Inspection on 10/01/06 for St Marys Gate (25)

This inspection was carried out on 10th January 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Marys Gate (25) 23/05/07

St Marys Gate (25) 25/08/05

St Marys Gate (25) 23/09/04

St Marys Gate (25) 27/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 St Marys Gate (25) 25 St Marys Gate Euxton Chorley Lancashire PR7 6AH Lead Inspector Val Turley Unannounced Inspection 10th January 2006 10:00 St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Marys Gate (25) Address 25 St Marys Gate Euxton Chorley Lancashire PR7 6AH 01257 241899 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) Link-Ability Charity Ltd Mrs Karen Whittle Care Home 4 Category(ies) of Learning disability (4) registration, with number of places St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Within the overall total of 4 a maximum of 3 service users requiring personal care who fall into the category of LD. Within the overall total of 4 a maximum of 1 service user requiring nursing care who falls into the category of LD. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 25th August 2005 Date of last inspection Brief Description of the Service: St Marys Gate is registered to accommodate four service users with a learning disability. The home is one of a number of properties operated by Link-Ability, which is a non-profit making Voluntary Organisation. Link-Ability provides a service for both adults and children who in addition to having a learning disability also have additional complex health and/or behavioural difficulties. It is the aim of the Organisation to provide a tailor made package of care for each service user. In pursuing this aim there is close collaboration between LinkAbility and the service users parents/relatives. St Marys Gate is a purpose built bungalow situated in the village of Euxton. There is a range of local amenities, and those which are accessed further away in the Chorley district. The home is well suited to the needs of the service users, with facilities and equipment having been installed to meet their individual care needs. These are regularly reviewed to ensure they remain appropriate. All clients have their own bedrooms and these have been decorated and furnished to reflect the individuals taste, preferences and interests. There is a communal lounge and dining room, kitchen, laundry and guest bedroom, which serves as the staff sleeping facility and office. There are gardens on either side of the home, one of which provides an enclosed and private area. The front of the home faces onto a courtyard, which is shared with neighbours. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in January 2006 by one regulatory inspector. The inspection involved observation of and interaction with two of the service users living at the home, discussion with and observation of the staff working there, discussion with a visiting relative, an examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection? What they could do better: St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 6 Some additional work should be undertaken by the home to ensure that the management and administration of medication protects both the service users and the support staff. The homes complaints procedure should be reviewed to ensure that service user and/or their families are provided with up to date information in respect of the homes policy and procedure in terms of making and managing complaints. The home should continue in its efforts to ensure that that repairs and refurbishment is undertaken by the housing association who have responsibility for the premises. The home should extend its quality monitoring procedures to ensure that the views of the service users and/or their representatives is available to all parties concerned and the views of involved health and social care professionals is also sought. 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 Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed at this inspection. EVIDENCE: St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 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 Service users were effectively supported by staff to make choices about all aspects of their daily life. EVIDENCE: Discussion with and observation of the support staff interacting with the service users indicated that they had a good knowledge and understanding of their individual methods of communication. Information in care plans confirmed that communication and an understanding of each service users preferences was crucial to being able to provide a relevant service. This knowledge and expertise on the part of the staff enabled them to encourage and support the service users to make choices and decisions in all aspects of their daily lives. Any activities that the service users took part in were risk assessed, ensuring the safety of the service user as far as possible. In respect of the management of service users finances, the home had transparent procedures in place allowing the expenditure on behalf of service users to be tracked. Families were also as fully involved as they wished to be in the management of service users finances. The home had recently introduced a policy, which outlined the need for a financial plan for each service user to be developed. The introduction of this will further protect the financial interests of the service users living at the home. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 10 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): 13, 15 and 17 Staff supported service users to participate in a range of appropriate community-based activities that service users had indicated a preference for. The support staff at the home recognised the importance of family links and friendships and supported the service users to maintain these. The nutritional needs of the individual service users were fully assessed and meals were provided taking into account service users preferences and independence skills. EVIDENCE: From discussion with the staff and from documentation it was evident that the service users participated in the local community as far as possible. This included attendance at concerts, shopping, trampolining, swimming, use of the local library, college courses and appointments at the local hairdressers. The service users had their own transport enabling them to access a variety of facilities. During the course of the inspection staff were heard to discuss the need to increase the number of staff on duty to allow service users to participate in a specific activity. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 11 Staff discussed the challenges they had to ensure some of these activities continued for the benefit of the service users and some of the additional work they undertook to ensure their success. Links with families and friends were viewed as vital part of the service and their involvement and support was welcomed. This was confirmed in discussion with a visiting relative and from information received in questionnaires received from families. Records of the individual monthly meetings held with families were documented. Care plans included details of the support required by service users to enable them to maintain contact with their families and friends. The home enjoyed good relationships with their neighbours and local shopkeepers. This plus service users attendance at the local college enabled service users to meet people who do not have a disability. The menus at the home indicated that service users enjoyed a varied and wholesome diet. Discussion with the staff gave insight into the thought that they put into the provision of meals with the preferences of the service users being considered as well as their skills in terms of eating independently or with as little help as possible. Where service users were fed through a percutaneous endoscopy gastronomy (PEG) tube a record of their intake was recorded. Service users weights were recorded on a monthly basis and there was evidence that a dietician had been consulted were there were concerns regarding a service users diet. Service users were able to eat in their bedrooms if they wished and this was observed on the day of the inspection. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 12 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): 19 and 20 The home had procedures in place to assess the health needs of the service users they supported and worked appropriately and sensitively to ensure that their health needs were met. Some additional work needs to be undertaken by the home to ensure that the management of medication meets the required standard and so protects both service user and support staff. EVIDENCE: There was documented evidence in place that outlined the support provided to service users to access a variety of healthcare facilities and professionals. On the day of the inspection a GP visited the home to attend to one of the service users who had been unwell. A visiting relative confirmed that the service users were supported to attend medical appointments and that as a relative she was very much involved in this process. From discussion with staff and from records in the individual service user files it was clear that the health of the service users was closely monitored. The home planned to introduce health action plans for each of the service users and some of the staff at the home had received training in this with a view to ensuring as far as possible that the health needs of the service users were fully met. The medication in the home was generally well managed. Medication administration sheets had been completed accurately and there was a record of all medications entering and leaving the home. All of the staff had received St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 13 training in the administration of medication. The service users consent to medication had not been obtained because of the service users communication difficulties. It was required that some guidance be prepared for staff regarding the individual service users mannerisms and routines when medication is being administered so that staff are able to make an informed decision as to whether a service user is consenting to or refusing medication. A checklist had been developed for use by senior staff to make occasional checks on staff to ensure competency in the various duties they were responsible for. The management of medication had been included on this although it was recommended that this be extended to include more detail. It was also recommended that staff be observed to ensure that they follow the protocol when administering a percutaneous endoscopic gastronomy (PEG) feed with a view to protecting both the service users and the staff. Some clarification was also required with regard to the frequency of refresher training in the administration of some medications including PEG feeding and the administration of suppositories. The staff stated that they had a good relationship with the community pharmacist and it was recommended that they request a visit from him to undertake a pharmacy audit at the home. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 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): 22 Although the home dealt with any concerns or complaints in a positive manner and service users were fully protected, the complaints policy must be reviewed and amended to ensure that all necessary detail is included. EVIDENCE: The home had a clear complaints policy that clearly outlined the procedure that would be followed if a complaint were received. However the policy did not include a statement to the effect that service users and their families would not be victimised for making a complaint. On the day of the inspection it was not possible to ascertain what information had been sent to families in respect of the organisations complaints policy and it was recommended that this information be issued again with the additional information included as well as the new contact details of the Commission for Social Care Inspection. Information received from families through questionnaires and from a visiting parent indicated that any concerns expressed by families were swiftly addressed by the organisation to the satisfaction of all parties. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 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 Although the home was clean and comfortable and provided a pleasant environment for the service users, support staff and visitors there were some outstanding repairs that needed attention. EVIDENCE: The home provided ground floor accommodation in a building designed to meet the needs of the service users. It was bright, clean, well decorated, cheerful and comfortable providing a pleasant environment for service users, support staff and visitors. The home is situated in a residential area close to local facilities. The premises were accessible to all the service users with wide doorways and ramps. Ceiling hoists had been installed since the last inspection and these had benefited both the service users and the support staff. All maintenance and repairs were the responsibility of the housing association and the staff stated that in general repairs were dealt with efficiently. The staff recognised that the kitchen was in need of repair or replacement and as such it was it was difficult to clean and in a safe condition. This had been reported to the housing association for their attention. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 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): 32, 34 and 35 Appropriate training and support is provided for staff to help ensure that the needs of the service users are being met. The home had a thorough recruitment procedure in place, which ensured as far as possible the protection of the service users. EVIDENCE: During the inspection the staff on duty were observed interacting with the service users and providing appropriate support. Discussion with them regarding the support needs of the service users also took place. They presented as a well-motivated team who were sensitive to the needs of the service users and their families. The staff team was stable and supportive of each other. Comments on questionnaires returned by families were positive and a parent visiting on the day of the inspection stated that the staff team were approachable and good at understanding the needs of the service users. From discussion with staff and from documented evidence it was clear that there were good working relationships with involved health and social care professionals. The home was continuing to work having 50 of its staff achieve a recognised care qualification, but did provide a varied range of training on an ongoing basis. The home had robust selection and recruitment procedures in place. Two staff files were examined and these contained evidence that all the necessary checks and references had been undertaken prior to the prospective members of staff being appointed. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 17 Standard 35 was partly assessed at this inspection and a recommendation made at the last inspection had been acted upon with staff now being made aware of all training courses available to them enabling them to increase their knowledge and skills in a variety of areas. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 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): 37, 39 and 42 The home was well managed with the aims and objectives of the home being achieved. The home had some good quality monitoring systems in place, however these must be further extended to ensure that the standard of care provided meets the expectations of service users and/or their representatives. EVIDENCE: At the time of the inspection the registered manager was on maternity leave. The management arrangements for this period of time had been agreed with the Commission for Social Care Inspection, with two senior members of staff sharing the management role. The acting managers were well-established members of staff with relevant experience. They had each undertaken a short management course to equip them in their new role. The staff team had individual roles and responsibilities in terms of monitoring systems and records within the home, ensuring as far as possible that high standards of operation were maintained. The home also received at least monthly monitoring visits from a member of the management team when St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 19 checks when additional checks were made to ensure that the care provided met the required standard. The home had achieved the Investors in People Award which is a quality assurance award accredited by an outside body. Consultation with families took place on at least a monthly basis and documentation supported this. There was evidence that policies and procedures had been reviewed in recent months. Service users, relatives and support staff were supported to participate in the inspection process. Some additional work must be undertaken enabling the views of service users and/or their representatives to be published and made available to interested parties. The views of any involved health and social care professionals and other stakeholders on how the home is achieving goals for service users should also be sought. Standard 42 was partly assessed at this inspection. A recommendation made at the previous inspection had been acted upon and the home had reviewed its fire procedure. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X 3 X 2 X X 3 X St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 21 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement Timescale for action 31/03/06 2 YA22 3 4 YA24 YA39 Guidance regarding the service users consent to medication must be developed for each service user. 22(5)(6)(7) The complaints policy must be 31/03/06 reviewed and a copy given to all families or the service users representatives. 23(2)(b) The premises must be kept in a 31/03/06 good state of repair. 24(3) The registered person must 30/06/06 establish a system for consulting with service users and/or their representatives and make a copy of the report available to service users and the Commission for Social Care Inspection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 22 1 2 3 4 5 6 YA20 YA20 YA20 YA20 YA32 YA39 The competency checklist for staff should be extended to include more details regarding the management of medication in the home. Staff should be assessed on a regular basis when administering a percutaneous endoscopic gastronomy (PEG) feed to ensure that protocols are adhered to. Clarification should be sought regarding the frequency of refresher training in PEG feeding and the administration of suppositories. The acting manager should request a visit from the community pharmacist to audit the homes medication. The home should continue to work towards having 50 of its staff achieve a recognised care qualification. The home should seek the views of stakeholders on how the home is achieving goals for service users. St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Marys Gate (25) DS0000005938.V264900.R01.S.doc Version 5.1 Page 24 - 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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