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

This inspection was carried out on 6th June 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 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Michael`s House 11/05/07

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 Key Unannounced Inspection 6th June 2006 10:00 St Michael`s House DS0000064252.V299359.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.V299359.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.V299359.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 (6) of places St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may accommodate six (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 six (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. 7th November 2005 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. Six service users currently use the home for respite services who are over the age of 65. All have used the home for respite since before reaching the age of 65. The home may continue to offer respite to these six 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.V299359.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 afternoon and the following morning, and including preparation time a total of 14 hours was allocated to it. Ten residents were staying in the home at the time of the inspection: seven on respite, one on assessment and two remaining long stay clients. The majority of time was spent talking to residents and staff, and discussions were held with the home’s manager and the service manager. Some time was also spent in the office looking at records, care plans, risk assessments, complaints, staff training, and staff files, and the inspector made a tour of the premises. The staff and residents were very welcoming. This was a positive inspection. The home is in a period of transition from provision for long term rehabilitation and independent living, to a service for short term assessment and respite care, and the residents and staff spoke about the improvements that have been made to the facilities and ethos of the home. The home continues to provide a good quality of care, but further improvements are needed to ensure that the needs of respite clients are fully met. What the service does well: What has improved since the last inspection? Two wings are currently used for respite and assessment, providing a total of twelve beds. These wings have been refurbished, with new bedroom furnishings, including height adjustable washbasins and televisions. One bathroom has been refurbished since the last inspection, and now contains a Jacuzzi bath and level access shower, with domestic style tiling to create a relaxing and homely environment. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 6 The home is developing an ethos of providing a positive and dynamic respite care experience, and both residents and staff commented on the changes that have been made, and that the atmosphere in the home has improved. The residents said that the activities on offer have improved, but they would like more variety to meet their needs for enjoyment and occupation during their respite stays. A letter was recently sent to all the clients who use the respite unit to ask what activities they would like and one of the care workers has taken on the responsibility of talking to each client and asking them what they would like to do during the week. The procedures for administering medication have improved, and a lot of attention has been given to ensuring that the procedures safeguard the respite clients. However the is still some element of risk, and the following this inspection the manager has asked the CSCI pharmacist inspector for advice on what is best practice in this area. The health and safety concerns raised in the last report have been addressed, and two concerns noted on this occasion were rectified speedily. Every effort has been made to ensure that risks to the residents are minimised. 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 DS0000064252.V299359.R01.S.doc Version 5.2 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 Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who use this service have sufficient information available about the home in order to make an informed decision about whether they would like to use the service for respite care. The assessment and admission procedure provides good information for the staff so that they can meet the needs of the residents. However further improvements are needed to ensure that the services provided meet the specific needs of the residents during any one week, such as age specific and culturally specific activities and interests. EVIDENCE: Prior to registration, St Michael’s House had provision for rehabilitation and independent living, as well as assessment and respite care. The focus of the service has changed, and the Statement of Purpose gives appropriate information on the home’s new provision for assessment and respite care, and has been updated as the service has developed. The licence agreement has also been revised to be specific to the terms and conditions, services provided and the residents’ responsibilities for respite care. However no completed and signed examples were seen during the inspection. The Service Users Guide has been amended as recommended in the last inspection report. Some small amendments are needed to ensure that it provides all the information listed in Standard 1 and this recommendation has been repeated on this occasion. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 9 Two long stay residents remain in the home. One is waiting for adaptations to be completed in his flat, but at the time of the inspection there were no concrete plans for the future of the second person. Following the inspection, the resident’s social worker wrote to outline the plans for him, with a timescale of two to four months. Four residents who have had several respite stays were spoken to, and one who was staying at St Michaels House for the first time. She said that she loves it here, and she felt that she was given good information about the home before her stay, and that the staff were aware of her needs. There is a signing sheet for staff in each ISP, but these are not fully completed, and in one case only thee staff had signed to say that they have read the ISP. The staff spoken to confirmed that they have sufficient information to meet the residents’ needs, and the residents said that the staff are competent to meet their needs, but there is no evidence that all staff read each ISP at the start of each respite stay. The staff have access to a good training programme that includes training on specific conditions such as multiple sclerosis, Parkinsons disease, diabetes and epilepsy. The residents said that the activities on offer have improved, but they would like more variety to meet their needs for enjoyment and occupation during their respite stays. (See Lifestyle.) The respite co-ordinator said that there is a thorough assessment and introduction procedure before a new client stays for the first time. This includes a planning meeting and a visit to look around the building. 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. The home’s Statement of Purpose states, “We provide culturally sensitive services and ensure that all people receive equal access to all our services, and equal treatment within them. We regularly review our achievements against the departmental, service and unit equal opportunity action plans.” However no evidence was seen that the clients’ race, religion or sexuality is recorded or arrangements made to meet those specific needs. The age range of the clients is between 18 and 76, and on the day of the inspection the residents were aged between 18 and 60. There is no differentiation of activities for the differing age ranges, or of consideration of the ages or interests of the residents staying for any specific weeks. This is something that could be developed in order to ensure that the needs of all the residents are met. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 10 The home should also seek to ensure that they provide a service that meets the cultural needs of their target client group, the disabled service users who live in Hertfordshire St Michael`s House DS0000064252.V299359.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents’ care plans (ISPs) contain detailed information on all their personal care and health care needs, and the residents spoken to say that they feel involved in decision making in the home. However there is little indication that the residents are involved in writing and reviewing their ISPs, in line with the principles of person centred planning (PCP). There is a lack of appropriate risk assessments that enable each resident to take acceptable, managed risks. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 12 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 one of the remaining long stay residents. The staff record daily events, and this recording is relevant to the ISP. For respite clients all the care plans are in one file, and all the daily records in another. It would be easier for staff to access all the information on each resident if the care plans and daily recording for the clients who are staying each week were placed together. There is a separate individual file for each person in the staff office. All the ISPs contain detailed information on the personal care that each person needs, and of their health care needs. However there is little attention to the purpose of each short stay, and outcomes from it. There is no skill development programme, nor is there a programme for the stay. There is little indication that the clients are involved in writing and reviewing their ISP. The ISP format could provide a basis for a person centred planning (PCP) approach, which should focus on the person being totally at the centre of all planning. The key workers could assist and enable residents to write and monitor their own objectives, for what they want to achieve in the long term, and short term goals towards that end. This needs to be further developed, in order to enable the respite stay to be a positive experience with recorded outcomes. Appropriate risk assessments were seen in the ISP of the long stay resident. 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. However there is a lack of attention to risk assessments for respite clients, which should identify any potential risks to their health and safety while in the home. Risk assessments should provide the staff with a useful tool to assist them in providing a good quality of care and support for the residents, enabling each resident to take acceptable, managed risks. A risk assessment was seen for one person for handling personal relationships, but there were no other risk assessments in the three respite files that were inspected. In particular, there were no risk assessments for the clients who look after and administer their own medication, which was highlighted in the last inspection report. There was no risk assessment for one person who uses warfarin. (See Personal and Healthcare Support.) The residents spoken to said that they are able to make decisions about their lives in the home, and the staff encourage and support them when needed. They can choose whether to look after their own money or give it to the home for safekeeping. There are appropriate and secure procedures in place for managing their cash. St Michael`s House DS0000064252.V299359.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents spoken to said that there has been some improvement in the activities available in the home, and a survey has been carried out to identify the needs and wishes of respite clients. However the provision of appropriate activities for respite clients, in order to provide a positive and purposeful experience, remains an area for development. All the residents said that they enjoy the food provided by the home. The menus offer a balanced and nutritious diet, although more fresh fruit should be available. Residents should be enabled to get hot and cold drinks for themselves whenever possible. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 14 EVIDENCE: Most people who come to the home for respite do so to give their carer a break. Currently the home offers little more than accommodation and care for them. There is no daily programme for respite clients to address their personal needs and goals, or for social activities. None of the residents who were spoken to feel that the home provides sufficient activities. The last full inspection visit (November 2005) set a requirement for a programme of activities to be developed for the respite unit, in order to provide a positive and purposeful experience. A letter was recently sent to all the clients who use the respite unit to ask what activities they would like and one of the care workers has taken on the responsibility of talking to each client and asking them what they would like to do during the week. The survey suggested a list of possible activities, including cooking classes, bowling, pub lunches, cinema, themes nights, fancy dress nights, shopping trips, quiz night, games nights, boat trips, theatre trips, church, film nights, and take away nights. The clients who responded also suggested aromatherapy, sports TV, day trips, crafts, trip to Hatfield House, museums, pool, snooker, and disco. It is too soon to see how this wish list will be implemented, but the activity programme displayed for June showed only one planned activity a week: games night, cooking class (3 times), film night and cinema. One resident said that he would like to do some cooking at St Michaels House as the facilities there are the right height for wheelchair use, and he is unable to access his kitchen at home. The cooking classes may address this wish, but his stay is one week long, and there is only one cooking class scheduled (and no other activity) during that time. Another person said that daily life in the home is much better since activity programme started, but she will like it more when more young people use the service. The service would be greatly improved with the provision of a programme of activities and outings that meets the needs and wishes of each client during the short time that they spend there. This would provide a positive experience and break from their life at home for the client as well as for their carer. 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. The staff were observed to have a good relationship with the residents, and the residents have responsibility for decisions about their daily activities, although as mentioned above, their options are limited. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 15 There is a kitchenette in each unit, and the remaining long stay residents are encouraged to plan for, buy and cook their own food. They are given money from the home’s budget for this purpose. Meals are provided from the central kitchen for respite clients. 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. The residents spoken to all said that they enjoy the food and that it is of high quality. For supper the previous evening one person had sausages, scrambled eggs and tomatoes, and for lunch on the day of the inspection, the menu offered boiled bacon with chips and vegetables, nut cutlets or cheese salad, followed by tinned fruit and ice cream. One person said that there should be more fresh fruit, especially bananas, and there was little fresh fruit in evidence on the menu or available in the home. There is a water cooler in the dining room and bottles of squash in the fridge underneath it, but all the cups and glasses were stored in inaccessible cupboards at head height and away from the water cooler. One of the care workers said that they always get drinks for the residents “in case they spill it”. There was no evidence in the ISPs seen that any resident had a risk to their safety if they were able to get their own drinks. During the inspection the staff did provide drinks for residents whenever they were asked to do so, but there seems to be no reason why they should not be enabled to get their drinks for themselves whenever possible. St Michael`s House DS0000064252.V299359.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff provide good quality personal care and treat the residents with sensitivity and respect. There is good recording of all the residents’ health care needs. All personal and health care support is well maintained within the home ensuring individual needs, choices and preferences are met at all times. The home has detailed procedures for medication for respite clients, but some risk of error in administration remains. EVIDENCE: The ISPs contain information on the personal care needs of each resident. The respite care clients who were resident in the home at the time of the inspection had no specific medical needs. One person needed a hoist for transfers. There was a moving and handling assessment in the ISP, with a detailed procedure for use of the hoist. The home has sufficient equipment to meet the needs of people with physical disabilities. There are four hoists, including a training hoist, and a tracking hoist has been fitted in the refurbished bathroom. One resident uses an electronic communicator, and the staff showed that they enable her to make her needs known by using the communicator, and they are patient and take the time needed to listen to her. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 17 The residents spoken to said that they feel well cared for and the staff treat them well. One particularly looks forward to her regular stays at St Michaels House because she is assisted to have a bath here, and especially in the Jacuzzi bath, as she only has a shower at home. Medication is stored in a room that has no natural ventilation. The temperature is now monitored, and there is a fan in the room for use when the weather is hot. During the inspection the thermometer showed a temperature of 25°C with the fan in operation, which is the maximum that the temperature should be. It was reported that an air conditioning unit is being considered. In the meantime, a more accurate temperature would be recorded by use of a maximum/minimum thermometer, so that the maximum reached when the door is closed can be checked. Medication for one of the long stay residents is provided in individual dosage blister packs. Respite clients are requested to supply their medication in a dossette box. One dossette box was seen, that had been provided filled by the person’s wife before his stay. The staff write the details of the medications on the MAR (medicines administration record) chart, and the MAR chart is signed for each medication. However, there is no indication on the dossette box of the medications that have been placed in it. A list of the person’s medication was provided the first time he stayed at St Michaels House, and his wife notifies the home of any changes. The staff cannot therefore be certain of what they are administering, and of what they confirm by their signature on the MAR chart that they have administered. All medicines are fully recorded when they come into the home, when they are administered, and when they leave the home, and there is a clear audit trail of what has been administered. The medications for two other short stay residents were provided in the original packaging, one of them because she was discharged to the home from hospital. The MAR chart was again completed by hand. When a MAR chart is completed by hand, the record should be signed by the person who copies it, and checked and countersigned by another person. This resident was prescribed digoxin in two strengths – a 1mg tablet and a 3mg tablet. The dosage was changed from 4mg to 4½mg, but the supplies were not changed. The staff therefore have to cut one tablet in half, and the remaining half is returned to the opened package. The procedures followed in the home provide as secure a system as possible for handling medications for people who only stay in the home for a short period of time, and who therefore supply their own medication. Following this inspection the CSCI pharmacist inspector was asked to advise the home on any further measures that can be taken to ensure that the residents and staff are protected from the risk of any errors in administration. None of the current residents have any controlled medication, and it was reported that it is very rarely required. There is a loose locked strong box in one of the medication cupboards for any controlled medication that may be required. This does not comply with the regulations for storage of medication. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 18 Most respite clients look after and administer their own medication. There is a lockable drawer in each bedroom to ensure that all medications are stored securely. However there are no risk assessments for the people who look after their own medication, to ensure that any risk to themselves and other residents is minimised. There should also be a risk assessment for the person who takes warfarin, to ensure that the risks from falls and bruising are recorded and understood. St Michael`s House DS0000064252.V299359.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 at least once during a 12 month period. 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. Residents are encouraged and enabled to make their views and concerns known. Procedures are in place to ensure that people living in the home are protected from abuse. 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. The complaints form includes details of the complaint, the action taken, the outcome, and any training points and follow-up action. Four residents had recently expressed a concern that they did not want to record as a complaint. The issues were taken seriously, and appropriate actions were taken. There are HCC policies on adult protection, whistle blowing, aggression to staff, harassment and codes of conduct. The staff spoken to showed good knowledge and understanding of these policies, and all have had training in adult protection. A leaflet on responding to allegations of abuse is given to each resident. One resident had made a complaint about another one that was treated as an abuse allegation, and resolved to the satisfaction of the complainant. St Michael`s House DS0000064252.V299359.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28, 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 residents, and the staff maintain a good standard of cleanliness and hygiene. The room sizes do not meet the minimum standard, but they provide acceptable accommodation for short term stays. EVIDENCE: St Michael’s House is a single storey building arranged in four units with shared communal areas. Two wings are currently used for respite and assessment, providing a total of twelve beds. These wings have been refurbished, with new bedroom furnishings, including height adjustable washbasins and televisions. 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 residents 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. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 21 Each unit has a shared bathroom and toilet, and its own kitchenette and laundry facilities for the residents to use. The lounge areas are shared between two units. There is a large communal dining room, and the wide corridor leading from the dining room to wings 3 and 4 is also used as a sitting area. The units surround a patio garden with well maintained flowerbeds. Several residents spent most of the afternoon sitting chatting in the garden. One said that there is no longer a designated smoking area inside the home, and residents have to go outside if they wish to smoke. 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. One newly refurbished bathroom has a Jacuzzi bath and has been decorated with blue and white tiles. The result is that it now provides a relaxing, less clinical environment than before. The kitchenettes are arranged with wheelchair height units, and the vanity units in the respite bedrooms are height-adjustable. There is a recharging area for wheelchairs at the side of the dining room. This is not ideal, as it could cause an obstruction if too many wheelchairs were stored there, but there is no other suitable place in the home for this purpose. 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. 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.V299359.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is staffed by experienced support workers who are appropriately trained to meet the needs of the residents. The staff spoken to are confident of their knowledge of the needs of the residents and feel well supported in their work. Evidence was seen of a thorough recruitment procedure that ensures that residents are protected by staff that are fit to work in a care home. All the required information on staff must be kept in the home. EVIDENCE: The staffing rotas show that there are four or five support workers on duty throughout the day, and two during the night. There were ten residents staying in the home at the time of the inspection, and the staffing levels are sufficient to meet their needs. The high level of staff to residents should also be sufficient to provide an improved schedule of activities (see Lifestyle), but little evidence was seen during the inspection that staff involve the residents in activities. All the residents spoken to said that the staff are very good and helpful. One said that “you know that they’re there if you want to chat.” St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 23 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. The training programme for June and July includes training on multiple sclerosis, Parkinsons disease, diabetes and epilepsy. 50 of the support workers have completed NVQ qualifications at level 2 or 3, and the remainder are working towards the qualifications. The staff files of three members of staff were inspected. Two contained all the required information to show that they are fit to work in the home. The third had transferred to St Michaels House from another HCC home, but her file had not been transferred to the home. When a member of staff transfers from another home, it is recommended that the previous manager should provide a current reference, and all information must be in the home for all people who are employed there. There are no photographs of staff members available, but it was reported that photographs have recently been taken. Some consideration is being given to displaying the photographs on a board so that respite clients can know who is on duty at any time. St Michael`s House DS0000064252.V299359.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well run by a competent manager who leads a dedicated and enthusiastic staff group. Residents and staff commented that the change to respite care provision has improved the home. An effective quality assurance system is needed, to ensure that views of the residents and their families underpin all selfmonitoring, review and development of the home. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. Two health and safety concerns were raised during the inspection. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home has changed from provision for long term rehabilitation and independent living, to a service for short term assessment and respite care. Two long stay residents remain in the home. One has a flat that is being adapted for him, but at the time of the inspection there were no concrete plans for the future of the second person. Following the inspection, the resident’s social worker wrote to outline the plans for him, with a timescale of two to four months. The home is developing an ethos of providing a positive and dynamic respite care experience (See Standards 6 and 14), and both residents and staff commented on the changes that have been made, and that the atmosphere in the home has improved. However no evidence was seen that the clients’ race, religion or sexuality is recorded or arrangements made to meet those specific needs. The home should also seek to ensure that they provide a service that meets the cultural needs of their target client group, the disabled service users who live in Hertfordshire. (See Choice of Home) The manager communicates a clear sense of direction and leadership, and she is available to both staff and residents when they wish to speak to her. She has been in post for five years. Both the manager and the deputy manager have completed the Registered Managers Award. There has been no quality assurance activity since the last annual review meeting in the home in August 2005. HCC has a sound policy for a comprehensive quality assurance review and implementation cycle. The quality assurance process should include regular audits and residents’ questionnaires, leading to service improvement reports and the annual review meeting, which monitors the achievements and performance of the home. The residents should contribute to the review through monthly residents meetings and questionnaires, and the review should include the outcomes of audits of the service and professional inspections. Questionnaires have been sent to all the respite clients concerning their choice of activities (see Lifestyle), and it was reported that one residents’ meeting has taken place. There has been no quality assurance audit this year, because the standards for auditing respite care have not been finalised. However some monitoring, particularly feedback from the residents, could be implemented without waiting for practice standards to be agreed. Questionnaires for residents when they leave at the end of their respite stay would provide some useful information on the quality of care provided, and a weekly residents’ meeting would give all residents a chance to meet and discuss their concerns and ideas during each stay. All staff records and residents’ records are stored securely to preserve confidentiality. The staff files do not contain all the required information as listed in the Regulations and Schedules (see Standard 34). St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 26 All health and safety records are completed appropriately, but the fire drill log does not clarify whether the drill was planned or caused or was by the activation of a fire alarm. The names of staff who are present for each fire drill are recorded, and attendance at a fire drill is compulsory for all new staff. However if the fire drills are not planned there is no assurance that every member of staff, including night staff, takes part in a fire drill once a year. During a tour of the premises, two health and safety concerns were noticed. 1. The door of the kitchen was held open with a wedge between 4.35pm and 4.45pm. No staff were in the kitchen or in the vicinity during that time, and the inspector entered the kitchen unobserved. Access to a potentially unsafe environment was therefore also available for any client. 2. Cleaning items including toilet cleaner were seen in an unlocked cupboard in the main laundry. The door to the laundry is not locked, and any client may have access. Immediate requirements were made to address these concerns. Following the inspection the manager has confirmed that an automatic door closer has been fitted to the kitchen door, and the laundry door is secured with a keypad. HCC provides a comprehensive set of policies and procedures concerning care practices, staffing and health and safety. However many of them were written several years ago. For example the policy on Working with people whose behaviour can be severely challenging was written in 1993, and staff guidelines on violence by clients were written in 1989, with no indication that they have been reviewed since then. The policy on the use of volunteers was written in 1990, and therefore makes no reference to the necessity for CRB (Criminal record Bureau) and POVA (Protection of Vulnerable Adults list) checks. No volunteers are employed in St Michaels House, and this policy is not therefore applicable at this time. However a large number of policies that were found to be without review during the last inspection and on this occasion. All policies and procedures should be reviewed regularly to ensure that they continue to comply with current good practice. St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 27 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 2 2 3 3 2 4 3 5 2 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 3 26 X 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 N/A 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 2 2 2 2 2 X St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 28 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 YA3 YA38 Regulation 12(4)(b), 16(2)(m) & (n) Requirement There is no consideration of the age range or cultural needs of the clients who are resident in the home each week. The registered person must ensure that services and activities are provided that take account of each person’s specific needs. The home should seek to provide a service that meets the needs of meets the cultural needs of their target client group. Timescale for action 31/12/06 St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 29 2. YA6 12(2) & (3) The individual support plans (ISPs) and risk assessments contain clearly written information on personal and health care needs, but there is little indication of the involvement of the resident in setting up and reviewing their ISP in accordance with the principles and practice of PCP. Measures must be put in place to ensure that residents are enabled to provide a realistic input into their ISPs and risk assessments, for example by setting their own targets and monitoring their own progress. Appropriate risk assessments are not in place for the respite care clients, that would enable each resident to take acceptable, managed risks. Appropriate and adequate risk assessments must be put in place for all residents, and kept under review. There is no programme of social activities in the home, and no daily activities for respite clients. The home must provide a programme of social activities appropriate to the needs of all the residents. In particular, a programme of activities must be developed for the respite unit, in order to provide a positive and purposeful experience. Previous timescale of 31/01/06 not met 31/12/06 3. YA9 13(4)(c) 30/09/06 4. YA13 YA14 16(2)(m) & (n) 31/12/06 St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 30 5. YA16 16(2)(h) There is a water cooler in the dining room, but all the cups and glasses were stored in inaccessible cupboards. Residents should be enabled to get hot and cold drinks for themselves whenever possible. The storage for controlled medication does not comply with the regulations. 31/07/06 6. YA20 13(2) 30/09/06 7. YA34 YA41 17(2), 19(1)(b) All medication in the home must be stored in accordance with the guidelines of the Royal Pharmaceutical Society and the relevant legislation. Previous timescale of 31/01/06 not met There was no information in the 30/09/06 home for one member of staff. There were no photographs of members of staff in the home. All the required information on staff as listed in Schedule 2 and Schedule 4.6 must be kept in the home, including appropriate references and a recent photograph. Previous timescale of 31/01/06 not met HCC has a sound policy for a comprehensive quality assurance review and implementation cycle, but it is currently not implemented in the home. A system for monitoring the quality of care must be established, that focuses on the consultation with the service users and other involved people, and provides feedback on the process and the results of the consultation. 8. YA39 24 31/12/06 St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 31 9. YA42 13(4)(a) Cleaning items including toilet cleaner were seen in an unlocked cupboard in the main laundry. 07/06/06 10. YA42 All substances that may be hazardous to health must be stored securely at all times. Following the inspection the manager has confirmed that the laundry door is secured with a keypad. 23(4)(c)(iii) The door of the kitchen was held open with a wedge. Fire doors must not be held open by artificial means. An automatic door closer must be fitted to any fire door that needs to be kept open for any reason. Following the inspection the manager has confirmed that an automatic door closer has been fitted to the kitchen door. Fire drills are not arranged at times that enable all staff to take part in them. The registered person must ensure that every member of staff, including the night staff, take part in at one fire drill a year. 07/06/06 11. YA42 23(4)(e) 30/09/06 St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 32 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 YA1 Good Practice Recommendations The Service Users Guide should be amended to ensure that it contains all the information listed in Standard 1. In particular, it should provide details of the provider, and the qualifications and experience of the manager. This recommendation has been repeated from the previous inspection report. There is no evidence that all staff read each ISP at the start of each respite stay. The registered person should ensure that all staff sign to indicate that they have read each ISP at the start of each respite stay, in order to ensure that they are aware of and can meet each person’s assessed needs. The licence agreement should be completed and signed by each client either before their first stay in the home, or for current clients before their next stay. The home has detailed procedures for medication for respite clients, but some risk of error in administration remains. It is recommended that the registered person should seek professional advice to ensure that all reasonable measures have been taken to minimise any risk to staff and residents. Many of the policies and procedures in the home were written several years ago, and there is no indication that they have been reviewed since then. All policies and procedures should be reviewed regularly to ensure that they continue to comply with current good practice. This recommendation has been repeated from the previous inspection report. 2. YA3 3. 4. YA5 YA20 5. YA40 St Michael`s House DS0000064252.V299359.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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. 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