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

This inspection was carried out on 7th November 2005.

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 found no outstanding requirements from the previous inspection report, but made 7 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 06/06/06

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 7th November 2005 10:00 St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 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.V258231.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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. This was the first inspection following registration. 3. Date of last inspection Brief Description of the Service: St Michaels House is owned by Hertfordshire County Council 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. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection since the home was registered with the Commission, and it was carried out over one day. 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. Comment cards were received from two residents. Most of the comments were positive, but both commented that the home does not provide suitable activities. Most of the standards were met or almost met. Requirements were made in relation to health and safety concerns, the information in staff files, the storage and administration of medication, and activities. 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. What the service does well: What has improved since the last inspection? Since the pre-registration site visit automatic door closers have been fitted to most bedroom doors following advice from the fire service. Plans have been put in place for the remaining long term residents to move to supported or independent living, or to a long term residential placement, and the process should be completed by the end of March 2006. The home will then provide services for short term assessment and respite care, in line with its Statement of Purpose. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 6 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.V258231.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 The home is in transition from providing a long term service to being a facility for short term assessment and respite care. There is adequate information available for prospective residents, and the residents who were spoken to feel confident that the staff can meet their needs. 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. Six long stay residents remain in the home, but plans are in place for each of them to move to supported or independent living, or to a long term residential placement. The Service Users Guide is provided to everyone who is admitted to the home for assessment or respite. It contains information on the services that the home provides for the residents, but some small amendments are needed to ensure that it provides all the information listed in Standard 1. Each resident is also given a licence agreement for their stay, which includes the terms and conditions for their stay, the services provided and the resident’s responsibilities. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 9 Each resident has an individual support plan that is drawn up following an assessment planning meeting. The planning meeting form was seen for a respite client, giving details of her routines and the assistance that she needs. A respite client was due to be admitted on the day following the inspection, and his room was prepared to meet his assessed needs, including a hospital bed and pressure relieving mattress. The assessment planning meeting takes place in the home, and the prospective resident has the opportunity to see the home and meet the staff and residents on that occasion. 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 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. A programme of activities needs to be developed for respite clients (see Standard14). St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 10 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, 8, 9 and 10 The residents’ care plans contain detailed information on all their personal care and health care needs, and comprehensive risk assessments related to each individual, which enable the staff to provide a good quality of care. The residents feel fully involved in decision making. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 11 EVIDENCE: Each resident has an individual support plan (ISP) that is drawn up following an assessment planning meeting. The ISPs for three residents were seen, one for a respite client, one for an assessment client, and one for one of the remaining long stay residents. All the ISPs contain detailed information on the personal care that each person needs, and of their health care needs. Skill development programmes are in place for the long stay and assessment clients. The skill development programme is agreed with the resident, and includes goals for improving independent living skills, such as menu planning, meal preparation, laundry and managing finances. There are also goals for changing behaviour, such as coping with anxiety and addressing self harm. The goals are clearly written, with an objective for each, the action needed, the target date and evidence of achievement. On the ISPs that were seen on this occasion, the target date was recorded as “end of stay”. The progress of the assessment may be monitored more effectively if more specific dates are set for each goal. 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. The ISP for the respite client contains details of personal care needs and health care needs, but there is no skill development programme, nor is there a programme for the stay. This needs to be further developed, in order to create that the respite stay should be a positive experience with recorded outcomes. Risk assessments were seen for each resident, for activities including cooking and bathing, and for epilepsy and behaviour. A risk assessment for challenging behaviour lists the possible triggers for the behaviour, and measures for addressing the behaviour. However some of the risk assessments are not specific to the individual, and for control measures do no more than refer to the home’s policies and procedures. It is not clear that this format provides 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. There are no risk assessments for the residents who look after and administer their own medication (see Standard 20). 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. All personal information is stored securely in the home, and each member of staff signs an agreement not to disclose confidential information as part of their contract of employment. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Long stay and assessment clients have programmes that focus on developing their skills for independence, and they are encouraged to take responsibility for their lives. However the provision of appropriate activities, particularly for respite clients, is an area for development. EVIDENCE: Before St Michael’s House was registered as a service providing short term assessment and respite care, the main focus was independent living and rehabilitation. The residents lived there long term, and their daily lives included attending local college and day centre, and organising their own social activities. One of the current respite clients said that she continues to attend her usual day centre, but most respite clients spend all their time in the home. Assessment clients have a skills development programme (see Standard 6) that includes goals for improving independent living skills, such as menu planning, meal preparation, laundry and managing finances. There is no programme for respite clients, and no programme for social activities. None of the residents who completed comment cards felt that the home provides suitable activities. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 13 Most people who come to the home for respite do so to give their carer a break. Currently the home offers no more than accommodation and care for them. The service would be greatly improved with the provision of a programme of activities and outings. This would provide a positive experience and break from their life at home for the client as well as for their carer. The action plan from the home’s annual review meeting in August 2005 stated the need to “continue to explore Community activities and negotiate access to Garden City Day Service for clients having respite or assessment stays”, to be completed by January 2006. No evidence of this was seen during this inspection. 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. There is a kitchenette in each unit, and the remaining long stay residents and those who are developing their independence on assessment 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, and assessment and long stay residents pay for any meals that are provided for them. The menus show a choice of two cooked meals or a salad at lunchtime, and a light meal, such as soup, hot dogs and baked beans on toast, in the evening. A long stay resident cooked her own lunch, but ate it in the dining room with the other residents. The residents spoken to said that they like the food. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 14 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, 20 and 21 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 satisfactory procedures for the administration of medication, but some improvement is required in storage and recording in order to safeguard the residents effectively. EVIDENCE: The aim for assessment clients is that they should become as independent as possible, and their ISPs contain detailed information on the personal care that each person needs, and of their health care needs. Guidelines are in place for behaviour management and epilepsy. One resident has a pressure sore, and the district nurse visits every day to dress it. The nurse keeps full records of the pressure care provided in the Single Assessment file that is kept in her room. The residents spoken to, and the responses on the service users comment cards, were that they feel well cared for and the staff treat them well. Medication is stored in a room that has no natural ventilation, and the temperature of the room is not monitored as it should be to ensure the integrity of the medication. There are two medication cupboards and sets of St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 15 MAR (medicines administration records), one for long term and assessment clients and one for respite clients. 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. The medication for long term and assessment clients is supplied in individual dosage blister packs, and the procedures for administration and recording were seen to be satisfactory. Two assessment clients look after and administer their own medication, and the medication is stored in a locked drawer in their rooms. For one the MAR chart states ‘self medicating’, but the resident has not signed the MAR chart to confirm that he has received the medication. There is no record of medication for the other resident. There is no risk assessment for self medication for either resident. A letter is sent to respite clients asking them to provide medication in a dossette box, with a list of the medication. This practice was implemented as an improvement to the previous system, when medication was provided in an assortment of containers, and there was often no clear indication of what it was. The RPSGB (Royal Pharmaceutical Society of Great Britain) guidance is that medication should only be administered from the packaging in which it is dispensed by the pharmacist. It was reported that a senior pharmacist from the health authority has approved the use of dosette boxes filled by the client or their carer. The medication for one respite client was supplied in the original packaging, from the hospital dispensary. The manager and service manager will seek further guidance on good practice in managing the medication for respite clients. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 16 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 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 how to refer a complaint to CSCI. Both written and verbal complaints are recorded and investigated effectively. The complaints recorded most recently were made by residents and their relatives, and concerned care practices, cleaning and disagreements with other residents. All were recorded as being concluded to the satisfaction of the complainant. 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. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 17 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, 26, 27, 28, 29 and 30 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. All the bedrooms are single, and none have en-suite facilities. The bedrooms all contain a washbasin, fitted wardrobe and chest of drawers, and the bedrooms for respite care also provide a TV. 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. Following the visit made to home for the registration process, advice was given that any further developments to the home must provide bedrooms of the required size. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 18 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 and is designated as the residents’ smoking area. This could cause a problem for non smoking residents and staff who have to pass through it. Following the visit made to home for the registration process, a requirement was made to consult the fire authority concerning adequate precautions against the risk of fire, and in particular with regard the use of a corridor as a residents smoking area. It was reported that the fire service do not consider this to be a fire risk. The home is heated by gas central heating. All radiators have low temperature surfaces and individual thermostats. There are water temperature regulators on all bathroom taps. 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 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.V258231.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 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 should be kept in the home. EVIDENCE: The staffing rotas show that there are four support workers on duty throughout the day, and two during the night. One support worker also sleeps in at night, although the need for this is being reconsidered. There were ten residents staying in the home at the time of the inspection, and the staffing levels are sufficient to provide solid support for the residents who are working to improve their skills for independence. The job description for the support workers includes working with the residents to increase their independence, and contributing to their care plans and reviews. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 20 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. Each member of staff has a learning and development log, and the courses that they have taken include dealing with difficult behaviour, diabetes, Parkinsons disease and strokes. The action plan from the home’s annual review meeting in August 2005 stated that training should be provided in stokes, multiple sclerosis, head injuries, sensory disabilities and sign language. Three of the six support workers have now completed NVQ2 in care, three are working towards it, and a further three have registered to start the course. Two support workers are working towards NVQ3. All staff have regular supervision, and the staff spoken to said that they are supported very well in their work through both training and supervision. The staff files of four members of staff were inspected. The regulations require that adequate information is kept in the home for each member of staff to provide evidence that they are fit to work in a care home. Three of the files seen did not contain any evidence of the person’s identity, or a recent photograph. CRB (Criminal Record Bureau) disclosures are kept by HCC Human Resources Department, and a notification is emailed to the home of a satisfactory outcome. This evidence, together with a similar confirmation of medical fitness and other information, is stored on computer. This is acceptable, but a list of the information held on computer should be in the staff file, so that it is clear where it may be found. The notifications of satisfactory CRB disclosures that were seen did not include confirmation of a POVA (protection of vulnerable adults) register check. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, and 42 The home is well run by a competent manager who leads a dedicated and enthusiastic staff group. The management within the home is secure and effective ensuring that the needs of the residents are met and that the home meets its aims and objectives. The quality assurance system ensures that views of the residents and their families underpin all self-monitoring, 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. Three health and safety concerns were raised during the inspection. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 22 EVIDENCE: The home is in the process of changing from provision for long term rehabilitation and independent living, to a service for short term assessment and respite care. Six long stay residents remain in the home, but plans are in place for each of them to move to supported or independent living, or to a long term residential placement. The home does not yet have the ethos of providing a positive and dynamic respite care experience (See Standards 6 and 14). However the residents spoken to all feel that the staff provide good support and care for them. One said that the home is a friendly place, and that there is a family atmosphere. 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. An annual review meeting is held to monitor the achievements and performance of the home. The residents contribute to the review through monthly residents meetings and questionnaires, and the review includes the outcomes of audits of the service and professional inspections. The last review meeting took place in August 2005, and the resulting action plan highlighted needs for day activities and outings, wheelchair access to local shops, a compliments log and a comments book for the respite unit, and specific training for staff. Three of the long stay residents are involved with the regular audits, by talking to the other residents and completing some parts of the audit. HCC consults residents through ‘Having Your Say’ questionnaires. These are returned directly to HCC Quality and Performance Unit, and feedback is given to the manager on any concerns that are raised. All health and safety records are completed appropriately, and 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). 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 violence to staff was written in 1996, and the procedures for fire precautions and for COSHH (control of substances hazardous to health) were written in 1994, with 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. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 23 The home has appropriate procedures for monitoring health and safety, including regular fire drills and a monthly review of the premises. However three potential hazards were noticed during the inspection. 1. Milk was seen in the fridge on one unit with a use by date that was 5 days out of date. 2. The door of one bedroom was held open with a waste bin. All other bedroom doors that were open were fitted with DorGard automatic door closers. It was reported that these have been fitted very recently, and the remaining door was the next one to be completed. 3. In one bathroom one of the three bins provided for the disposal of incontinence pads was overflowing. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 1 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Michael`s House Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 2 2 X DS0000064252.V258231.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? N/A 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 YA14 Regulation 16(2)(m) & (n) Requirement 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. The temperature of the room in which medication is stored is not monitored, and the storage for controlled medication does not comply with the regulations. The recording of medication for residents who are self medicating is inadequate. All medication in the home must be stored and administered in accordance with the guidelines of the Royal Pharmaceutical Society and the relevant legislation. Timescale for action 31/01/06 2 YA20 13(2) 31/12/05 St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 26 3 YA34YA41 17(2), 19(1)(b) The staff files seen did not contain satisfactory evidence of the fitness of the person to work in the home. 31/12/05 4 YA42 13(4)(c) All the required information on staff as listed in Schedule 2 and Schedule 4.6 must be kept in the home, including evidence of identity, a recent photograph and evidence of a satisfactory POVA check. Out of date milk was seen in the 31/12/05 refrigerator on one of the units. Food that is out of date must not be stored in the home. One bin provided for the disposal of incontinence pads was overflowing. Clinical waste must be stored securely before disposal to ensure that there is no risk of spread of infection. One bedroom door was held open with a waste bin. An effective system of fire door closures must be put into place for all bedroom doors. 5 YA42 16(2)(k) 31/12/05 6 YA24 23(4)(c) 31/12/05 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. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 27 2 YA6 The individual support plans (ISPs) and risk assessments contain clearly written information on all aspects of the residents life, but could be further developed to incorporate the principles and practice of PCP. There is no skill development programme, or programme for the stay of respite clients. It is recommended that the staff should encourage and enable residents to provide a realistic input into their ISPs and risk assessments, for example by setting their own targets and monitoring their own progress. The programmes for respite clients need to be further developed, in order that the respite stay should be a positive experience with recorded outcomes. 3 YA40 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. St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 Page 28 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. Extracts may not be used or reproduced without the express permission of CSCI St Michael`s House DS0000064252.V258231.R01.S.doc Version 5.0 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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