Inspection on 07/02/08 for St Patrick`s House

This inspection was carried out on 7th February 2008.

CSCI found this care home to be providing an Good service.

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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Patrick`s House 16/11/06

St Patrick`s House 18/11/05

St Patrick`s House 13/06/05

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 Patrick`s House Porton Road Amesbury Wiltshire SP4 7LL Lead Inspector Elaine Barber Unannounced Inspection 7 and 8 February 2008 10:35 th th St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Patrick`s House Address Porton Road Amesbury Wiltshire SP4 7LL 01980 626434 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) Cornerstones (UK) Ltd John Edwin Maloret Care Home 8 Category(ies) of Learning disability (8), Physical disability (1) registration, with number of places St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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. 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 not last 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. Any placement of an emergency admission must be notified to Commission in advance where possible, or within the next working day, or two days if over a weekend. An emergency 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. 16th November 2006 3. Date of last inspection Brief Description of the Service: St Patrick’s House is an 8 bedded home for adults with learning disabilities aged 18 - 65 years. 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 Patrick’s. St Patricks is a large chalet bungalow with 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 was first registered on 31st January 2003. At least four staff are on duty during the day time and two staff sleep in at night. The fees range between £1500 and £2000 a week. A copy of the last inspection report is available in the home. Inspection reports are also available through the Commission’s website at: www.csci.org.uk St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection included two visits to the home on 7th and 8th of February 2008. We obtained evidence during the visits through: • • • Discussion and time spent with five people who used the service. Discussions with the manager, deputy and with two support workers. Examination of the some of the records. Other information has been obtained, which we have taken into account as part of this inspection: • • • An Annual Quality Assurance Assessment, known as an AQAA, completed by the manager. Notifications to the Commission since the last inspection. Comment cards that were completed by seven people who used the service, four relatives and by three healthcare professionals. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: People’s individual needs were assessed so that their needs could be met. One of the two people who moved in recently had an assessment by a social worker. Both of these people had assessments conducted by staff in the home. Where practical, people had the opportunity to visit the home so that they were familiar with the home and the people who lived there before they moved in. One of the people moved in in an emergency and was not able to visit. The other person visited twice and stayed overnight before they decided to move in. People had their abilities, needs and goals reflected in their individual plans to ensure that their needs were met. Each person had a detailed support plan which they had agreed. The plans were monitored and reviewed so that people’s needs continued to be met. People made decisions about their lives with assistance as needed. Any restrictions were agreed with the person, their relatives and relevant professionals. People were supported to take risks and given opportunities for independence. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 6 People were provided with a range of activities and opportunities and had access to their local community facilities. People were able to maintain and develop appropriate relationships with family and friends. Staff supported people to visit and phone their family. People’s rights were respected and their responsibilities were recognised in their daily lives. People were offered a healthy diet and enjoyed their meals. People’s healthcare needs were being met. Each person saw their GP when needed and saw other healthcare professionals such as the psychologist, psychiatrist, dentist, optician and chiropodist. They also had specialist healthcare when needed. There was a complaints procedure and people knew how to make a complaint. They had visits from advocates who would help them to complain. There were policies about protection from abuse and staff had received training. This meant that people were protected by the home’s policies and practices about complaints and protection. People lived in a comfortable, clean and safe environment, suitable to their needs. There was a large communal sitting room, with sofas and pictures, which gave it a homely feel. There was a large dining table in the kitchen and people sat at the table after returning from their activities. The accommodation was well maintained. People said that the home was fresh and clean. There was a minimum of three staff on duty at any time during the day. The numbers of staff increased to support people with their activities and appointments. There was a training programme and new staff had learning disability award framework induction and foundation training. Three people had National Vocational Qualifications (NVQ) at Level three, one person had NVQ level 2 and one person was working towards level two. Four more staff were due to register for NVQ. There was a range of training for staff. People were supported by an effective staff team, who were appropriately trained and competent to meet their needs. The registered manager was suitably qualified, competent and experienced, so that people benefited from a well run home. A quality assurance survey had been conducted and views of people who lived in the home and relevant professionals had been collected. People’s views underpinned all selfmonitoring, review and development by the home although the report about these views needs to be published. There was a range of health and safety measures and staff had received appropriate training. People’s health and safety were protected by the majority of the systems in place. What has improved since the last inspection? No improvements were identified at this inspection. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 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 Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 Quality in this outcome area is good. People’s individual needs were assessed so that their needs could be met. People had the opportunity to visit the home so that they were familiar with the home and the people who lived there before they moved in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We read the care records of three people. One of these had moved into the home in an emergency on a Friday afternoon. Staff from the home received verbal information about the person’s needs from the social worker when they moved in. The manager said that the social worker faxed their assessment on the following Monday. Since then the staff at the home had also completed their own assessment of the person’s needs as part of their support plan. Another person had moved in since the last inspection. An assessment of their needs had been completed by staff at St Patrick’s and assessment information formed part of their support plan. We noted that the third person had lived in the home for several years. There was an assessment of their needs in their file, which was completed when they moved into the home. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 10 Staff said that the person who moved into the home in an emergency had not had the opportunity to visit the home before they moved in. The manager and a staff member said that the other person, who moved in recently, visited twice and stayed overnight before they decided to move in. They said that the person’s mother also visited. We noted at previous inspections that the people who had lived at St Patrick’s a long time had had the opportunity to visit before they moved in. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. People had their abilities, needs and goals reflected in their individual plans. People made decisions about their lives with assistance as needed. People were supported to take risks and given opportunities for independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care records of three people. Each person had a very detailed support plan including personal care, health care, support with behaviour and a physical intervention plan. One person’s physical intervention plan did not describe very well which particular behaviours required intervention and this needs to explain more about which behaviours will need intervention by staff. Apart from this we noted that the plans were very detailed and clear and easy to amend as needs changed. Restrictions were recorded in the plans. People had signed their plans to show their agreement with them. The plans were evaluated monthly and were reviewed according to the needs of the person but at least six monthly. Four relatives who St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 12 completed comment cards said that the home always met the needs of their relative well. One said that they were looked after well and another said that they were very happy with the care. We noted that the monthly evaluations were very detailed and provided evidence of how people made choices and decisions about their lives. For example they showed how people chose to go out or take part in activities and when they contacted their families. People had individual rooms and had made decisions about how to furnish and decorate them. Three people who completed comment cards said that they always made decisions about what they did each day and four people said that they sometimes did. One of them said sometimes staff made decisions but they did too. Six of them said that they could do what they wanted during the day and evening and at weekends. One said that they could do what they wanted during the day and weekend but not in the evening. They did not explain why. One person had a health problem, which needed some dietary control. The staff had arranged a multi-professional planning meeting to help the person to decide how to manage this. Two people had listening devices in their rooms because of health problems at night. Both people had monitoring protocols in their files. These had been agreed with each person, health care professionals, social workers and relatives. We saw this as an area of good practice. One relative said in their comment card that they thought the staff had the balance about right between people’s right to self-determination and personal privacy and the need to maintain their health and hygiene. We saw detailed risk assessments in the files, which included environmental and behavioural risks. These included control measures and action to be taken to reduce risks. We noted that there was no information in the risk assessments about why people were taking risks and how participating in activities that may be hazardous was a benefit to them. The manager said that he was going to change the format of the risk assessments to include the benefits and harms. He also said that he intended to write simple general risk assessments like for using the kettle and more complex assessments of particular risks for people. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. People were provided with a range of activities and opportunities and had access to their local community facilities. People were able to maintain and develop appropriate relationships with family and friends. People’s rights were respected and their responsibilities were recognised in their daily lives. People were offered a healthy diet and enjoyed their meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In the AQAA the manager gave several examples of opportunities for education and occupation. They said that one person was training at the Shaw Trust one day per week in gardening and was doing voluntary work gardening two days a week, all safety equipment had been bought by St.Patrick’s. One person worked with their father three part days a week on St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 14 reception at their father’s work. One person was attending an evening class in creative writing. During the visits we talked to this person about their course and read a piece that they had written. We also noted that each person had a weekly timetable of activities. This showed when they went to work or to a day service. We saw one person cleaning the kitchen during one of the visits. They told us that they were paid to do this. When we read the records we saw that people’s leisure and recreation needs were recorded in the support plans. Social activities were also recorded in their monthly evaluations. These showed that people were offered a range of activities. A record was also made when someone had been offered an opportunity and turned it down. During the past month a range of activities were recorded for each person. These included drama, arts, gardening, skittles, shopping, pantomime, discos and parties, going to the bank, going out for a drive, a club, a pub lunch and seeing an Abba tribute band. At home people were involved in the household chores, watched TV and DVDs and listened to music. In the AQAA the manager said that one person had joined a local football club, was training and playing in tournaments. They also said that all, with the exception of one person who chose not to, had joined a social club in Salisbury. We saw records about people’s contact with their family and friends. The monthly evaluations showed when people had visited or been visited by their family and friends. They also included records of telephone calls. One person had a record of visits from an advocacy group. The staff and the manager said that three people had been to stay with relatives at Christmas. We spoke to three people who said that they had visits from family and went to visit their family. One person said that they phoned their parents. We saw them during one of the visits making a phone call. Four relatives who completed comment cards said that the home always helped their relative to keep in touch with them. Two said that staff from the home took them to see their relative and also took their relative to visit them. Two said that their relative kept in contact by phone. We saw that each person had their own room which was individually decorated and furnished. Each person had a key to their room if they wanted one. Staff only entered people’s rooms with their permission. We noticed that people could choose to spend their time in their rooms or in company in the lounge or dining area. People had access to all parts of the home except other people’s rooms. Some people were able to go out independently while others needed staff support. Any restrictions were agreed and recorded in the support plans. Where restrictions had to be imposed these were agreed in a meeting of professionals who were involved with a person. The manager told us that people were involved in meal preparation one at a time. They also said that three of the people particularly liked to cook. The St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 15 manager said that people could have drinks and snacks when they chose and we saw people having drinks and snacks at different times during the visits. The records showed that people were involved in the food shopping. The food records showed that a varied diet was being served. Some of these records were very detailed and it was possible to tell whether a balanced meal was being served. Other records were less detailed and for example said curry and pasta or chilli and rice. The manager said that people could have what they liked. The food records confirmed this. They showed what each person had eaten and at times everybody had the same thing and at others people ate different things. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. People received support in ways they preferred and required and their physical and emotional health needs were met. People were generally protected by the home’s policies and practices about medication although some attention was needed to recording. This judgement has been made using available evidence including visits to this service. EVIDENCE: We looked at the care records of three people. These records showed that each person had support in ways that they preferred. People were supported to access the health care that they needed. Visits to health care professionals were recorded. People saw the GP, community psychiatric nurse, psychiatrist, dentist, optician and chiropodist. One person was receiving specialist treatment and appointments with the specialist were recorded. They said that they were due to see the specialist soon. The manager and staff talked about the specialist care that this person was receiving. In the AQAA the manager stated that this person had regular meetings with a best practice group consisting of Care Manager, family, Psychologist, Advocate, specialist nurse, St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 17 key worker and house manager to support them. The three health care professionals who completed comment cards said that people’s health care needs were met. One said that St Patricks is very aware and active in promoting each person’s health care. We saw that each person had a record in their support plan of the medication they took. They also had a list of homely remedies agreed by the GP. A monitored dosage system was used and this medication was stored in a locked cupboard. This had an external lock which it was possible to break off. This could be made more secure by fitting an internal lock. A record was kept of medication received into the home, administered, returned and destroyed. We noted that the administration records for one medicine stated that the medicine was to be given as directed. The manager said that this was because the dose was changed frequently. There was separate booklet for this medicine, which contained full details about how this medicine was to be given and when the dose was changed by the doctor. We noted that there was another medicine where the records stated that this was to be given ‘as directed’. There was no information in the record about how this was to be given and the medicine label contained no directions either. Further information should be obtained from the prescribing doctor about how this medicine is to be given. A monthly check was made of each person’s medication. A record was kept to keep track of medication taken into and out of the home, for example when people went to visit relatives. The GP or consultant reviewed the medication regularly. Unused medication was returned to the pharmacist. There were some controlled drugs. These were stored in a controlled drugs cupboard. There was a separate controlled drugs register, which was signed by two staff when a controlled drug was given. This was being properly maintained. A requirement was made at the previous inspection that two staff must sign the medication record sheet when entries or changes to medication have had to be handwritten. This had been partly addressed. Some hand written changes to the record sheets had two signatures but some changes to the timing of medication had not been signed by two people. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. People were protected by the home’s policies and practices about complaints and protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a complaints procedure. There was a complaint format book, which had duplicate pages so that any complaints received in the home could be dealt with properly. One copy was given to the person who made the complaint and the other was held in the book. No complaints had been made by people since the last inspection. Staff asked people whether they had any complaints in service user meetings. The manager stated that he recognised the limitations of this and a representative of the local advocacy network came in ever week to ten days so people could make any complaints to them. People who were spoken to and who completed comment cards knew how to make a complaint. There was a policy about protection from abuse and information about the local safeguarding adults procedures. All staff had been given copies of the ‘No Secrets’ booklet. Staff had received training as part of their Learning Disability Award Framework (LDAF) training. The training records showed that all staff had either received the Protection of Vulnerable Adults (POVA) training or LDAF training and some had received both. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 19 Each person had a behavioural support plan and a physical intervention plan to ensure that their behaviour was managed safely and people and staff were protected from harm. Reports were made to the Commission and to the social worker when physical intervention was used to show that intervention was made in line with these plans. People were supported to collect their own benefits and staff helped people to manage their money. People’s financial records described the amount of benefit received and identified the amount of personal allowance. People signed the records when they withdrew money. Receipts were attached to the appropriate monthly records. All balances were checked daily. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. People lived in a comfortable, clean and safe environment, suitable to their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked around the shared areas as part of the inspection. There was a large communal sitting room, with sofas and pictures, which gave it a homely feel. There was a large dining table in the kitchen and people sat at the table after returning from their activities. The accommodation appeared to be well maintained. The manager showed us the maintenance schedule. This showed the plan of works over the next year to keep the home clean and tidy. This included the flooring, carpets, decoration and lighting. There was a utility room in the extension and another utility room close to the dining area in the kitchen. These had large domestic style washing machines St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 21 and tumble driers to accommodate the laundry demands. The home was clean and tidy on the days of inspection. Six people who completed comment cards said that the home was always fresh and clean and one said that it sometimes was. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. People were supported by an effective staff team, who were appropriately trained and competent to meet their needs. People were not wholly protected by the home’s recruitment practices. People benefited from being cared for by well supported and supervised staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the staff training records and talked to the manager and three staff. We found from the information that there were thirteen staff. Three of these had a National Vocational Qualification at level three. The deputy had an NVQ level two and was working towards the Registered Managers Award. However, they had gone on maternity leave. Four staff had recently finished their learning disability foundation training and were due to start NVQ. One member of staff had recently stated NVQ. More members of staff need to complete NVQ level 2 or above to meet the standard of 50 of staff having a qualification. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 23 When we looked at the staff rota we saw that there were at least three staff on duty but usually more. The rota was flexible so that people could have the support that they needed with activities and appointments. There were two staff sleeping in at night. We spoke to one member of staff who said that there were usually four staff on duty unless one of the people who lived at St Patrick’s was staying with family or friends. During the two days when we visited the home three care staff and the manager were on duty. There was a recruitment procedure. In the AQAA the manager said that equality and diversity started with the selection of staff. He said that they aimed to recruit staff who held beliefs that would ensure that needs in relation to race, gender identity, disability, sexual orientation, age, religion and belief are promoted and incorporated into what the staff do. We looked at the recruitment records for three members of staff who started work since the last inspection. All these staff had completed an application form, which included a declaration about convictions. One person had a Criminal Records Bureau (CRB) check, and two written references and they had completed a health questionnaire. At the front of their recruitment file there was a checklist to show the checks that had been completed and the start date. This was not filled in. The date when the references were received and the date when the person started work were not recorded. It was therefore not possible to tell if all the necessary checks had been done before they started work. Two other staff had also completed an application form with a declaration that they had no convictions. They had completed separate declarations that they were physically and mentally fit. Both of these staff had had a CRB check and a Protection of Vulnerable Adults (POVA) check. The dates when these were received were recorded. They also had two written references one of which was from their previous employer. The dates when these were received were not recorded. Again, each had a checklist, which was not completed and there was no record of the start dates. The manager said that staff always started work after their POVA first check arrived and they worked under supervision. There were always several staff on duty so they were always supervised. It appeared that all the checks had been done before staff started work but it was not possible to confirm this from the records. There was a training plan. This showed the requirements for training, the training that each staff member already had and the action required so that each staff member had the required training. We looked at the training records. These showed that new staff had learning disability award framework induction and foundation training. A range of training was provided including first aid, food hygiene, health and safety, infection control, manual handling, medication, fire safety, physical intervention, prevention form abuse, communication and makaton. The records showed that training was updated at regular intervals. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 24 Physical intervention training was provided by the manager and training manager and there was ongoing refresher training. We made a recommendation at the last inspection that the training about physical intervention should be accredited to ensure that it is up-to-date and remains best practice. The manager had obtained a large amount of information from the internet about accreditation and after considering this had decided not to pursue accreditation. There was a policy and procedure for supervision of staff. The manager provided supervision to the team leaders and the team leaders supervised the care staff. We talked to three members of staff who said that they had regular supervision. One said that they had supervision every six weeks to two months. Another said that they had supervision about every two months but sometimes frequency varied because of leave. All these staff said that they had informal supervision on a daily basis. One said that their supervisor gave good support and the support at St Patricks was second to none. This person had previously worked in other care homes. We saw the plan of supervisions arranged for staff for the forthcoming month. There were annual appraisals. The manager said that these were all done around the same time and they were planned in for January and February. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. The registered manager was suitably qualified, competent and experienced, so that people benefited from a well run home. People’s views underpinned all self-monitoring, review and development by the home although the report about these views needs to be published. People’s health and safety were protected by the systems in place although some attention was needed to recording. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had worked in the home since the home was opened. He had a range of skills in managing people with challenging behaviour. He was appropriately qualified. The training records showed that he kept his training St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 26 up to date. He had overall responsibility, although some tasks were delegated to the deputy manager and other staff in the home. At the last inspection we noted that quality assurance was being developed. Questionnaires had been sent to care managers, doctors, community nurses and other professionals. The views of the people who lived in the home had been sought. The information had been collated at head office but a report of the findings and an improvement plan had not yet been produced. We made a requirement that a report must be produced and a copy must be sent to CSCI. We have not received a report about St Patricks and a copy of a report was not available during the visits. The manager said that questionnaires had been sent out again. The minutes of the recent management meeting confirmed this and identified that the results were due to be collated in March 2008. There was a health and safety policy. There was information about health and safety, Control of Substances Hazardous to Health (COSHH), food safety and manual handling. Staff received training about health and safety, first aid, food hygiene, and manual handling. Radiators were covered and the hot water temperature was regulated to reduce the risk of burns and scalding. The temperature of the water was also checked daily. Portable appliances were tested annually. There was a fire risk assessment and this was updated in December 2007. The fire officer visited in August 2007 and identified no issue for attention. Fire safety checks took place and records were kept. We made a requirement at the last inspection that when staff have attended fire safety training a record of the date must be made above the person’s initials. A record was made when staff received fire instruction but the date when it took place was not being recorded. St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 28 x 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 YA17 Regulation 17(2) Schedule 4 , 13 13(2) Requirement The records of food served must contain sufficient detail so that the person reading them can judge whether a balanced diet is being served. Two staff must sign the medication record sheet when entries or changes to medication have had to be handwritten. The registered person must produce a report of the findings from the quality assurance survey, supply to the Commission a copy of the report and make a copy of the report available to people who live in the home. Timescale for action 07/02/08 2. YA20 07/02/08 3 YA39 24 30/04/08 4. YA42 23(4) (d) When staff have attended fire 07/02/08 safety training, the actual date of training session must be recorded above the persons initials. (This was a requirement at the last inspection and the two before.) St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 29 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 YA6 Good Practice Recommendations The physical intervention plans should be reviewed to ensure they contain enough information about which behaviours may need intervention and changed if necessary. The risk assessments could be improved by including the benefits to people of taking particular risks. This would show why risks are being taken and whether it is in the interests of the person. The lock on the medicine cabinet should be changed to an internal lock to ensure that people’s medication is stored securely. When it is written on the medication administration sheet that a medicine must be given ‘as directed’, and no guidance has been provided, the registered person should refer back to the prescribing doctor for clear instructions. More staff need to be enrolled for NVQ and complete the course to ensure that there are sufficient qualified staff to support people. The recruitment checklist should be completed and a record should be kept when each check is received and when staff start work to show that all the appropriate checks have been carried out. 2. YA9 3. 4. YA20 YA20 5. 6. YA32 YA34 St Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Patrick`s House DS0000060340.V354666.R01.S.doc Version 5.2 Page 31 - 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. 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