Inspection on 20/02/06 for St Michael`s House

This inspection was carried out on 20th February 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Michael`s House 17/02/09

St Michael`s House 01/03/07

St Michael`s House 27/01/05

St Michael`s House 10/06/04

St Michael`s House 21/01/04

Similar services:

Trevayler Residential Care Home

Thornham Grove

Thistle Hill Hall

Conifer Lodge

Westwood Lodge

Egerton Lodge Care Home

Alfred Minto House Care Home

St Matthews Unit

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 St Michael`s House 1/3 St Michael`s Avenue Northampton Northants NN1 4JQ Lead Inspector Mr Gary Robinson Unannounced Inspection 20th February 2006 01:00 St Michael`s House DS0000012925.V284116.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 Michael`s House DS0000012925.V284116.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 Older People and 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 DS0000012925.V284116.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Michael`s House Address 1/3 St Michael`s Avenue Northampton Northants NN1 4JQ 01604 250046 01604 638496 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) Mrs Anne Going Mr Kenneth Going, Mr Raymond Galbraith, Mrs Marian Galbraith Mrs Anne Going Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (4) St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may continue to provide care for 1 existing named service user under 45 years of age The Home provides care for Service Users in the Age category of 45yrs and 65yrs and 65yrs and over. 27th of January 2005 Date of last inspection Brief Description of the Service: St Michael’s House is situated in a residential street close to Northampton town centre. The Home is registered to provide personal care, without nursing, for up to thirteen people with mental health needs. St Michael’s House is a Victorian property, providing accommodation in two double and nine single bedrooms, two of which have en-suite facilities. There are two lounges and a small dining room. As there are no lift facilities in the Home, people accommodated in upstairs bedrooms must be able to safely negotiate the stairs. There is an enclosed garden to the rear of the premises. St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out at one o’clock, just after lunchtime at the Home. St Michael’s House was inspected using the method of ‘case tracking’. The process of ‘case tracking’ involves inspecting the standard of care received by a number of people resident at the Home, and on this occasion meeting with several people in the communal lounges to seek their views on the quality of care provided at St Michael’s House. Samples of records kept at the Home and relating to the service provided for those people were also inspected. The Inspector also met with Mrs Going who is the registered Manager as well as being one of the owners, to review the action taken to address previous requirements arising from the last inspection. On this inspection two recommendations were made and relate to the selection below, ‘What they could do better’. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 The Manager and staff members at St Michael’s House inform people about the service they will receive and overall people can be confident of receiving the support and care they need. EVIDENCE: There is documentary evidence on file that supports the conclusion that each person’s care needs are appropriately assessed prior to admission to St Michael’s House. People say they were welcome to visit St Michael’s House to see if the Home suited them. St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 People living at St Michael’s House are encouraged to be independent and can rely upon being treated with respect and having their personal care needs sensitively met. EVIDENCE: People living at St Michael’s House said they were treated well by the staff team and could rely upon them to provide the help and encouragement they needed. People also said that they are consulted about their care and the manner in which it will be provided. There are policies and procedures in place for the safe administration of all medicines kept within the Home. St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 People living at St Michael’s House are free to choose their preferred lifestyle and to be part of the wider community as much as they are capable of participating in. EVIDENCE: St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 10 People said they liked to do as they pleased and if they wanted to do something in particular they only had to ask. Relatives or friends who wish to visit are welcome. Several people said they often go out to the local shops. The menu for the day was on display and people praised the food and said it was very good. St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The people living at St Michael’s House can rely upon their health and personal care needs being sensitively met. EVIDENCE: There is documentary evidence on file that confirms that healthcare professionals are appropriately consulted. People living at St Michael’s House said staff members are kind and helpful. There are policies and procedures in place for administering and storing medicines. St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The Manager ensures that the staff members are provided with the appropriate training and guidance that enables them to help protect people from the risk of harm or abuse of their rights. EVIDENCE: Policies and procedures are in place at St Michael’s House with regard to disclosure of abuse or poor practice that may adversely people living in the Home. People said they would not hesitate to speak to a staff member, or the Manager, if they were unhappy or worried about their care or the care of someone else. St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,30 St Michael’s House, overall, provides a satisfactory standard of comfort in the communal areas and bedrooms, although access to the upper floors is restricted to people who can safely negotiate stairs. EVIDENCE: The carpet in the front lounge does have a badly stained area that cannot be rectified by routine cleaning. It is acknowledged that the Manager does have a replacement carpet that is due to be fitted. St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 14 The Home appears to be kept clean and was free from odour. A number of people do, however, enjoy smoking and people are informed of this prior to coming to live in the Home. People personalise their bedroom as they choose. At the time of inspection damage caused to the fabric of the building caused by a vehicle colliding with an outer wall next to the kitchen area is being repaired. The Manager confirmed that this area has been deemed structurally safe until repairs are completed. St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Staffing levels at the time of this unannounced inspection appeared to be satisfactory, although refresher training for all staff in basic skills, such as food hygiene and first aid, does require the Manager’s consistent attention. EVIDENCE: Staff members providing care have completed or are just about to complete their National Vocational Qualification (NVQ) in care. There has been training provided in mental health issues for staff members by a visiting Community Psychiatric Nurse (CPN). The Manager is organising an external trainer to provide refresher training for all staff. The Manager takes an active participatory role in daily ‘hands-on’ care. St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 The Manager is experienced and runs St Michael’s House sensitively and efficiently. EVIDENCE: St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 17 The Manager, who is also one of the registered owners or providers of the service, has had considerable experience in providing care and support for people with mental health related needs. As noted in the previous report, the Manager’s approach is very friendly and people living in the Home say they feel at ease with her and can rely upon her. The Manager is about to complete her National Vocational Qualification (NVQ Level 4 in management training). St Michael`s House DS0000012925.V284116.R01.S.doc Version 5.1 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 4 X 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 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 3 39 3 40 X 41 X 42 3 43 X 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Michael`s House Score 3 3 3 X DS0000012925.V284116.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement Timescale for action 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 YA24 2 YA35 Refer to Standard Good Practice Recommendations It is recommended that the replacement carpet is now laid in the front lounge as soon as practically possible. The Manager should review her methodology for effectively and consistently monitoring the refresher training needs for each staff member in such areas as first aid and food hygiene, especially for those staff members who may have been employed over a long period of time. 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