Inspection on 11/05/07 for St Michael`s House

This inspection was carried out on 11th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Michael`s House 06/06/06

St Michael`s House 07/11/05

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

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

CARE HOME ADULTS 18-65 St Michael`s House Holwell Road Welwyn Garden City Herts AL7 3SF Lead Inspector Claire Farrier Unannounced Inspection 11th May 2007 10:15 St Michael`s House DS0000064252.V332913.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 Michael`s House DS0000064252.V332913.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 Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michael`s House Address Holwell Road Welwyn Garden City Herts AL7 3SF 01707 320273 01707 393499 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) Hertfordshire County Council Sarah Elizabeth Nicholas Care Home 24 Category(ies) of Physical disability (24), Physical disability over registration, with number 65 years of age (7) of places St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate seven (named) service users aged over 65 for respite care. The manager must inform CSCI when the above (named) service users no longer require the services of the home, or the home can no longer meet their needs. This applies only to these seven (named) service users and ceases to be in force when they no longer require the services of the home, or the home can no longer meet their needs. 6th June 2006 Date of last inspection Brief Description of the Service: St Michaels House is owned by Hertfordshire County Council (HCC) Social Services Department. It was opened in the 1980s and provides accommodation and care for up to 24 people with a physical disability. It provides respite care and short term assessment for a maximum of four months. The home does not provide permanent accommodation for any service users. Seven people who are over the age of 65 currently use the home for respite services. All have used the home for respite since before reaching the age of 65. The home may continue to offer respite to these seven named people as long as it can continue to meet their needs. The home is situated in a residential area of Welwyn Garden City, and next to a day centre for people with physical disabilities. Local shops and amenities are within easy reach. There is an accessible bus service to the town centre. St Michael’s House is a single storey building arranged in four units with shared communal areas. Each unit has its own kitchenette and laundry facilities for the residents to use. All the bedrooms are single, and none have en-suite facilities. The room sizes do not meet the minimum standard, but they provide acceptable accommodation for short term stays. The home and courtyard garden are fully accessible for wheelchair use. All prospective clients are referred to the home by HCC Social Services. The Statement of Purpose and Service Users Guide provide information about the home for the referring social workers and prospective clients. The current charge for respite or assessment is £634 per week. St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day. The focus of the inspection was to assess all the key standards, and some additional standards were also assessed. We talked to as many of the people who were staying in the home as we were able to. Eight people completed Have Your Say surveys before the visit to the home, and we have used some of their comments in this report. These give a representation of what the people who stay at St Michael’s House for respite or assessment think about the home. We also talked to some of the staff, both individually and during the staff handover meeting. The manager sent some information about the home to CSCI before the inspection. When we were in the home we looked at the home’s records, care plans and staff files, and we made a tour of the premises. We talked to the manager about what we had seen during the day. What the service does well: The ethos of St Michael’s House is that each person’s views are valued, and they are able to make decisions about what they do and the support that they receive. Everyone can discuss their care plan and make changes to it if they want to. There are residents’ meetings where people can discuss any concerns that they have, and make suggestions for improvements in the home. The home has a good system for quality assurance that includes asking the people who stay there for their views. One person commented, “I can ask anyone for help of any kind and always get it. The staff on all levels could not be friendlier.” The people who stay in the home have opportunities for a wide range of activities that suit their own interests, both in the home and at the day centre next door. This makes each person’s respite or assessment stay in the home an enjoyable and rewarding experience. The care staff who we spoke to were enthusiastic about their work, and said that they have a good level of training and support to enable them to meet the needs of the people who live in the home. Most of the care staff have NVQ qualifications. One person who stayed at the home while adaptations were made to his home wrote a poem that expresses his concerns before the stay, and how much he enjoyed his time there. We spoke to him following the inspection, and he gave his permission for the poem to be used in this report. He asked for his name to be published as the author of the poem. St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 6 St Michael’s House By Ken Mills Kicked out of my house so the builders could move in!! So I went to St Michaels; my adventures to begin. All wood and bricks, my first impressions went deep. Was this place really cold, would I manage to sleep? The rooms were bright and airy, but of carpets I’m not sure. I found it hard to move about and any odours would store! After a while though, I soon settled in and enjoyed, The company was good my spirits soon buoyed! I found it rather daunting, meeting all those new friends. So many disabled by disease, or what nature sends!! The staff were really good to me; I can’t mention them all. The cook was really special; I was reduced to a crawl!! A diet was called for; but Ron went travelling away! I’m back to normal size now; it probably saved the day! I really enjoyed cooking myself, we did so much!! Perhaps more hands on; then we won’t need that crutch! Thank you all so much for putting up with me! I hope to see you again one day; if only for a cup of tea! What has improved since the last inspection? The manager and staff have worked hard to make the changes that have resulted in the provision of a very good service that meets the individual needs of the people who stay in the home. All the requirements and recommendations that have been made following previous CSCI inspections have been acted on, and the manager has asked for further professional guidance to ensure that the home has sound procedures that protect the people who stay in the home. The home looks after people’s medication very well, and the staff who look after the medication make sure that people are given their medication properly. Immediate action was taken to address two health and safety concerns from the last inspection. The last inspection report stated that the provision of appropriate activities for respite clients, in order to provide a positive and purposeful experience, remained an area for development. The greatest improvement seen in the home on this occasion is the provision of activities. The people who stay in the home have opportunities for a wide range of activities that suit their own interests, both in the home and at the day centre next door. Everyone who was spoken to on the day was very happy with the social life in the home, and this is now a major part of each person’s stay. The way that the care plans are written has been changed and improved. They now focus on supporting each person to be as independent as possible and, for assessment clients, on improving their skills for independent living. Everyone St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 7 said that they are involved in planning their stay in the home, and they have a lot of choice in what they do and how they receive the support that they need. 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 Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 8 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 Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 9 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 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who stay at St Michael’s House for respite or assessment have good information about the services that the home provides, and know that their stay will be both productive and enjoyable. EVIDENCE: Since the last inspection the remaining long stay residents have moved out. Everyone stays in the home for a planned short stay, either for respite care or for assessment and rehabilitation. One person in the home has stayed for longer than four months because they are waiting for adaptations to be completed in their home. The Statement of Purpose and the Service User’s Guide provide information on the services that are provided for respite care and assessment. Most of the people who completed a Have Your Say survey for this inspection said that received enough information about the home so they could decide if it was the right place for them. One person said “I visited in advance of respite care, however no leaflet or written information was provided beforehand.” The bookings for respite care have increased since the last inspection. St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 10 Following the initial assessment, social workers can now book respite care for their clients on-line, and regular clients can book their preferred weeks for themselves. There is a good range of activities available that make the respite stays an enjoyable experience. Plans are in place for a special interest week for under 30s, and another for over 50s in the summer. A planned programme of independent living skills is put in place for each person on assessment. The staff said that they have sufficient information and training to enable them to meet the residents’ needs, and everyone who took part in this inspection said that they have learned a lot and they feel confident about living independently when they leave St Michaels House. The sample files seen included a comprehensive assessment from the referring social worker and the home’s assessment completed at the planning meeting. Information from the assessment is then transferred to the client’s Individual Service Plan (ISP). There is an induction programme for each new resident that includes meeting all the residents and staff and explaining the licence agreement and the home’s policies and procedures. The number of weeks that each person can stay at St Michaels’ House is agreed by Social Services at the beginning of each year, and varies between a long weekend, a week six times a year, or a longer period for specific needs. St Michael`s House DS0000064252.V332913.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, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in the home are actively involved in their own care planning and are consulted on every aspect of community life in the home. EVIDENCE: Each resident has an individual support plan (ISP) that is drawn up following an assessment planning meeting. The ISPs for four residents were seen, three for respite clients and one for an assessment client. The sample included people with a range of needs. They all provide good details of the support that each person needs, and they are written clearly and from the person’s point of view. The focus of the ISP is on supporting each person to be as independent as possible and, for assessment clients, on improving their skills for independent living. There is a skill development programme for each assessment client, and details of the likes and dislikes of each respite client. The ISP includes a section for each person’s aims and objectives for their the stay in the home. In the examples that were seen, where this was completed it St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 12 stated just “respite”. This could be used more effectively in recording each person’s aims for their stay. One person who took part in the inspection said that when they return home they would like to live more independently with the support of their carers, instead of the carers doing everything for them. This could be recorded as their objective, and provide a focus for them to assess their own progress. The staff record daily events, and this recording is relevant to the ISP. The daily records seen show several examples of when members of staff have spent time discussing a person’s problems and feelings. All residents have a moving and handling assessment as part of the preadmission procedure, and one seen included a detailed procedure for use of the hoist. There are appropriate risk assessments that provide procedures and safeguards to enable people to take part in the choice of activities safely. Everyone said that they are involved in planning their stay in the home, and they have a lot of choice in what they do and how they receive the support that they need. There is a weekly residents’ meeting, when they discuss what they want to do during the week. St Michael`s House DS0000064252.V332913.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, 13, 14, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are able to take part in their own choice of activities, which make each person’s respite or assessment stay in the home an enjoyable and rewarding experience. EVIDENCE: The last inspection report stated that the provision of appropriate activities for respite clients, in order to provide a positive and purposeful experience, remained an area for development. The greatest improvement seen in the home on this occasion is the provision of activities. During the day the assessment clients have an individual programme for improving their skills for living independently. One person said that they have gained a lot of new skills, and when they return home they would like to live more independently with the support of their carers, instead of the carers doing everything for them. This person returns to their own flat at weekends and stays at St Michael’s St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 14 House during the week. Respite clients can attend the day centre next to St Michael’s House for planned activities that include art, poetry, yoga, computer use and music appreciation. It was agreed with the day centre that respite clients do not need a referral to the day centre for the short time they are in the home. A senior support worker has responsibility for co-ordinating activities during the evenings and at weekends. She contacts each person shortly before their booked respite break to discuss any particular interests they have. They can also book a variety of massages and treatments with an aromatherapist who visits the home every week, for which they pay and additional charge. Every Monday there is a residents’ meeting, which the people who stay at the home have chosen to call “Knights of the Round Table”. This is a social time and introduction for new service users, and a chance to discuss what is happening during the week for people who have stayed in the home before. The programme of activities covers all seven days of the week, and includes games, quizzes, a film night, cookery and gardening. The cookery sessions are very popular, and several people said that they particularly enjoy them. The people who take part assess the recipes that they use, for how easy they are, how long the dish takes to prepare, and how enjoyable it is. These assessments are available for anyone to use, and they are considering making them into a book of tried and tested recipes. Two people said that they enjoy gardening and looking after the raised flower beds at the home. Sky television has been installed since the last inspection, at the request of some people who enjoy watching sport on television. A lack of transport restricts opportunities for organised outings. Some people are able to go out independently, and information leaflets are available in the communal areas about local facilities and events. Plans are in place for a special interest week for under 30s, and another for over 50s in the summer, and transport has been agreed for these. Most of the people who completed Have Your Say surveys for this inspection said that there are activities arranged by the home that they can take part in. One person said, “Always nice to meet friends I have met at St Michaels and new users.” Everyone who was spoken to on the day was very happy with the social life in the home, and this is now a major part of each person’s stay. Respite stays are usually for one or two weeks, and assessment is usually between six and twelve weeks, with a maximum of four months. The residents maintain their family and social relationships during this time. Many of them enjoy meeting friends who are staying at the home at the same time. Three of the older clients were in the home at the same time during this inspection. There is a kitchenette in each unit where people can make hot drinks for themselves. The assessment clients prepare their own food as part of their daily programme. One person was supported to prepare his lunch during the inspection, and they then ate it in the main dining room with the other residents and staff. The menus show a choice of two cooked meals or a salad at lunchtime, and a light meal, such as sandwich, bacon roll etc in the evening. Staff and residents eat lunch together, and the inspector joined them for lunch St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 15 during the inspection. Everyone said that they enjoy the food and that it is of high quality. Several people said that they particularly like the cooked breakfasts that have been introduced, and that this encourages them to get up in the mornings. The is a water cooler and fruit juice available in the dining room that people can help themselves to at all times. St Michael`s House DS0000064252.V332913.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 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has an experienced and enthusiastic team of staff, who have the training and skills to provide a good quality of care for the people who live in the home, and to ensure that individual needs, choices and preferences are met at all times. EVIDENCE: The care plans (ISPs) that were inspected provide good details of each person’s’ personal care and health care needs, and a good relationship was observed between the staff and the people in the home. The staff are fully involved in the home’s ethos of supporting people to be as independent as possible. The care plans are written from each view of the help that they need, and the word ‘support’ is used rather than ‘help’. During the staff handover, the staff spoke of supporting a person with high needs to have a bath. Everyone who completed a Have Your Say survey for the inspection said that they receive the care and support they need. Some surveys said that they sometimes receive good care. One person said, “Sometimes I am left for quite a while before someone sees to me, they then tell me that they are either (a) St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 17 very busy or (b) short staffed! In actual fact at these times they give these excuses I have seen them standing talking and laughing for a considerable time.” However all the other quotes confirmed that the care is usually or always good. Everyone spoken to during the inspection said that the staff are very good, and always available when they are needed. One person said, “The staff here are brilliant. Even the cleaners and handyman, they can’t do enough for you”. Another person said, “ Everyone (the staff) is so sociable. They’ll make time for you, which is just lovely.” Most of the people who completed a Have Your Say survey said that they always or usually receive the medical support they need. One said, “Excellent medical care given as soon as it is asked for.” All respite clients are registered with a local surgery during their stay, and district nurses came when they are needed, for example to change dressings. Moving and handling assessments are in place for each person. There are track hoists in three of the bathrooms, and electric hoists for use in the bedrooms. One person who needs to be hoisted was full of praise for the support and care that they receive in the home. One person who has regular respite stays has a PEG feed. The staff have been trained to administer this, and the room that this person usually uses has been decorated and fitted with some sensory equipment so that they can relax there while the feed is administered. Following the last inspection, the manager asked for further advice on the policy and procedures for medication for respite clients. The CSCI pharmacy inspector visited the home on 18th July 2006. He found that the current procedure for the decanting of medication from labelled containers carried an unacceptable risk of medication error. The current storage facilities for medicines provided adequate space and security but the storage temperature gave rise to concern since this was above the recommended maximum of 25°C. The current ‘Sentry’ box used for the storage of medicines controlled under the Misuse of Drugs Act 1971, did not comply with the requirements of the Misuse of Drugs (Safe Custody) Regulations, 1973. All the advice that the pharmacy inspector gave has been acted on. An air conditioning unit has been installed in the medication room, and the temperatures are monitored to ensure that they remain below 25°C. An approved cupboard for controlled medications has been installed. Most people who stay in the home look after their own medication. They have facilities in their rooms to store medication securely, appropriate risk assessments are in place, and there is a list of each person’s medication in their file. These procedures ensure that they are able to take responsibility for their own medication and the risks to any other person in the home are minimised. For those who are unable to look after their own medication, the medicines are supplied in the original packaging, and the home has good procedures for administering, recording and checking that the medication is administered properly. The only advice given on this occasion was to record when each package is opened, which would make it easier to carry out an effective audit. The senior support worker who has responsibility for medication has completed a course on medication that she found excellent. St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 18 Training for the staff now includes the Skills for Care knowledge log, to assess their competency in understanding and administering medication. St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 19 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who stay in the home are encouraged and enabled to make their views and concerns known, and appropriate procedures are in place to ensure that they are protected from abuse and neglect. EVIDENCE: The complaints policy is a generic one for Hertfordshire County Council (HCC) Adult Care Services. A summary of the policy is also contained in the Service Users Guide and the licence agreement, and these include details of CSCI. Both written and verbal complaints are recorded and investigated effectively. People who stay in the home are confident that if they have any concerns they will be listened to and dealt with. Two good examples were seen in the care plans. One was a complaint by one person about another, this was discussed sensitively and at length with both of them, and both their views and needs were taken into consideration. Another person was worried about a hospital admission. This was discussed with them at length, and the person was given a lot of support for their concerns. There are HCC policies on safeguarding adults (adult protection), whistle blowing, aggression to staff, harassment and codes of conduct. A leaflet on responding to allegations of abuse is given to each resident. The staff spoken to showed good knowledge and understanding of these policies. Some of the staff have not had training in adult protection (see Staffing). St Michael`s House DS0000064252.V332913.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, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and well-maintained environment for the people who stay there, which the staff maintains to a good standard of cleanliness and hygiene. EVIDENCE: St Michael’s House is a single storey building arranged in four units with shared communal areas. All the bedrooms are single, and none have en-suite facilities. All the bedroom doors have been fitted will automatic closing devices in case of fire, and residents can have a key for their room if they wish. The size of the bedrooms does not meet the standard of 12 sq m for an existing home for people who use wheelchairs, and bedrooms are not large enough for the bed to be placed with access from both sides, but they provide acceptable accommodation for short term stays. The bathrooms provide a variety of equipment for disabled service users, including an Arjo bath with a track hoist, a level access shower and static and mobile hoists. The kitchenettes are St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 21 arranged with wheelchair height units, and the vanity units in the respite bedrooms are height-adjustable. The home appeared to be clean and well maintained, and appropriate policies and procedures are in place for the maintenance of hygiene and control of infection. One person said, “Much better now that there is no smoking.” The central laundry meets the standards for control of hygiene. There is also a domestic style washing machine and tumble dryer on each unit so that residents who are able to can do their own laundry. St Michael`s House DS0000064252.V332913.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 and 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Irrespective of their job descriptions and professional status, all staff appeared to be wholly dedicated to understanding and meeting resident’s needs. EVIDENCE: The home has a team of experienced and well trained staff who are competent to meet the different needs of the people who stay in the home each week. There is a good level of staffing, with four or five support workers throughout the day, and two during the night. There were ten people staying in the home at the time of the inspection, and the staffing levels are sufficient to meet their needs. If the numbers increase to the maximum, or a number of people have high needs, extra staff can be brought in. All staff complete a HCC induction programme, and a comprehensive induction into care services that meets the Skills for Care guidelines. HCC provides a thorough training programme that includes regular updates of all mandatory training and training specific to the needs of the residents. However it was reported that the training programme is only provided for three months at a St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 23 time, which can make planning training effectively difficult to manage. Some of the staff have not had training in adult protection, and some have not had training in control of infection. Several members of staff are qualified trainers and assessors for moving and handling, and the training for the staff is carried out in the home using the equipment that is used in the home. Most of the support workers have completed NVQ qualifications at level 2 or 3. All staff are expected to apply for the course when they have worked in the home for a year, and experienced staff are encouraged and supported to take further qualifications. The files of two members of staff who have recently started to work in the home were inspected. They showed evidence of a thorough recruitment procedure, including comprehensive application forms, references and notes of the interviews. Photographs of the staff are displayed on a board in the entrance hall, to aid identification and so that respite clients can know who is on duty at any time. St Michael`s House DS0000064252.V332913.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, 38, 39 and 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed, and the management actively seeks the views of the residents and other involved people in order to ensure that a good quality of care is provided. EVIDENCE: The manager has been in post for six years. She communicates a clear sense of direction and leadership, and some responsibilities, such as activities, medication and training, are delegated to senior members of staff. The management style is to value and support the staff, and to be available to the people who live in the home. Both the residents and staff said that the manager is always available to talk to, and this was observed during the day. St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 25 The ethos of the home is to provide a person centred service to the people who use the service, both for respite and for assessment and rehabilitation. The staff see their role as supporting people to take decisions about their stay in the home, and to be as independent as possible. The responses to Have Your Say surveys from the people who stay in the home, the information in care plans, observation of the staff and residents, and discussions with staff and residents, all confirmed that everyone is encouraged to make their views and wishes known. The manager has made the necessary changes, and acted on all the recommendations that have been made to promote good practice, and the result is a service that provides an enjoyable and rewarding experience for the people who stay in the home. The home has a sound quality assurance system in place that meets the needs of the service. The area manager carries out monthly monitoring visits to the home that include talking to the people who live there. There are weekly residents’ meetings. An annual survey is sent to everyone who uses the service, but there has been a very low response to these. A questionnaire has now been devised for respite clients to complete after each stay. Hertfordshire carries out regular audits of the service. In June 2006 the staff attended a Team Day to look at how they could take the service forward, and several ideas for improvements have been implemented as a result, in particular the improvements in activities. There is an annual review meeting, which is attended my managers, staff, service users and social workers. The last review meeting in August 2006 reported what changes had been made during the previous year, and agreed actions that were needed. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff generally follow the home’s policies and procedures. There was an environmental health inspection of the kitchens in February 2007. The report stated that the kitchen is clean and well organised, and the staff implement a good standard of food hygiene. The Fire service carried out a fire safety inspection the week before this inspection. It was reported that there were no major concerns. A fire alarm took place during the inspection. One person said that there have been two fire drills in the home in the three months that she has been there, and all the staff and residents take part in them to make sure that they understand they procedures. St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 26 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 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 N/A 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 4 X 4 4 3 X X 3 X St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 27 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 YA35 Regulation Requirement Timescale for action 30/09/07 18(1)(c)(i) The manager must ensure that all the staff complete the mandatory training, including training in control of infection and prevention of abuse. This training will ensure that the health and safety of the people in the home is fully protected at all times. 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 YA6 Good Practice Recommendations It is recommended that the staff should encourage and enable residents to set their own objectives for their stay in the home. St Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Michael`s House DS0000064252.V332913.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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