Inspection on 21/02/07 for St Paul`s Hostel

This inspection was carried out on 21st February 2007.

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

Other inspections for this house

St Paul`s Hostel 31/01/08

St Paul`s Hostel 24/02/06

St Paul`s Hostel 01/07/05

St Paul`s Hostel 13/10/04

St Paul`s Hostel 21/04/04

Similar services:

22 Sandown Road

The Highlands

Dilston College Of Further Education

West View House

Prince Bishop Court

Park View (15)

Craigmore House

1 Lanark Close

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

CARE HOME ADULTS 18-65 St Paul`s Hostel 4 St Paul`s Road Middlesbrough TS1 5NQ Lead Inspector Joanna D White Key Unannounced Inspection 21st February 2007 10:05 St Paul`s Hostel DS0000033846.V320235.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 Paul`s Hostel DS0000033846.V320235.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 Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Paul`s Hostel Address 4 St Paul`s Road Middlesbrough TS1 5NQ 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) 01642 241620 F/P 01642 241620 Middlesbrough Council Louise Naylor Care Home 21 Category(ies) of Learning disability (21) registration, with number of places St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two named individuals who are over the age category are allowed to reside in the home. 24th February 2006 Date of last inspection Brief Description of the Service: St. Pauls Hostel is situated at 4 St. Pauls Road in Middlesbrough and is a local authority care home for adults with a learning disability. The home is registered with the Commission for Social Care Inspection under the Care Standards Act 2000. St. Pauls Hostel is a two-storey building providing care and accommodation for twenty-one adults. The home is divided into two distinct units for seven respite service users and fourteen assessment/long stay service users. The latter unit is further sub divided for the differing service user groups. All bedrooms are for single occupancy. Two bedrooms have an en-suite facility with a toilet and washbasin and another two bedrooms have a bathroom and a separate toilet facility. The home also provides communal washing and bathing/showering facilities for all service users occupying the other bedrooms. Service users have access to the town centre and local amenities. Travelling further afield is by means of the homes mini bus. Staff said service users are encouraged to continue with educational and leisure interests. Each service user has a weekly programme of activities; most attend day care, Monday to Friday, at various locations in Middlesbrough. The home has regular service users meetings where service users are able to give their views about the running of the home. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a key inspection and was unannounced on the first inspection day. There were two visits to the home by one inspector on 21st February 2007 from 10.05am until 06.42pm, and 28th February 2007 from 09.35 until 06.42pm. One visit was made to Middlesbrough Council on 19th March 2007h from 1.10pm until 2.00pm to look at three staff recruitment and selection files. All of the key standards were examined during the inspection. In total six residents files were examined four belonging to those residents receiving long term care and two for those residents who were provided with respite provision. Four staff files were examined including personal training and development plans. In addition the medication records, health and safety records and policies and procedures, were examined during the inspection. A walk around the home also took place. A pre-inspection Questionnaire, which the manager had completed, was also provided. Ten ‘ Have your say about ‘ were completed by the residents including six relatives / visitors comment card. The inspector spent time with six of the residents finding out what it was like for them to live in St Paul’s. The manager informed the inspector, that the charges for residents’ accommodation were based on assessed and sliding scales the minimum being £62.35 per week. What the service does well: One Relatives/Visitors Card said, “ St Paul’s gives an excellent service. Staff pleasant and welcoming. We really appreciate the service” and another wrote, “The staff in St Paul’s is the most valuable asset and to date the staff have proved excellent.” One resident wrote down in ‘Have your say about “ It’s alright here”. Another resident wrote, “I love living here. I like the support I get from the staff. “ The staff team are committed to meeting the needs of the residents. The residents were observed to be relaxed and happy in the presence of staff with whom they were able to communicate their wishes, views and feelings. The home ensures it provides activities, which meet the needs of all of the residents. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home needs to develop a maintenance programme, which identifies dates on which particular pieces of work are going to take place. A number of areas were observed to be in need of refurbishment and re decoration which included the decorating/partial decorating of eleven rooms, seven of which were residents bedrooms, the top of a radiator cover which was rusting, and wardrobe doors in seven residents bedrooms. Replacing the tops of four taps, a wardrobe handle, a cooker door, which was missing, and a worn chair. Repairing a crack in the second drawer of a three-drawer unit, another drawer in the lounge dresser unit, a crack in the laundry ceiling and a lock, which was broken on wardrobe doors. Re grouting was required in four rooms. Flaking paint was observed in two other rooms where one room had cracked tiles. Four immediate requirements (immediate action to be taken by the manager to address concerns) were issued in respect of unsafe shower doors, an unsatisfactory inspection of the electrical installation, a loose drawer which did not close properly, a loose door at the top of a tall storage unit which was loose and did not close properly, and a worn carpet which caused a potential tripping hazard. A number of other areas were identified as being in need of development, which included, ensuring care staff received one to one supervision at least six times yearly with their senior/manager, the provision of ramped access for residents at the front of the property, the presence of the signature of the member of staff administering medication in both the long term and respite unit, detailed information always being available about medication leaving the home from the respite unit, and written evidence being obtained from an authorative source about the medicine the resident was taking prior to their admission to the respite unit, reviewing the procedures for the disposal of medication from the home to ensure that there was no mishandling and providing written confirmation that the medication records were audited. Further development of the quality assurance systems, was also required. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 7 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 Paul`s Hostel DS0000033846.V320235.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 Paul`s Hostel DS0000033846.V320235.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s individual needs and aspirations were assessed and recorded. EVIDENCE: A proportion of the current residents had lived in the long-term unit at St Paul’s between twenty and thirty years. Discussion with the manager confirmed that any new residents who were admitted to St Paul’s received a comprehensive needs assessment, completed by their social workers and health professionals. A copy would always be shared with the home prior to the admission of the resident to afford an opportunity for the needs assessment for each prospective person to be considered against the homes statement of purpose as well as ensuring the staff had the necessary skills, ability, and qualifications to meet the assessed needs of the perspective resident. An examination of four residents’ files confirmed assessments supplied by the placing authorities social worker were received by the home, including any assessments undertaken through care management arrangements. A copy of each residents care plan was also obtained before their admission. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 10 Evidence was available that information was provided from a range of sources, which included other relevant professionals such as GP’s, Consultant Psychiatrists, Community Psychiatric Nurses and Psychologists. The views of relatives were also considered. Potential residents would also be given an opportunity to spend time in the home via tea visits and overnight stays during which the staff would have a chance to confirm their needs and identify any additional support, which was necessary. The assistant unit manager of the respite unit confirmed that there were a number of residents who regularly used the respite service provided by St Paul’s. She shared with the inspector a copy of ‘The rolling programme from October 2006 to November 2007’, which was provided for residents and their families and outlined when their respite provision would be available. In addition she said referrals and carers assessments were also received from social workers prior to the admission of perspective residents to the respite unit. She explained following receipt of this information an introductory visit was arranged for the perspective resident and their family, to have a look around the unit. Tea visits would then take place followed by an overnight stay during which opportunities would be available for the staff to ensure that the unit had suitable facilities and equipment to meet the identified needs of the residents. An examination of two residents’ files confirmed referrals and carers’ assessments were present St Paul`s Hostel DS0000033846.V320235.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents assessed, changing needs and personal goals are reflected in their care plans. Residents make decisions about their lives. The staff provide support when necessary. The residents live individual lifestyles and are supported to make appropriate decisions. EVIDENCE: In total six residents files were examined four belonging to those residents receiving long-term care and two for those residents who were provided with respite care. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 12 The files belonging to those residents receiving long term care included a “‘Personal Planning Book - This book is to help you create a detailed personal plan for yourself “ which provided information about,” Important people in my life, my circle of support, my life now, my life story, health and keeping safe, things I like, things I don’t like etc. and there was evidence that, “ ….. is acting as an advocate for me to help put my ideas into this book” Care plans were also present and contained a health section, which gave details of any health concerns, a health action plan book, health reviews and assessments, medication, mobility etc. One resident said “ I like always to have someone with me when I attend health appointments” Pen pictures and photographs of each of the residents were also available. In addition the assistant manger confirmed a daily recording sheet for each resident receiving respite care was also completed which provided information about personal care, behaviour, meals, communication, activities, sleeping patterns, etc. The manager, staff and the assistant manager of the respite unit informed the inspector that the residents participated in activities to promote their independence. An examination of residents’ files confirmed that appropriate risk assessments had been completed for these residents to take part in daily activities such as going out alone, or making tea and coffee. Risk assessments were also in place for the residents to participate in additional activities such as washing and ironing. One resident said, “I like to have a set routine.” Another resident said, “ I have not done washing before. The staff do it for me I am happy with that.” Staff told the inspector another resident “ Went to work.” Other residents attended the Gateway Club and some residents, “ did their own washing and are assisted to do the ironing” One of the residents had returned from the day service and said “ I have had a great day. I have been really busy. I have been doing drama and learning computer skills” The records also evidenced that the residents were seen by the home as individuals in their own right who were able to make decisions about areas of their life, which were important to them such as, relationships, one resident said “ I am going to my boyfriends/girlfriends “, personal finances, community participation, leisure, work, education, and support. One residents care plan, which was examined, stated “ I like my key worker” The manager also confirmed the residents were empowered to make decisions about every day things such as, menu planning, and choosing where to go on holiday and trips and outings. She added the residents had been to Spain and discussions were taking place about going to New York and Blackpool this year. St Paul`s Hostel DS0000033846.V320235.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 and 17. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Staff assist the residents to take part in valued and fulfilling activities and support them in continuing their education or training. Staff in accordance with the residents assessed needs and Individual Plans encourage them to become part of and participate in the local community Relatives and friends are encouraged to maintain contact with the residents. The residents individual choice and freedom of movement is ensured by daily routines and house rules which promote independence The residents’ nutritional requirements are promoted by a varied diet. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 14 EVIDENCE: During discussion with the manager she confirmed that the residents visited the local shops and cafes, cinema, theatre, pop concerts, art and craft events, and went on holiday and had weekend breaks away from the home. Activities provided for the residents within the home, included board games, watching television, and videos, bingo, quizzes, karaoke, listening to the radio and CD’s. One resident liked Elvis and was going to an “ Elvis look alike concert” Another group of residents went away for a weekend to see “ Dirty Dancing” One resident had gone to a Doctor Who convention. One member of staff who spoke to the inspectors said the residents were always occupied and “ I am taking a group of residents out tonight to celebrate a birthday. Last year at this time we went out for a meal. We are always doing something.” Another member of staff said,” I really like working here I feel I make a great difference to the life of the residents. There is always something really interesting to do and we have transport at the weekends and have recently been to York and Whitby. The residents had a great time”. A resident said “ I go to church on Sunday and I also go during the week, I have lots of friends there. I really like to go. We talk a lot” Another resident said “ I like pamper evenings, buying new clothes, music watching television, shopping disco parties, going out for dinner, going to church.” Another resident said,” I play my guitar and my play station, I like music and karaoke, I like going out for the day” The manager confirmed that the residents had the opportunity to develop and maintain important personal and family relationships. One resident said “ I am going to visit my boyfriend/girlfriend tonight.” Family members were encouraged to visit the home regularly. One resident said, “ I like to have a nice room and I always look after it” Another resident was described as always knowing where everything was in his /her room and said, “ I like it to be a certain way” The residents also said “ We have great food here. We can choose what we want. There is always a lot of fruit and we have vegetables too” The menu was examined and confirmed the meals were balanced and nutritious and catered for the dietary and cultural needs of the residents. On the first day of the inspection the inspector had salad, potato croquets, and lasagne for tea. An option was available which consisted of pork chops, peas, mashed potato, onion rings and cabbage. One resident was observed asking for a second helping. Choices of cold drinks were available as well as coffee and tea. The food was very well presented and appetizing. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 15 A choice of apple pie and custard or yoghurt for desert was also available as well as fresh fruit. Mealtimes were observed to be very social and relaxed occasions. One resident said, “ The food here is great. We always have a choice I like the curries” .A tour of the kitchen on the first day of the inspection confirmed that there was an adequate supply of fresh vegetables, and the pantry was very well stocked. There was also evidence of a birthday cake being made for one of the residents. It was noted during a walk around the home that the bedroom doors did have locks fitted and residents were provided with keys for their rooms. The inspector also observed that staff respected the privacy and dignity of the residents by entering the residents’ bedrooms and bathrooms with their permission. One member of staff said, “ I treat the residents how I would like to be treat myself” Another member of staff said, “ I always make sure I can speak to the resident in private.” The residents told the inspector that they could choose when to be alone or in company and when not to join in an activity. On one day of the inspection a resident was observed watching television in the lounge, on another day a resident was observed waiting for a lift in the hallway to the Gateway club. On another day a resident was observed talking to their support worker in their flat. On another day a group of residents were going out together to the local pub. St Paul`s Hostel DS0000033846.V320235.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 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In accordance with the wishes of the individual resident staff meet the residents healthcare and personal needs in a sensitive and flexible manner. The residents’ physical and emotional needs are met. The homes medication policies and procedures are not as robust as required and need further review and development to ensure safe and effective systems are in place. EVIDENCE: The manager and the assistant manager in the respite unit confirmed that the staff responded appropriately and sensitively in all situations involving the residents personal care by ensuring that it was conducted in private and by a person of the same gender. Staff who were spoken to said. “ The residents dignity, independence, and choice, is really important” St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 17 The inspector observed that aids and equipment were provided to encourage the maximum independence of the residents. One resident was observed using a wheelchair. The staff said, “ The residents have supper when they want it and can choose when to go to bed”. The staff said they knew the residents very well and consequently would share any concerns about their emotional health within the staff team to ensure that there was consistency of care and that their health needs were met. Residents’ records confirmed that they had contact with the GP, Consultant Psychiatrist, Community Psychiatric Nurse, Optician, Chiropodist, Dentist, Nurses, and Occupational Therapist, The files of four long-term residents, and two respite residents, were examined and there was evidence in their individual care plans of written consent to medication. A copy of the ” Consent form for administration of household remedies “ signed by the GP was also present. The manager stated that none of the residents administered their own medication. One resident said, “ I like staff to give me my tablets. I need staff to order my tablets. I like the staff to give me my medication. I don’t want to sort it out myself.” The medication administration records for four long-term residents and two respite residents were examined and confirmed a record was maintained of the current medication for each resident. The signature of the member of staff administering the medication was not always present in both the long term and respite unit. Detailed information was not recorded about medication leaving the home from the respite unit, and on one occasion a respite residents medication had been retained which was against the homes medication policies and procedures. There was also no evidence, that on admission into the respite unit, written confirmation of the medicine the resident was taking had been obtained from an authorative source. The procedures for the disposal of medication from the home to ensure that there was no mishandling also required review. In addition there was also no written evidence that the medication records were audited. The manager confirmed she had discussed these matters with the assistant manager and staff and changes had been introduced immediately to ensure safe and effective systems were in place. She also confirmed the homes medication Policies and Procedures would be reviewed and updated. Discussions with the staff and an audit of four staff files revealed that only staff who had undertaken medication training administered medication. St Paul`s Hostel DS0000033846.V320235.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 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The manager and staff listen to the views of the residents and are fully aware of how a complaint investigation is conducted. Written procedures are in place to promote the welfare of the residents. EVIDENCE: The complaints procedure was examined and contained the required information in terms of how to make a complaint. The inspector had received six relatives/visitors comments card, four of which confirmed the relatives/visitors were “aware of the home’s complaints procedure” and none of the six had “ever had to make a complaint.” Nine of the ten” Have your say about,” which had been completed by the resident’s, confirmed that they would know how to make a complaint. The pre inspection questionnaire completed by the manager confirmed that in the preceding twelve months the home had not received any complaints. The home had also received a number of “Thank you” cards. One relative/visitors comment card said, “ My..has been a resident in St Paul’s for some years now and I have always been happy with the staff who keep me well informed and am very happy about the care of my….” St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 19 Discussions with the staff confirmed that they would know how to respond should a resident wish to make a complaint and an examination of four staff files and Personal Training and Development plans confirmed, that all staff had received training in Protection of Vulnerable Adults and No Secrets Training. In addition staff that were spoken to gave clear examples of how they would respond in particular situations. There had been no vulnerable adult referrals. One resident said, “ Everyone who cares for me helps me to stay safe and well” St Paul`s Hostel DS0000033846.V320235.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): 24,26 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Remedial repairs, maintenance and re decoration are required to ensure the residents live in a homely, well-maintained environment to meet their needs and lifestyles. The residents live in a clean and hygienic environment. EVIDENCE: A walk around the home took place and whilst St Paul’s provided the residents with a welcoming, and clean environment there were areas of home, which required remedial repairs, maintenance and re decoration. One relative/visitors comment card said, “The interior is now looking a little tired” St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 21 Wallpaper, which was dirty, peeling and had been written on, including a crack in the second drawer of a three-drawer unit, and a missing cover from the top of the cold-water tap, were observed in room 3. In room 4 the top of the cold-water tap, and in Room 5 the top of the hot water tap were missing. Marks were observed on the wall above the bed in room1, and the seat cushion and arms of the chair were worn. Staining was observed around the window. In room 2 the wallpaper was marked and the cover was missing from the top of the cold-water tap. There was a mark on the ceiling in room 6 and the wallpaper was marked in room7. The bottom cooker door was missing in room 38. The manager informed the inspector the resident did not use the cooker and it had been disconnected from the electricity supply. The windows had flaking paint, and grouting was missing from around the pipe work in room 57 and from the corner of the ceiling in room 59. In addition paint was flaking from the ceiling, and there were cracked tiles, and grouting missing from around the sink in room 58. Re- grouting was also required in room 49 where the top of the radiator cover was rusting. Wardrobe doors were either stained or the paint was chipped in rooms 56, 55, 54, 53, 52, and 50 and in room 52 a drawer handle required re placement. In room 54 the lock on the wardrobe doors was broken and in room 55 and 56 marks were observed on the walls. A handle was missing from the wardrobe in room 51. The ceiling was cracked in the laundry. The lounge dresser unit drawer needed repairing. In addition the manager was asked to take immediate action to carry out the necessary maintenance work to a drawer under the sink unit and the door at the top of the tall storage unit that was loose and did not close properly in room 30. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 22 The seal at the bottom of the shower door had become dislodged, and the shower door was coming away from the shower frame, in the respite unit, downstairs bathroom and the manager was asked to take immediate action to address this issue. The seal at the bottom of the shower door had also become dislodged in the respite unit, upstairs bathroom, and again the manager was asked to take immediate action to address this issue. The carpet in the downstairs hallway outside of the main office was worn and caused a potential tripping hazard. The manager was instructed to take immediate action to address this issue. The manager informed the inspector that new nets had been purchased for all of the windows in St Paul’s and a new carpet had been ordered for the downstairs hallway. The dining room had also been re decorated and new curtains, pictures, and matching table clothes had been purchased which had resulted in a modern, bright and cheerful environment for the residents to enjoy. One resident said, ” Do you like the dining room we’ve got new curtains” All of the resident’s bedrooms were seen by the inspector and contained personal items such as televisions, CD players and CD’s, videos, and photographs, One resident said, “ I like my flat it is big” another resident said, “Come and see my room. I really like it” and another resident said “ All my personal belongings are in my room “. The manager confirmed since the last inspection there remained no ramped access at the front of the property for wheelchair users. The outside of the property was well kept. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 23 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): 32,34 35 and 36. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The residents’ benefit from competent, knowledgeable, qualified and welltrained staff. Adequate staffing is provided to support the service users assessed needs at all times. The recruitment records contain sufficient information to ensure that service users are fully supported and protected. Staff do not receive supervision at least six times per year. EVIDENCE: The manager said the current staff had the necessary skills, experience and training to meet the needs of the residents. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 24 Four staff files were examined and confirmed that the staff had received the following training, Safe Handling of Medication, National Vocational Qualification (NVQ) Level 2 and NVQ Level 3, No Secrets, Dementia, Handling Violence and Aggression, Diabetes, Person Centred Planning, Corporate Cultural Awareness, Assessor up Date Training, An introduction to Medicines and Prescriptions Refresher Course, Understanding and Prevention of MRSA, and Healthy Eating, and all of the required mandatory training including fire, first aid, health and safety and food hygiene. The pre inspection questionnaire confirmed that future planned training would include National Vocational Qualification Level 2, NVQ Level 3 and NVQ Level 4, No Secrets Level 1, Cultural awareness, Cultural Diversity, Open learning, and Health and Safety training as required. The pre inspection questionnaire also stated that currently 65 of the staff were trained to NVQ Level 2 or above. A visit was made to the Council’s Office in Middlesbrough where the recruitment and selection records of three staff were examined and confirmed they included all of the information as stated in Schedules 2 & 4 of The Care Homes Regulations 2001. A copy of the “Successful Candidate Checklist “was also shared with the inspector and confirmed the council had effective internal recruitment and selection monitoring processes in place. The inspector also had discussion with the senior manager (Recruitment and Selection), on the 13th February 2007, who stated a small staff development team, had been established which focused on the Council’s recruitment and selection processes, to ensure all of the necessary information was collated before contracts of employment were provided. A previous inspection report had highlighted that the staff had not received, at least six times yearly, one to one supervision with their manager. An examination of four staff files and discussion with the manager confirmed that this was still the situation. The manager shared with the inspector a copy of the home’s yearly supervision schedule, which she said, would address this issue. Dates for staff annual appraisals were also recorded. St Paul`s Hostel DS0000033846.V320235.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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager is appropriately qualified and experienced. The views of the residents are actively sought to underpin all self- monitoring, review and development by the home The health, safety and welfare of residents and staff are not promoted and protected. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 26 EVIDENCE: The manager had the required qualifications and experience and said she worked continuously to improve services to ensure an increased quality of life for the residents. The manager added she was person centred in her approach and lead and supported a strong staff team who had been recruited and trained to a high standard. Quality assurance was discussed with the manager who shared with the inspector a copy of a “Questionnaire Adults with Learning Disabilities using/Requiring Respite/Short term break Services” It stated “ The questionnaire can be completed by you the client, a parent/carer, ……….on your behalf or through help available by an advocate. If the views of the parent or carer are different from the client or service user then please record them in the comments section.” Questions asked included, “ Are you happy with the current short term break/respite services that you receive? Would you say the short-term break service is right for you? Are you happy where the buildings are? What do you think is important about respite /short term break service? Value for money? How are you cared for? Etc. A report evidencing outcomes was shared with the inspector and included comments such as “ It’s like home from home” “ Warm welcome” “ Peace of mind” Suggestions for improvement included “ More information about service available” However, there was no evidence that the home had sought the views of stakeholders in the community on how the home was achieving its goals for the residents. The manager said the views of the residents were actively sought, and shared with the inspector the minutes of the last residents meeting which had been recorded in a pictorial format on the wall of the lounge and covered topics such as, “What has happened since the last meeting, bingo nights, trips in the mini bus, Elvis Redcar Bowl, quiz night, general knowledge, and brochures to go on holiday to Spain and New York. Health and Safety records were examined. Maintenance matters such as boiler, and PAT (Portable Electrical Appliances) testing were noted to be up to date. The manager confirmed that all portable appliance equipment brought into the home by those residents receiving respite was checked on a yearly basis. However following a five yearly test and inspection of the electrical installation the inspection report declared “ the installation was overall in unsatisfactory condition” as a result of which, the manager was asked to take immediate action to address this matter. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 27 The inspector also requested a representative from Cleveland Fire Brigade undertake an audit of the fire safety arrangements at St Paul’s the outcome of which was “ to impose upon the responsible person a requirement to carry out a fire risk assessment of their premises” and to ensure, “ The staff are adequately trained and instructed as to their actions in the event of a fire. The aim should be to ensure that all staff receive training appropriate to their responsibilities in the event of an emergency. It shall be based on written instructions. Exercises for staff shall be held at regular intervals to ensure the smooth operation for dealing with an emergency” St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 28 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 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 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 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 4 13 4 14 X 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 1 X St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 The registered person must ensure the homes policies, and procedures for the receipt; recording, handling, storage, safe administration and disposal of all medicines are reviewed and updated. The registered person must ensure that there is a system in place to effectively audit all aspects of medicines management within the home. The member of staff responsible must sign for all medication at the time of administration. Timescale for action 20/06/07 2. YA20 13(2) 01/03/07 3. YA20 13(2) 17 4. YA24 13 23 The registered person must 01/03/07 ensure records are kept of all medicines received, administered and leaving the home or disposed of to ensure that there is no mishandling. The registered person must 01/05/07 ensure the carrying out of all remedial repairs, maintenance and re decoration to the following; Room 38 St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 30 The bottom cooker door was missing Room 49 Re- grouting required. The top of the radiator cover was rusting. Room 57 The windows had flaking paint, and grouting was missing from around the pipe work. Room 59 Grouting was missing from the corner of the ceiling. Room 58 Paint was flaking from the ceiling, and tiles were cracked. Grouting was missing from around the sink. Laundry A cracked ceiling. Lounge Repair to dresser unit drawer. The grounds No ramped access for wheelchair users (This requirement is outstanding since the inspection which was undertaken in July 2005) 5. YA24 13(4)(a) 23(2)(a) The registered person must ensure the home within twentyfour hours carries out the necessary maintenance work to the drawer under the sink unit and the door at the top of the tall storage unit which are loose and do not close properly in room 30. 01/03/07 St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 31 6. YA24 13(4)(a) 23(2)(a) The registered person must ensure the home immediately carries out the necessary maintenance work to the seal at the bottom of the shower door which has become dislodged, and the shower door which is coming away from the shower frame in the respite unit downstairs bathroom 28/02/07 7. YA24 13(4)(a) 23(2)(a) 8. YA24 13(4)(a) 23(2)(a) The registered person must 28/02/07 ensure the home immediately carries out the necessary maintenance work to the seal at the bottom of the shower door, which has become dislodged. in the respite unit, upstairs bathroom. The registered person must 28/02/07 ensure the home immediately carries out the necessary maintenance work to the carpet, which is worn, and causing a potential tripping hazard in the downstairs hallway outside of the main office. The registered person must ensure the carrying out of all remedial repairs, maintenance and re decoration to the following; Room 1 Marks on the wall above the bed, and a chair with a worn seat cushion and arms. Staining around the window. Room 2 Marked wallpaper and a missing cover from the top of the coldwater tap. Room 3 Dirty, peeling and written on 01/05/07 9. YA26 16(2)(c) St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 32 wallpaper, including a crack in the second drawer of a threedrawer unit, and a missing cover from the top of the cold-water tap Room 4 A missing cover from the top of the cold-water tap. Room 5 A missing cover from the top of the hot water tap. Room 6 A mark on the ceiling. Room 7 A mark on the wallpaper. Room 51 A missing handle from the wardrobe door. Room 52 Replacement of a door handle. Room 54 A broken lock on the wardrobe door. Room 55 Marks on the wall. Room 56 Marks on the wall. Rooms 50 52 53 54 55, and 56 Wardrobe doors with stains or chipped paint. 10. YA36 18(2) The registered person must ensure all care staff receive one to one supervision at least six times yearly with their senior/manager 01/06/07 St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 33 (This requirement is outstanding since the unannounced inspection which took place on 24/02/06) 11. YA39 12 (1) (a) The registered person must 01/08/07 24 (1) (a) ensure the homes quality (b) (2) (3) assurance systems are developed to include the views of stakeholders in the community. An analysis of the results must be published in a report, which must be made available to residents and other stakeholders including the Commission for Social Care Inspection. (1)(e) The registered person must 28/02/07 ensure an immediate inspection of the electrical installation is completed. (1)(e) The registered person must 01/03/07 ensure the home complies with the Cleveland Fire Brigade The Regulatory Reform (Fire Safety) Order 2005 schedule of work dated 01/03/07 Specification of work required Article 9 Fire Risk Assessment and article 21. 12. YA42 13. YA42 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 YA20 Good Practice Recommendations The mobile trolley, which is used to store medicines, should be locked and fixed to the wall when not used for medicines administration or secured in a locked designated place. Upon residents admission to the respite unit written confirmation of the medicine the residents are taking 2. YA20 St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 34 3. 4. 5. YA20 YA22 YA37 should be obtained from an authorative source. The registered manager should ensure all staff understand how to accurately measure liquid doses of medicines. The complaints procedure should be shared with the residents and relatives /visitors The registered manager should continue to ensure she address the identified areas for development within St Paul’s. St Paul`s Hostel DS0000033846.V320235.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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. 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