CARE HOME ADULTS 18-65
St Michaels 166 London Road Temple Ewell Dover, Kent CT16 3DE Lead Inspector
Julie Sumner Announced 18/08/05 at 10:00am 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 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 Stationary 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 Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service St Michaels Address 166 London Road, Temple Ewell, Dover, Kent CT16 3DE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01304 823017 stmichaels@hqls.org.uk High Quality Lifestyles Limited Registered Care Home 7 Category(ies) of Learning Disability registration, with number of places St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd February 2005 Brief Description of the Service: St Michaels is a home for people with learning disabilities and communication difficulties who present challenging behaviour at times. The home is owned by the private company: High Quality Lifestyles. The companys philosophy is to support people who have displayed behaviour that has caused them and others difficulty and has limited ordinary/usual kinds of life opportunities by positive guidance and a specialised environment. St Michaels is registered to provide accommodation for up to 7 people. At present 6 people live in the home and one service user is moving out to another home within the company. There are no plans for anyone else to move into the home as it is the companys intention for a maximum of 5 people to live in the home in order to provide a high quality level of support to each individual. St Michaels is a detached home in the village of Temple Ewell near to the town of Dover. There are basic amenities within walking distance of the home and the town of Dover is approximately 15 minutes drive. There are reasonable public transport links near to the house and there is the facility for service users and staff to use the house car. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over one day in August and commenced at 10:30am. Some of the time was spent with service users and staff including having lunch. Service users were participating in their normal daily activities in and out of the home. The deputy manager has been promoted to manager, having had several years experience working in the home and his application to be the registered manager is being finalised. There have been some changes to the staff team since the opening of a new home in the company. Currently, there is a mixture of established staff and new staff. Experienced staff have spent time with service users and got to know them well and new staff are being guided. Training has been provided in strategies to encourage communication skills and positive behaviour and staff demonstrated their skills in this. Questionnaires were given out to relatives and visiting professionals to get their viewpoint on the home. All feedback received was positive. The following methods of inspection and information gathering were used: One-to-one discussion and group discussion at different times with service users and staff, observing activity in the home, touring the home and reading and discussing policies, plans and records including individual service user plans, medication charts, some staff records including training records and duty rota. What the service does well:
Service users are supported well to cope with outbursts of challenging behaviour. Sometimes this is displayed as aggression or verbal outbursts and staff guide service users positively to divert into positive sociably acceptable behaviour. Staff were observed to follow written guidelines well when a service user displayed challenging behaviour. There are good support strategies to enable service users to participate in activities in the community. Staff were preparing for one service user to go on holiday who had not been able to go away before. One service user had been to Disneyland Paris and had an album of photos and souvenir items that he had made on his return and talked about his experience.
St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 6 There is good support with communication skills to develop current verbal and non-verbal skills and systems for signing, pictures and symbols to aid understanding. Service users are empowered to express their feelings and develop their confidence in social situations. Where it is indicated in the agreement between the home and the care managers for one or more members of staff to give individual support, this is given consistently. Staff spoke of the changes in displayed challenging behaviour from when they started work in the home to now. Good records are kept to demonstrate and evidence changes. What has improved since the last inspection? What they could do better:
Staff training is not being organised quickly enough before it needs to be updated. This includes training that should be attended by law, for example, courses in first aid and health and safety. A requirement has been made to prepare a plan for all training that is outstanding for all staff. There is a need to develop a quality assurance system to make sure that how the home is supporting service users and what is happening in the home is fully meeting everyone’s needs and wishes. The company had made a start on this but due to unforeseen circumstances this was interrupted. Plans have been made to continue and an initial service user feedback form has been started. The development of the complaints procedure for service users that has been started also needs to be part of this process. The fire safety officer had made a recommendation regarding the safety of an evacuation point at the front of the building. There was some concern that the evacuation route might encourage service users to go down the road instead of round to the garden. A request for a perimeter fence has been made to ensure that service users go outside safely in the event of an emergency but this is still outstanding. A requirement to ensure fire safety recommendations are carried out and provide a safe route out of the home has been made.
St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Assessments have been completed for all service users and give a good basis of current needs and abilities. EVIDENCE: Assessments are carried out prior to moving into the home and then reviewed in the home following monitoring of the persons’ wellbeing skill development and behaviour. Assessments are carried out in conjunction with the behaviour support team. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 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 standard(s) 6, 7, 9 Service users know that their views are listened to and that their personal goals are reflected in their individual plans and potential risks are managed. Service users receive good support to develop social skills and overcome challenging behaviour that limits their opportunities. EVIDENCE: Service user plans are well designed with clear guidelines for staff. Permission for support with behavioural strategies has been obtained from appropriate medical and psychology specialists. Service user plans are reviewed every six months and more frequently if needs or circumstances change. Records are kept to monitor effectiveness of support and modify the guidelines for support as needed. Service users are supported to make decisions on a day to day basis. Communication skills are developed using aids for less able service users. Meetings are held each week to discuss any issues. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 11 Risk assessments are in place for all relevant circumstances and have been designed to provide appropriate staff support for different activities. Additionally when service users are going out in the community this is also risk assessed prior to going due to changing situations and individual emotional status. There is good documentation to record opportunities and responses to give an overall picture of the welfare of each individual. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 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 standard(s) 12 13 15 Service users are able to go out with appropriate support and develop skills to cope with and enjoy different opportunities in the community. Service users are enabled to go on holiday if they wish. Service users are supported to go out and exercise to relieve tension and keep fit and healthy. Contact with service users’ families and friends is encouraged and supported. EVIDENCE: A variety of activities are offered to service users including attending discos, swimming and walking over the local hills. New experiences are introduced gradually to develop opportunities to pursue different interests. Holidays have not been possible for the service users in the past due to challenging behaviour and the high degree of risk to themselves and others in the community. Staff support service users by increasing the opportunities to go for days out increasing the experiences and supporting the development of
St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 13 skills to cope with being in a social and unpredictable environment. Gradually a holiday experience is introduced. One service user had recently been to Disneyland Paris and spoke about his experience very positively. He had also been helped to compile an album of photos and souvenirs from his trip. One service user was going on holiday the next day with his key workers for the first time. He had therefore made considerable progress with reducing challenging behaviour. Staff support service users to maintain contact with their families and friends. One service user was looking at the staff rota and working out when to go to London to visit members of his family and staff were supporting him. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 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 standard(s) 20 Service users have medication only if necessary to assist with the support given to promote and maintain their health and wellbeing. EVIDENCE: Medication records and storage viewed. Nomad system used. All records completed accurately. Policy and procedure with clear guidelines for action to be taken by staff in the event of PRN being necessary. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 15 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 standard(s) EVIDENCE: Not inspected at this time. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 16 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 standard(s) 24 A written maintenance and refurbishment plan would speed up the redecoration and repair of areas and replacement of items in the home due to heavy wear and tear. EVIDENCE: The home was showing signs of wear and tear in some areas. New lounge and quiet room furniture had been ordered, current furniture was severely worn. The regular replacement of furniture has been included in the home’s budget. Each service user has his own bedroom that has been decorated and furnished to suit them. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35 Service users benefit from the consistent support of staff who have taken the time to get to know them well. Staff training would enhance the quality of support provided and provide staff with skills to further increase opportunities to service users. EVIDENCE: There have been changes to the staff team in the last year following the opening of a new home in the company. This caused some disruption to the home and strain on the manager and existing staff due to teaching and supporting new staff but the service users and home have settled down now. All checks have been made as part of the recruitment and appropriate records kept. All new staff have received induction training. The training matrix was viewed and gaps in mandatory training including fire training were evident. New staff were waiting for training as well as existing staff who’s training was out of date. All staff have completed training in the safe management of aggressive behaviour.
St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 18 2 staff have achieved NVQ\level 2, 1 staff is well into the course and 2 have been enrolled. There are restrictions by the training company on how many staff can be enrolled on the course to 2 each intake. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 42 The health and safety of service users and staff has not been ensured due to the lack of training provided in safe working practices. EVIDENCE: The manager has almost finished the registered managers award. At present there is no quality assurance audit system in place by the company. The only aspect of monitoring is by the company representative carrying out regulation 26 visits although these have not always been carried out monthly and service user participation is negligible. It was the company’s intention to set this up last year but due to unforeseen circumstances this process was halted. A quality assurance system needs to be developed and a requirement has been made for this. Financial procedures and systems were viewed and discussed with the manager. Good, clear records are kept providing an audit trail to safeguard service users. The finances are also audited as part of the regulation 26 visits.
St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 20 The financial director of the company oversees all finances in the company and an external audit is carried out that includes service user finances. A summary of the report of the audit needs to be included in the quality assurance process. As part of the most recent fire safety risk assessment carried out by the fire safety officer there was a recommendation regarding the evacuation route to the assembly point in the event of a fire. The most direct route guides service users and staff to the front door. To ensure service users’ safety it would be necessary to erect a perimeter edging like a fence to guide them round to the assembly point in the garden and away from the road. A requirement to make the exit route safe has been made. SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6
St Michaels Score 3 Standard No 24 25 26 27 28 Score x x x x x
Version 1.20 Page 21 H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc 7 8 9 10
LIFESTYLES x x 3 x
Score 29 30
STAFFING x x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score 3 x x x 1 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x Standard No 37 38 39 40 41 42 43 Score x 3 x x x 2 x St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 22 yes 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 35 Regulation 18 (1) (a) (c)(i)(ii) Requirement Timescale for action 30th November 2005 2. 3. 39 42 A training programme needs to be implemented to ensure that all staff have up to date statutory and essential training to ensure the safety and welbeing of service users and staff. Plan to be received by CSCI by timescale. 24 (1) Develop quality assurance (a,b) (2) system in the company for the (3) home. 12(1)(a,b) Implement fire safety guidance 23 (4)(b) recommendations and ensure safety of serice users when evacuating the building in the event of fire. 31st March 2006 30th November 2005 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 32, 37 Good Practice Recommendations To continue to work towards achieving NVQ targets including the manager to continue to work towards his NVQ level 4/RMA. St Michaels H56-H05 S23580 St Michaels V226727 180805 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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