Care Home: St Albans Close

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Albans Close 1-2 St Albans Close Northampton NN3 2RJ two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judith Roan Date: 2 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 30 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: St Albans Close 1-2 St Albans Close Northampton NN3 2RJ 01604785775 01604415489 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Royal Mencap Society Name of registered manager (if applicable) vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 7 0 care home 7 learning disability Additional conditions: Date of last inspection 2 6 1 0 2 0 0 6 A bit about the care home St Albans Close is a residential care home providing personal care and support to 7 men with learning disabilities; a service provided by the national charity Mencap. St Albans Close is situated on a residential estate on the outskirts of Northampton Town Centre with access to a range of community facilities. The Home comprises two semidetached properties, which have been merged, and undergone major refurbishment to create a spacious and Care Homes for Adults (18-65 years) Page 4 of 30 homely environment suited to the needs of the service users. Gardens to the rear of the house have been landscaped and provide spacious outdoor facilities. A small self-contained flat has been created on the first floor and is occupied by one of the residents? who has a high level of independence and self-skills. Staff provide support and supervision as needed, the service user concerned is able to access all other facilities and services of the Home on an equal basis. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home At this inspection we randomly selected two people who use the service and tracked the care they receive through discussion with several people during the visit, review of their records, the care staff and observation of care practices. In observation it was evident that people were happy with the support they received. We also received information from support staff and a health care professional. The homes registered manager also completed an Annual Quality Assurance Assessment (AQAA) a document required by CSCI. The inspection was unannounced and lasted 6 Hours. Care Homes for Adults (18-65 years) Page 7 of 30 People using the service said that I like the support staff and they are kind and helpful That they enjoyed the leisure activities they became involved in My room is how I like it and I can make choices with support staff on how it is decorated We also help to choose items in the dining room and lounge If I am not well the support workers help me to see my doctor We can choose what we would like to eat. Fees are according to level of support required. They include personal care, accommodation, meals, laundry and a seven day holiday. Additional charges include chiropody, toiletries, clothing and travel. Care Homes for Adults (18-65 years) Page 8 of 30 What the care home does well The registered manager and support workers demonstrated that they provide a good standard of care and support to people who use the service. Creating opportunities to develop independence with everyday living skills is promoted. The home is clean and comfortably furnished. The home provides a choice of different communal areas where individuals can spend time alone if they wish. There is good access to all parts of the home and garden. People living at the service were observed to be comfortable and relaxed within their home. Care Homes for Adults (18-65 years) Page 9 of 30 Training is provided for support workers to develop the specific skills to meet the needs of people who use the service. What has got better from the last inspection Management have actively recruited to staff vacancies providing continuity in care. Training now meets care sector standards. Care Homes for Adults (18-65 years) Page 10 of 30 Records have improved and provide evidence on how needs are met. What the care home could do better The provider must review medication storage facilities at the home to ensure that controlled drugs can be safely stored and meet the new regulations that came into force in 2007. Care Homes for Adults (18-65 years) Page 11 of 30 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Judith Roan CSCI Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 12 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The admission process ensures that needs are assessed and that service users are fully involved within the process. Evidence: All of the people living at St Albans Close have lived at the home for many years. It is evident that continuous assessment is carried out to take account of individuals changing needs. For new admissions a process would entails the registered manager and members of the support worker group spending time with the person considering the service, their family, gathering detailed information from any previous placements and the funding authority. The information is updated with ongoing work especially in relation to health care needs. The statement of purpose and service users guide has been updated and contains the Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: required information set out by the Care Homes Regulations 2000.The homes statement of purpose sets out the aims and objectives and details the facilities and services provided. One person completing the survey confirmed that this information was available to help them make a decision about the suitability of the home. The service users guide also provides confirmation of what can be expected for people already using the service. The registered manager states that all information about the service is being reviewed and transferred to different formats Mencap have an assessment tool and a clear admission procedure that includes obtaining copies of all relevant assessments. The registered manager has worked to update files with this information. Review of individuals files identified that there was a copy of a licence agreement signed by people using the service. This agreement details the charge, made to the person by the housing association and Mencap. The agreement states what is included within the charge i.e.; accommodation, food, heat, light and other services including a contribution towards support or care. Details of total fees charged and how individual charges to residents are calculated were not available. Care Homes for Adults (18-65 years) Page 15 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People using the service can expect that practices within the home promote their involvement and independence. Evidence: The care files of two people using the service were reviewed and reflected current needs. Support plans have been updated and are reviewed as required. The outcomes for people who use the service are in the main positive but it was evident that the needs of one individual was taking priority of the needs of others and was at times creating an unequal service. The registered manager was aware of the situation and is taking steps to address the situation. In discussion with support workers it was evident they are very knowledgeable about the needs of individuals that use the service. Support for individuals enables them to develop their skills and participate in everyday activities that they previously were not able to achieve. Personal learning is achieved by the consistent approaches used by support workers and individuals having access to and observing a broad spectrum of daily living Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: activities. Risks within activities are considered on an individual basis and plans made to minimise these for each person. Everyone is encouraged to be as independent as possible with appropriate support. In this way people using the service are included within activities and not excluded because of any behaviour that may arise. Support plans are important tools in guiding staff as to the actions required to meet an individuals needs and preferences. Support plans have been developed and are continually updated to meet their changing needs. Support workers confirmed that each person is involved in the development of their plans within their ability. They also demonstrated during the inspection the importance of the person using the service and their family/advocate being involved. In discussion with the registered manager and a statement made within the AQAA support plans and meeting individual needs has been a high priority since they took on the role as manager. They also acknowledged that more work is still required and that support plans and records need to demonstrate how people using the service achieve their agreed goals. The AQAA states that making support plans person centred and having accessible resources to aid communication with people using the service will achieve this. Care Homes for Adults (18-65 years) Page 17 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Planned intervention enables and supports people using the service to develop personal skills and take opportunities for social and community activities. Evidence: Experiences for people using the service remain good and varied. It was evident that individuals on the day of the inspection were in part involved with day to day living tasks within the home. However the increasing needs of one person was pulling support staff away from preparing the evening meal. A decision was made to have a takeaway so the meal could be served at the normal time. In observation this did result in some people not being involved in a daily living task and reduced support to everyone. Normally support workers freshly cook the main meal with the involvement of people using the service. A menu is chosen at the house meetings and records are maintained. Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: The planned activity for evening was the regular house meeting that enables people to voice their views and discuss common topics. This was a very long meeting and in observation it appeared that some people using the service found this difficult. It is recommended that this be reviewed to explore how the experience could be improved for everyone. Mencap have a family charter and through the quality assurance system their views are sought. The AQAA indicates that by using the family charter contact is maintained and supported. Files seen demonstrate that through letters regular contact is maintained. Families are invited to forthcoming shared events. Several of the people using the service attend day activities away from the home. In discussion with them it appears they are happy with their placements. Others are in work related schemes where a small salary is paid. All daily activities are kept under review with day care providers to ensure that individuals are still gaining benefits and enjoying their time. Support workers and the manager confirmed that people do have opportunities for leisure activities. The surveys however stated that more community activates need to be available. One person using the service would also like to do more and be involved in the decisions. People using the service are supported to be involved in a local bowling team on a weekly basis. Some people also attend and support the local football team. Each year people using the service are able to have a seven day holiday that they choose and plan at meetings. Not all people go together thus giving a wider choice of who to go on holiday with and where to go. Brochures, a map and DVDs are obtained to assist individuals with these choices. People spoken to on the day of the inspection all concluded that they were happy living at the home and that they were supported to make choices. Care Homes for Adults (18-65 years) Page 19 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . A trained staff team ensures that service users are well supported in meeting their physical and mental well-being. Evidence: People using the service users are supported to have regular health checks and there is evidence on files that GP, specialist, dentist and optician appointments are made. Individuals are encouraged to attend appointment rather than have healthcare professional visiting the home. In a survey a community nurse said that staff respond well to advice given. Improvements have been made in how records are maintained regarding access to healthcare services and the AQAA confirms that New health care action plan forms that are in an accessible format will demonstrate how health care needs are identified and met. Personal support is provided mainly in a discreet manner but support workers need to be aware of the professional boundaries within their role. There are always sufficient male and female co-workers on duty to provide gender appropriate support. Support workers were seen to be on the whole respectful of residents privacy and dignity. Discussion with staff and observations indicated that they are caring and keen to work Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: in the best interests of people using the service. Times for getting up and going to bed are flexible and based on individual preferences and the activities they are involved in. Files seen contain background information on specific medical conditions that aided support workers understanding of the needs of people using the service. The home has a good medication recording system that demonstrates the path of medication coming into the home with safe administration and disposal. In a spot check of medication for people case tracked it was confirmed that medication received into the home is recorded, securely stored and that a signed record is kept of all medication administered. One person using the service manages their medication and has been provided with a lockable storage box to keep the medication securely. All incidents are recorded on file to show how support workers have reviewed practice to minimise future risks. Care Homes for Adults (18-65 years) Page 21 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Safeguarding policies and practices within the home protect people using the service. Evidence: The service has comprehensive policies and procedures in relation to handling concerns and complaints made. As some of the people using the service have limited communication support workers are trained to observe changes in behaviour that may indicate that an individual is unhappy about a certain aspect of their life. Support workers undertake safeguarding awareness training as part of their induction/ foundation training. The inspector was able to check out their understanding and responsibilities during the inspection. In discussion with people who use the service and from questionnaires individuals were fully aware of the complaints policy and procedures if they needed to express a concern. The open approach of the registered manager enables people to feel comfortable if there was a need to make a complaint or express a concern. There have been no complaints since the last inspection. Care Homes for Adults (18-65 years) Page 22 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is maintained to a good standard, providing a warm and relaxed environment with good personal and communal space. Evidence: There are adequate rooms to enable everyone to have their own personal space in the large converted dwelling. Individual bedrooms are personalised, comfortable and well maintained. People using the service are supported in maintaining their rooms to a high standard of cleanliness and safety. The home is well maintained and decorated to a good standard. There is a family size kitchen that is large enough for one or two people using the service to assist. A large family dinning room allows everyone to share the evening meal. The communal areas provide space for individuals to undertake a range of activities. People who use the service have free access to all parts of the home including the garden, which is a good size and enclosed. The garden was well maintained at the time of the inspection. Garden furniture is available for use during the summer months. One person has their own flat within the house enabling them to live semi-independently. Three bedrooms are located on the first floor of the house; these have en-suite toilets and showers. The three bedrooms on the ground floor have an en-suite toilet and a Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: large washbasin; a wheelchair user can access all these rooms. There is also a large communal bathroom on the ground floor, which has a bath with a hoist for assisted bathing. All bedrooms have locks on their doors, which promotes privacy however rooms can be accessed in the case of emergency. Care Homes for Adults (18-65 years) Page 24 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The trained, competent and supported staff team ensure that the service is professional and meets identified service user needs. Evidence: Prior to support workers taking up their post extensive recruitment checks are undertaken to ensure that they meet Mencaps high employment standards. Files seen confirmed that references are taken up by the organisation as part of the screening process. All have a Criminal Records Bureau checks (CRB) and undergo a full interview where people who use the service are represented. Support workers are offered a range of opportunities to train. All new support workers undertake and complete an induction period and foundation course that meets the care sectors standards. The AQAA confirms that 50 of the staff team have achieved National Vocational Standards at level two in care or above. Records seen confirmed that in addition to initial training support workers have access to a range of additional training that is role specific like dementia and epilepsy. The registered manager is working towards their registered managers award. Supervision is carried out on a regular basis and staff spoken to and responses in surveys received confirm that they are well supported and have a good working Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: relationship with the manger. In addition to supervision there are regular meetings where issues are discussed and informal training takes place. The previous inspection identified staff shortages. These have been addressed and the team demonstrated that they work well together and are dedicated to develop the service. Staff spoken to during the inspection showed this commitment. In discussion with the registered manager concerns about role boundaries was raised. They agreed to discuss the issue with their line manager on how best to respond to the sensitive issue around Care Homes for Adults (18-65 years) Page 26 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is effectively managed and ensures that people using the service receive a quality service where their views are respected and their safety is safeguarded. Evidence: The Registered Manager effectively manages the home in the best interests of people using the service users and support workers. The registered manager and area manager work together to action the continuous improvement plan. This plan is the results of a range of monitoring activities undertaken within the home to ensure that people, using the service are involved in the development have a voice and choice. The home has undertaken all health and safety checks required. The management of monies on behalf of people using the service is maintained in accordance with Mencaps financial procedures. Since the last inspection the acting manager has applied and successfully been registered by the Commission for Social Care Inspection. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 31/03/2009 The provider must review storage facilities at the home to ensure that controlled drugs can be safely stored. If controlled drugs were to be prescribed the provider must ensure that they meet the regulations that came into force in 2007 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 18 Support workers role boundaries need to be reviewed to ensure the equality of service. That training opportunities are available to reflect the issues around equality, roles and boundaries between support workers and people using the service. 2 35 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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