Inspection on 13/06/05 for St Patrick`s House

This inspection was carried out on 13th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Patrick`s House 07/02/08

St Patrick`s House 16/11/06

St Patrick`s House 18/11/05

St Patrick`s House 04/02/05

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 St Patricks House Porton Road Amesbury Wiltshire SP4 7LL Lead Inspector Jacqui Burvill Unannounced 13th June 2005 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 Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Patricks House Address Porton Road Amesbury Wiltshire SP4 7LL 01980 626434 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) Cornersones (UK) Ltd John Edwin Maloret Care Home 6 Category(ies) of LD Learning Disability (6) registration, with number PD Physical Disability (1) of places St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users who may be accommodated in the home at any one time is 6. 2. Only the one, named, male service user currently in residence in the age range 18-64 years with a physical disability may be accommodated in the home. 3. Cornerstones (UK) Ltd must ensure that a quality assurance audit is carried out at least annually as to the way the home is performing. This audist must also specify any corrective measures that need to be put in place with suggested timescales for action. Any such audit must be carried out by a reputable and competent person or company with experience of quality assurance systems and processes. A copy of the audit must be provided to the Commission within 6 weeks of its production. The first audit must be provided by 4 July 2005. 4. Any placement for short-term care must be agreed with the Commission before placement commences. For the purpose of this condition, short term is defined as a placement that will last no longer than three months. Any placement that will last longer than three months must be reviewed to assess the short term status of the service user. 5. Any placement of an emergency admission must be notified to the Commission in advance where possible, or within the next working day, or two days if over a weekend. An amergency admission is defined as an admission where a service user is likely to be placed at short notice without an up to date assessment of needs having been carried out and the person has not had the opportunity to visit the home prior to placement. 6. The company must employ one or more administrators working for a period of not less than 5 hours per week in this home. This person must provide the home with administrative support in the maintenance of good records, including financial records, and any other documentation and relevant paperwork necessary for running a care home. The administrator must be in place by 1 October 2004. Date of last inspection 4th February 2005 St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 5 Brief Description of the Service: St Patricks is a 6 bedded home for adults with learning disabilities aged 18 – 65 years. Both male and female service users may be admitted.The home provides a service to people who may require high level support with behavioural problems, communication difficulties and psychological problems.The home does not provide care for people requiring high levels of support for personal care needs.The home is one of 6 homes owned by Cornerstones UK Ltd, a company run by Mr and Mrs Sinclair.One of the other homes is adjacent to St Patricks. St Patricks is a large chalet bungalow that has been fully refurbished and redecorated prior to opening. It has a large garden to the rear of the property and space at the front for several vehicles. It is within walking distance of Amesbury town centre and local amenities. The home is curently being extended by two additional bedrooms, with full ensuite facilities. These beds are not registered yet. The home was first registered on 31st January 2003. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over one day on 13th June 2005. The inspector spoke to 5 of the 6 service users who were home during the inspection. One newly appointed staff member and two other staff including the manager, who came to the home to talk to the inspector. The inspector toured the premises, but was unable to enter the extension at the time. (There was a previous visit carried out on 22nd April 2005 to measure the rooms in the extension) Records seen included care plans, monitoring notes, evaluation notes, medication and associated records and fire safety training records. The inspector and the manager discussed the conditions attached to the registration of the home, primarily the condition that relates to a quality assurance audit. The manager requested that a meeting takes place with the Commission to discuss the new system that is planned and how it will be implemented. Service users spoke frankly about living in the home. One service user said he could not imagine having progressed so far if he had not come to live at St Patrick’s. One service user shared the experience of moving in to a new home with the inspector. All of the service users spoken with said they felt they could approach staff easily with any concerns they had. This was seen during the inspection several times. The inspector also observed that there a high number staff were on duty in order to respond to the service users needs – some were off to college, others were doing jobs around the home, playing music, or shopping. What the service does well: What has improved since the last inspection? The record keeping in the home was already improving at the time of the last inspection. On this occasion, record keeping had improved a stage further with a logical sequence to records in care plans and other files. All records were easy to find and up to date. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 7 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 Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 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 Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 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 are made as comprehensively as possible, by gathering information from previous placements in order to ensure that the service users’ needs can be met by the home. EVIDENCE: There has been one new service user admitted since the last inspection. Records of assessment are in place, although more recently, there is a request for a re –assessment of the service users’ needs as staff have become more aware of needs and strengths. Details of the original assessment were sent to the inspector prior to admission, as this is a condition of registration. The assessment record also included records of times when the service user had visited the home before being admitted. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 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 Care plans are detailed and frequently reviewed to ensure that they reflect the service users needs and how they are to be met. Risk assessments are comprehensive, up to date and include a good level of detail about how the risk is to be managed to support the service user. EVIDENCE: Care plans are very detailed and easy to follow, describing guidelines for managing behaviour and what the expected outcome will be for the service user. All sections are dated, up to date and in some places have also been signed by the service user. There are also monthly evaluations of the records, which are plotted onto a graph. This shows that continuing assessments are being made as aspects of behaviour changes and develops. The monthly evaluation also shows how care objectives have been met, as well as other aspects of care – physical and mental health, occupation and recreation community contacts and other additional comments. There are two different formats in the home and the alternative format does record details about behaviour and any restrictions, it would be advisable to stay with one format. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 11 The manager stated that the service users need to be ‘on side’ as this is their care plan and their co-operation is needed when agreeing strategies and how to put them in place. Service users can read their care notes daily. Risk assessments are in place and relevant to the risks that are likely to occur. All risk assessments are reviewed between 1 and 3 months. The risk assessment details the specific behaviour that results in a hazard as well as the control measures in place and any other control measures that are required. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 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) 12,15, 16, 17 Service users enjoy active lives, taking part in activities that interest them and meeting friends and families regularly. Service users are able to choose meals that they enjoy and that appear to be healthy and nutritious. EVIDENCE: There is a plan that shows service users’ weekly activities. This includes college, day care centres and clubs. This is changed on a weekly basis in consultation with the service users. Daily notes also show contact with friends, family and any specific restrictions are detailed in the care plan. One service user told the inspector about a new job that he was pleased to have got. The menu shows what every individual service user has to eat for all meals taken in the home. The records shows when service users may have eaten out, or may be on holiday or visiting relatives. Service users have keys to their rooms in most cases. Staff should enable service users to use keys to open the front door to their home. Service users told the inspector they had a key to their own room, but most chose not to use it. The manager stated that extra keys would be cut, so that all service users can have one. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 13 All service users spoken to said that if they didn’t like some foods, then staff would give them something they liked instead. One service user told the inspector about a particular dish that he dislikes and is never given and that he is always asked what alternative he would like, which is cooked especially for him. Some entries do vary – for example, some staff are recording sandwich fillings, whilst other staff do not. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 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) 18, 19, 20 Service users are supported in managing aspects of their personal care with dignity and sensitivity. Staff have used the record keeping system in the home ineffectively, when medication has been taken from the end of the month’s blister packs. This could lead to shortfalls and further administration errors. EVIDENCE: There is evidence of medical appointments and changes to medication, letters from medical professionals and all of this is detailed in a logical order in the care plan file. Any support with personal care is described in detail in the care plan. The service users said that staff support them with personal care in a way that they like, and are sensitive to their privacy and dignity. Emotional and behavioural support is also evidenced in the care plan. No service users self medicate at this time. There are records of what medication is received as well as a weekly check. On close examination, 1 tablet had been taken from the last day of the months pack in one instance. This was discussed with staff at the time. No records had been made as to why this had happened. (For example, 1 tablet may have been dropped.) This had not been picked up on the weekly checklists. Four staff have completed medication training. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 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) 22, 23 Service users cannot be fully protected against abuse, as staff have still not received training set as a requirement at the last inspection. Service users finances are not properly audited, which could result in financial inaccuracies. EVIDENCE: There is a new complaint format book, which has duplicate pages in, so that any complaints received in the home can be properly dealt with. One copy would be given to the service user to keep and the other would be held in the book. Staff have not received training in adult protection and awareness. (Only one senior staff member attended training in 2004) Service users finance records describe the amount of benefit received and identifies what forms part of personal allowance. The receipts for these records were not held logically. Monthly receipts should be attached to the monthly record, which can they be filed away. All receipts are in a folder and may not relate to the monthly sheet. All balances are checked daily. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 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 Parts of the home that have been re –decorated need to be finished as this is not nice for service users to live and sleep in. The remainder of the home was clean and tidy on the day of inspection. The lounge is not a ‘homely’ space for service users. EVIDENCE: Service users showed the inspector their rooms. Two were in the process of being re – decorated; one was being done with help from another service user. Service users were not clear how long the rooms had been like that. The inspector discussed this with the manager, as both rooms need to be completed as quickly as possible. The inspector asked service users if they wanted other parts of their room cleaned, such as the carpet. Service users were not keen as they were worried about the disruption to their room. Some more furniture would help make the lounge seem more homely. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 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) 35 The training programme is under development and this appears to be benefiting the service users in the home. EVIDENCE: There was a previous requirement that could not be assessed as the records were locked away and the manager was not present. Staff from Cornerstones are receiving some training in conjunction with another group of care homes in the area. Staff have taken part in recent training, which included; manual handling, John O’ Brien’s Five Principles, the Role of the Keyworker and Food Hygiene. There is evidence of staff training and certificates gained in staff training files. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 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 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 There is no measurement of quality systems in the home, or within the organisation. The effect on service users means that their views on the service and the wider implications are that the quality of their care has not been assessed. Arrangements for managing fire safety training needs to be improved to include more detail, in order to ensure that service users are safe and protected. EVIDENCE: The home bought a quality assurance pack some time ago and this needs to be implemented and a report prepared for the CSCI by 4th July 2005. This is one of the conditions of registration. So far, no report has been forthcoming. The manager explained that there is a new person within the organisation who will support the assessment of new standards that relate to the National Minimum Standards for Younger Adults. This must ensure that it includes the views of service users, stakeholders, and relatives. The inspector discussed the Regulation 26 visits. They do not seem to happening monthly for this service. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 19 The fire records were seen. The fire risk assessment is dated January 2005 and includes an assessment of all individual rooms and areas. Fire systems are checked weekly. Fire drills are taking place, but staff names are not being recorded as only the number of staff attending is recorded. Naming the staff ensures that the fire safety officer can verify who has attended a drill and assess the effect of the fire safety training. Five staff are still waiting for fire safety training for the April – June quarter. It is important that the actual date of the training is entered above the staff initials. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 x x 3 x 2 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Patricks House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 2 x D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 21 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 YA20 Regulation 13(2) Requirement When medication has been used in place of one being dropped for example, this must be properly recorded either on the MAR sheet or on the homes own weekly record checklist. All staff must receive training in awareness of the ‘No Secrets’ guidance and adult abuse.(Carried forward from last inspection. Due to be completed by 31st July 2005) Failure to meet this requirement may result in enforcement action. Service users bedrooms that have been partly re - decorated must be completed. The registered person must ensure that the recruitment practice in the home is safe, robust and that any queries over CRB checks are discussed with the inspector. New staff must have two references, one of which should include the last employer.(Carried forward from last inspection - unable to be verified on this occasion) The registered person must provide copies of all reports that are made under Regulation 26 to Timescale for action 31st July 2005 2. YA23 13(6) 31st October 2005 3. 4. YA24 YA34 23(2) (b) 19 31st July 2005 31st October 2005 5. YA39 26 4th July 2005 and monthly Page 22 St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 6. YA39 26 7. YA39 26 8. YA42 23(4) (d) the CSCI each month.(Carried forward from the last inspection. Failure to meet this requirement may result in enforcement action) The registered person must ensure that at least once in each calendar month a representative of the organisation visits the home unannounced and reports of their findings.( Carried forward from the last inspection. Failure to meet this requirement may result in enforcement action) The registered person must establish and maintain a system for reviewing and improving the quality of care in the home. (Carried forward from the last inspection. Failure to meet this requirement may result in enforcement action.) When staff have attended fire safety training, the actual date of training session must be recorded above the persons initials. from now on. 4th July 2005 and monthly from now on. 4th July 2005 31st July 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. 2. 3. 4. Refer to Standard YA6 YA16 YA17 YA22 Good Practice Recommendations All care plans should have a similar format. Service users should have keys to the front door. Staff record light snacks on the menu sheet consistantly. The manager should make arrangements for someone external to the team to periodically monitor and audit the financial records kept on behalf of service users.(Carried forward from the last inspection.) Service users receipts should be attached to the monthly log sheets they are related to. The manager should consider keeping a compliments file. D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 23 5. 6. YA23 YA23 St Patricks House 7. 8. YA23 YA42 (Carried forward from the last inspection) The complaint record should be checked three monthly. (Carried forward from the last inspection. The names of staff attending fire drills should be recorded. St Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham SN15 2BB 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 Patricks House D51_D01_S60340_StPATRICKS_v232604_130605Stage4.doc Version 1.30 Page 25 - 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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