CARE HOME ADULTS 18-65
St Michaels 166 London Road Temple Ewell Dover Kent CT16 3DE Lead Inspector
Julie Sumner Unannounced Inspection 6th March 2006 10:00 St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Michaels Address 166 London Road Temple Ewell Dover Kent CT16 3DE 01304 823017 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) High Quality Lifestyles Limited Mr Duncan Robert Wood Care Home 7 Category(ies) of Learning disability (7) registration, with number of places St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th October 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. 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. At present 3 people live in the home. 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 DS0000023580.V258561.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during one afternoon in March and just over three hours were spent in the home. Service users were participating in their normal daily activities in and out of the home. Since the last inspection the manager has become registered manager with CSCI. Three people are living in St. Michaels at present. There is one staff vacancy and the staff team is established and stable. Experienced staff have spent time with service users and got to know them well and new staff are being guided. The following methods of inspection and information gathering were used: Discussion with registered manager, meeting 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, maintenance plans, some staff records including training records and recruitment information. What the service does well:
Training has been provided in strategies to encourage communication skills and positive behaviour and staff demonstrated their skills in this. Service users continue to be 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 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. This has been developed with all staff attending makaton signing training and practicing to become competent so that they can use signing as part of the day to day interaction with service users. There are good support strategies to enable service users to participate in activities in the community. One service user successfully went on holiday for the first time.
St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 6 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. Good induction training is provided for new staff including shadowing experienced members of staff to get to know how to put knowledge and training into practice. What has improved since the last inspection? What they could do better:
Whilst there has been improvement in the training provided, there are not enough training courses organised so that all staff will have up to date training in all areas that they need to have by law. This includes: health and safety, first aid, moving and handling, basic food hygiene and infection control. A requirement has been made to develop the current plan for all training that is outstanding so that all staff are up to date. 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 requirement made at the previous inspection has been carried over. The front door bell needs to be repaired, as it does not always work. A requirement has been made for this. There are plans to improve the access to the home by providing an alternative entrance. This would also incorporate the fire safety officer’s recommendations and would allow staff and visitors to be briefed and to enable informed positive responses when first meeting with service users. The
St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 7 requirement made at the previous inspection has been carried over as it is necessary to incorporate it into the building work and has therefore delayed the erection of the perimeter fence proposed. 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 Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 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 the following standard(s): EVIDENCE: Not inspected at this time. St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 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, 9 Service users know that their views are taken into account and that their personal goals are reflected in their individual plans and potential risks are managed. EVIDENCE: This group of standards was assessed more fully at the previous inspection. A sample of service user plans and daily logs were viewed containing relevant information and clear guidelines for staff. St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 11 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): 16, 17 Routines in the home are flexible and freedom is promoted within risk assessed boundaries. Service users are provided with a good range of meals and are able to choose where and when they want to eat. EVIDENCE: Service users have one-to-one support and can access all areas of the home except other people’s bedrooms with support. Service users are offered quiet time on their own when they indicate that they need it. Risk assessments indicate necessary restrictions and guidelines for staff support needed. Menus have been designed around fresh food with plenty of fresh vegetables and home cooked. The home have had the benefit of an increased food budget as less service users are currently living in the home. Service users looked well nourished and healthy. There are good records kept of food provided and what is actually eaten by individuals. There is a cooking rota and guidelines for supporting each individual to prepare some of the meal, how much depending on their level of ability. This includes hand washing, safety and getting ingredients ready as well as cooking.
St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 12 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 Service users’ preferences in how they are supported are taken into account. Service users are supported well with maintaining their health and managing individual health conditions. EVIDENCE: Each service user has one-to-one support. Staff were observed supporting each individual in a different way depending on what support they needed and interaction observed was service user led. Guidelines for support are included in the service user plan of care. All service users are registered with a GP and go down to the surgery for arranged appointments with support of staff. There is a record of all appointments attended. There are health check update sheets which are completed for every incident related to individual health and kept in their service user plan folder for reference. A sample of health records were viewed and discussed. St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 13 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, 23 There is an effective complaints procedure and systems are being developed to make it more accessible to service users. There are effective procedures in place to protect service users from risk of abuse. EVIDENCE: There is a complaints procedure and this is included in the statement of purpose/service user guide. Staff get to know service users and judge from their responses and behaviour if they are unhappy about something. The registered manager has set up one-to-one meetings with one service user who benefits from having this time to talk through any concerns. The complaints procedure also needs to extend to service users who have communication difficulties. There is a complaints log and there have been no complaints. The home had one adult protection investigation following an allegation of incorrect restraint procedures regarding one individual that has now been closed with no further action needed. Adult protection training is included in the induction for all new staff and staff spoken to had attended training in February. St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 14 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, 30 The home was clean throughout and overall, has been maintained well. There is a good size laundry room with appropriate equipment to meet service users’ needs. EVIDENCE: A tour of the home was undertaken. There are new carpets in the lounges and new laminate flooring in the dining room. The kitchen cupboard doors have been replaced. Bedrooms were not viewed at this time. Furniture is in the process of being replaced. A high backed sofa has been identified having assessed individuals’ needs. There are plans for the current quiet lounge to be developed into a sensory room. The maintenance plan was viewed and is both a plan of replacement and redecoration and a communication to the maintenance person of what needs repairing and records of when items have been actioned. A recommendation has been made to extend this to planned replacement of large items of equipment and furniture and a cycle of planned redecoration to speed the process up. There are plans for an alternative and additional entrance to the home. This would ease security and enable staff to access the home and have a handover
St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 15 so that they are able to respond more positively and be informed of anything necessary prior to meeting service users. This proposal affects the perimeter fence that was to be erected and this will be incorporated in the new building work. As this was part of the fire safety recommendations the requirement made at the previous inspection has been modified and carried over. The current front door bell does not work reliably and needs attention. A requirement has been made for this. St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 16 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): 34, 35 There is a good and robust recruitment process. There has been steady progress towards all staff having training to meet assessed needs of service users. EVIDENCE: A sample of staff files were viewed and contained evidence of requests for CRB/POVA checks and at least 2 references, proof of identification, induction, supervision and training records. Discussed training with the registered manager. Viewed the training schedule. All courses that are available have been booked with around two staff at a time. Two staff have commenced NVQ training and two staff are booked to commence on the next scheduled start date. The training records of courses attended by staff were also viewed. Training has been organised around individual needs. The content of the ‘skip’ training was discussed with the manager. This has been developed to provide a wider range of skills and more emphasis on a variety of ways to prevent, divert and calm disturbed behaviour. Makaton training has been provided and two staff are attending a trainers course so that they can teach the rest of the staff team, particularly if there are changes in the team. One service user uses makaton signing. Everyone
St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 17 has been practicing and developing their confidence in signing so that this is part of everyday life in the home and meaningful for service users. St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 18 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, 39, 42 Service users benefit from a well run home. There is a clear vision and clear direction to develop the service. Development of the quality assurance monitoring system would determine whether the service being provided in the home is what service users want and is meeting their needs. This would provide the basis for the development plan for the home. Continuing the health and safety training provided to staff will make the home and workplace safer. EVIDENCE: The registered manager has over two years experience in management and has completed NVQ 4 in management and care but has not had the final verification and certificate yet. HQL has designed a training programme for the senior staff to provide them with specialist skills to support people who display challenging behaviour. The registered manager is currently studying the first year of this course. St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 19 The company are developing the quality assurance system. Records written and kept in the home will feed into this system. Regulation 26 visits have been carried out monthly by a company representative who has direct experience working with people with learning disabilities and communication difficulties. Staff training records and the training plan were viewed. There has been some steady progress since the last inspection in mandatory training attended but there are still insufficient courses provided. Some staff have received training in health and safety, manual handling, fire training, first aid, basic food hygiene and infection control. Not all staff have attended all courses and therefore the requirement to provide training for all staff has been carried over. Other training to protect service users and staff that has been identified by the company as essential including the diversion and management of challenging behaviour has been attended by all staff. The registered manager discussed the training content as one of the roles of the home manager is to attend training to train the staff team. The course has been developed to include more emphasis on providing an increase in various skills in diversion and prevention. St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 20 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 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 x x 3 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x x 3 x 2 x x 2 x St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 21 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 YA35YA42 Regulation 18 (1)(a) (c)(i)(ii) Requirement Timescale for action 31/05/06 2. YA39 3. YA42 4. YA42 All staff must attend mandatory training and any other essential training identified by the home to ensure safe working practices and ensure the health and welfare of service users. (A training plan providing sufficient courses for all staff to be up to date this year to be provided by timescale) 24(1)(a,b) To set up a quality assurance (2)(3) audit system within the company to measure success in achieving aims and statement of purpose of the home based on views of service users and their representatives. System structure and planned implementation to be completed by timescale. (previous timescale March 2006) 12(1)(a,b) Provide action plan of proposed 23(4)(b) building work to additional access to home that will incorportate implementation of fire safety guidance recommendations. 23(2)(b) The front door bell needs to be repaired/replaced. 31/05/06 31/05/06 27/03/06 St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 22 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. 2. Refer to Standard YA24 YA32 Good Practice Recommendations To extend the maintenance and renewal plan to replacement of furniture and equipment to speed up the time it takes to aquire the items requested/needed. To continue to work towards achieving NVQ targets. St Michaels DS0000023580.V258561.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 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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