August 2005 Brief Description of the Service: St Marks provides long term care for people over the age of eighteen who have been diagnosed as having an autistic spectrum disorder. This can include people with Aspergers syndrome. Each residents needs in respect of education and leisure time are assessed and a programme of activities arranged. The property is situated in a residential area on the West Hill of Hastings and is within walking distance of Hastings. St Marks is a three-storey building. There is no lift so residents need to be able to use the stairs. St Marks is one of three homes owned by the proprietors Mr and Mrs Kennard. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the second inspection in the year running from April 1 2005 to March 31 2006. The inspection lasted from 4.00pm until 6.30pm. During the inspection there was an opportunity to meet with four of the residents either in the lounge or in bedrooms. The manager facilitated the inspection and during the inspection one of the staff team provided additional advice. A number of records were examined including, staff training, menus, new procedures and health and safety documentation. What the service does well: What has improved since the last inspection?
The home responded very well to the requirements and recommendations of the last inspection. The service user guide is almost complete and residents have been involved in the production. Residents are encouraged to share their views as part of the staff recruitment process. A number of new procedures have been introduced which have had a very positive impact on the way the home is run. They include having suggestion meetings with a small number of the residents prior to the weekly house meetings. The suggestion meetings are an opportunity for residents who find it difficult to make decisions quickly, to think about what they would like choose for outings and meals at the weekend so that they can then make a positive contribution at the house meetings when these topics are discussed. The home has introduced a staff photo board so that residents know who is going to be on shift each day. There is also a new shift plan in place which details the tasks that need to be completed by staff on any given shift and who has responsibility for carrying them out. The home has updated their quality assurance questionnaire and they will be distributed to the relatives of the residents to comment on the quality of the care provided in the home. In addition the manager has set up
St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 6 an emergency procedures file with all relevant contact details. There is also a missing persons file with key information about each individual including information about how autism affects them. 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 Marks DS0000021225.V267131.R01.S.doc Version 5.0 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 Marks DS0000021225.V267131.R01.S.doc Version 5.0 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 The involvement of residents in the production of a service user guide is considered very good practice. EVIDENCE: The manager confirmed that the residents have put together a service user guide and all information collated to date was seen. One of the residents has taken on the role of lead co-ordinator for sorting out the photos to be used in the document. The resident concerned spoke to the inspector about the types of photos that he would like to see included such as the view from the rear of the house. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 The home has introduced new ways for staff to document the very positive work they do to ensure that residents have a say in the running of their home. This is considered to be very good practice. EVIDENCE: House meetings continue to be held weekly. Some of the residents find the weekly meetings difficult, as they need to take time over making decisions. In order to assist the process staff meet with a few of the residents individually in private in advance of the house meeting. These meetings are called suggestion meetings and staff assist residents to work out what they would like to put forward as proposals for activities and meals at the house meetings. The manager advised that the introduction of the suggestions meetings has helped residents to be more confident expressing their individual views at the house meetings. Each of the residents is aware of their own responsibilities in relation to the running of their house and there is a rota detailing which tasks need to be undertaken daily and by whom. A new staff photo board has recently been introduced so that residents are clear about who is to be on duty. Feedback from residents about the new board has been very positive. As recommended
St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 10 at the last inspection, feedback is obtained from residents as part of staff recruitment and a record is kept of all contributions made by the residents. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12 & 17 The home is continuing to work on building up the range of activities on offer to residents. There is emphasis on encouraging residents to be as independent as possible and the system in use for determining levels of perceived risks are good. EVIDENCE: There is an activities monitoring sheet in place for each resident. Each activity is assessed in terms of risk. Triad and motivational factors are considered and a task analysis is undertaken to break down the steps that need to be taken to ensure that each activity runs smoothly. There are at a glance guidelines in place along with more detailed guidelines for staff. All staff are required to sign and date that they have read the documents. Two of the men have recently started a work placement. There was an opportunity to speak with one of these residents and he said that he works one hour a week. Duties so far have included shelf stacking and unloading a van. He hopes to build up to a few hours a week but is happy to continue with one hour until he is more confident with the work. He stated that he is enjoying the work.
St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 12 Every other Thursday some of the men have an aroma-massage. On the evening of the week when there is no aroma-massage two of the men meet with two female friends and go out for an evening meal. At Christmas a hall was hired for a party and residents from all of the homes within the company, their families and friends and staff were all invited. The owners presented certificates of achievements and there was a disco. All the residents were involved in producing a calendar for the home. Each month includes a photo of one of the men and the calendar also features pictures of the men during some of the main events and holidays undertaken in 2005. The menu on offer shows variety and indicates that residents receive a well balanced diet. As indicated earlier there is a set menu for Monday to Thursday and residents meet weekly to decide the menus from Friday to Sunday. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 19 The home seeks support and responds well to advice obtained from other professionals. EVIDENCE: The home seeks professional advice and support when required to meet the individual needs of the residents accommodated. At the time of inspection one of the resident’s health care needs had changed and the home had sought advice from a range of sources to assist this individual. They were keeping the residents’ social worker informed of the situation. Each of the resident’s individual weights are monitored on a regular basis. Appointments are made as required for residents to attend dentists, opticians, chiropodists and general practitioners. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 14 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): EVIDENCE: These standards were not inspected on this occasion. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 15 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): 24,25,27 & 30 Accommodation provided is comfortable and homely in design. The exception to this is the ground floor toilet, which should be redecorated so that the décor is in keeping with the rest of the house. EVIDENCE: Areas seen during this inspection included the lounge/dining room, the kitchen, ground floor toilet, top floor bathroom and two bedrooms. One of the two bedrooms seen had been redecorated since the last inspection. The residents occupying these bedrooms were proud of their rooms and advised that they had been involved in choosing colour schemes and furniture. The fan in the top floor bathroom had been fixed as was required at the last inspection. In the toilet on the ground floor, there were some loose tiles and the towel rail was loose. The kitchen had been repainted since the last inspection of the home. All areas seen were clean and there were no unpleasant odours. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 16 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): 31,32,34,35 & 36 The arrangements that have been put in place for staff training will be of benefit to the staff in meeting the needs of the residents. The new procedures for planning and recording shifts should ensure that staff are very clear about their individual roles and responsibilities and those of others within the team. EVIDENCE: Since the last inspection a new shift plan checklist has been introduced. The new plan clearly states the roles and responsibilities for each staff on any given shift. Also detailed are the tasks that residents need to complete on a daily basis. One member of staff has almost completed NVQ level three. Another member of staff is due to commence studying for level two on 16 February and a senior and two carers are signed up to commence the next available NVQ course at the local college. Arrangements are being made for staff to attend courses that are autism specific. Courses identified so far include `sexuality and aspergers’ and `social skills and integrated training’. The manager advised that she is speaking with all staff individually in supervision to discuss their individual training requirements. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 17 Arrangements have also been made for the management team to attend a number of day courses. They were due to attend a health and safety course the week following the inspection and `healthy eating’ training was booked for 1st March. Staff meetings are held monthly and in each meeting time is allocated to discuss one of the residents. During this discussion they update assessments, look at behaviour as a way of communication and to talk as a team about the best approach to use. As stated earlier in this report in relation to recruitment the home’s documentation now includes a section for recording the views shared by residents as part of this process. There is also a checklist on each of the recruitment files so that the home can monitor that they have carried out all checks prior to appointing a new member of staff. The manager confirmed that staff supervisions are all up to date and that staff appraisals are due to be carried out now. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 18 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): 38,39 & 42 There are good support systems in place for the manager and her staff team. The new emergency procedures will be of benefit to staff so that they are clear about who and when to call for support in an emergency. In relation to the one resident who has refused to have the portable appliances in his room tested, the owner should meet with the resident’s social worker and anyone else involved in his care to discuss and agree the action that needs to be taken to ensure that the tests are carried out in the interest of this resident and everyone else living at St Marks. EVIDENCE: The manager advised that she receives regular supervision from the owner. She described the owner as `very supportive’. The managers from each of the homes within the company meet monthly and these meetings are also a useful support for the manager. There are clear `on call’ arrangements in place and some of the senior staff now take on this role in addition to the managers. The manager reported that portable appliance testing has been carried out in all but one of the bedrooms. This resident refuses to allow anyone into his
St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 19 room. The company that carried out the testing of the home were supportive and took time to speak with this resident regarding the work that needs to be carried out. The local Environmental Health department were also contacted for advice and support. The manager advised that they would continue to seek to get the agreement of the resident to test appliances in his room. There was an opportunity to speak with a relative of a resident on the telephone during the inspection. Comments received were very complimentary such as that the keyworker `is brilliant and she keeps in touch regularly’. She also stated that `the environment is lovely’. New activities are assessed in relation to risks and are not introduced until she is happy with the proposed plans. The manager advised that she has written to the relatives of the residents to remind them of the home’s complaint procedure and to advise them about availability of inspection reports. The company’s quality assurance satisfaction questionnaire has recently been updated and the manager reported that it would shortly be sent out to all relatives to seek their views on the quality of the care provided in the home. The residents’ satisfaction questionnaire is also due to be distributed. A new emergency procedures file has been introduced. This includes details of whom to contact in an emergency, for example, in the event of a flood, gas leak, burglary and fire. In addition there is a missing persons sheet, which includes at a glance information about each of the residents and also an explanation of how autism affects them. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 3 X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 X 2 X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 X 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
St Marks Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score X 3 3 X X 2 X DS0000021225.V267131.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No 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 YA42 Regulation 13(4a,c) Requirement All portable appliances must be tested. Timescale for action 30/04/06 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. Refer to Standard YA27 Good Practice Recommendations The ground floor toilet must be redecorated. St Marks DS0000021225.V267131.R01.S.doc Version 5.0 Page 22 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
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