Care Home: St Andrew`s House

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What the care home does well The home provides good quality support for three residents who live in a small stable residential setting. The home enabled residents to live in a relaxed and happy atmosphere where choice, and independence are promoted. There are good arrangements to ensure that admission procedure to fill the current vacancy. Good arrangements are in place to meet resident`s health care needs. The medication policy in place ensures that residents receive their medication as prescribed. Residents benefit from individual leisure activity arrangements. Individual activity programmes reflect choice, hobbies, and interests. Staff support residents to follow a healthy eating plan. Residents plan their menus and shop for food. There is also a house rota for cooking and washing up. The staff team are well established and have the experience and qualifications required to meet the current needs of the residents. The management structure in place means that the home is very well managed and qualified staff are available to support residents at all times. Quality assurance is monitored and residents stated that they are always consulted for their views and suggestions. The health, safety, and welfare of the residents and staff are promoted and protected. What has improved since the last inspection? The requirements and recommendations from the last inspection have been met. What the care home could do better: No requirements were made as a result of this site visit. It is important that manager reviews all policies, procedures, care plans and documentation to ensure that the style and information contained with are user friendly and clear and designed to be used by anyone and not just the existing groups. Key inspection report Care homes for adults (18-65 years) Name: Address: St Andrew`s House St Andrew`s House 93 Downland Way Tattenham Corner Epsom Surrey KT18 5SH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kenneth Dunn     Date: 1 0 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: St Andrew`s House St Andrew`s House 93 Downland Way Tattenham Corner Epsom Surrey KT18 5SH 01737210304 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs R Young The registered provider is responsible for running the service care home 4 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home St Andrews House is a semi detached house located in Epsom Downs at Tattenham Corner. The home is registered to provide personal care for up to four service Users with learning disabilities. The service Users? accommodation comprises of 4 single bedrooms, lounge, kitchen, dining room, toilets and bathroom. The home has its own Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 4 Brief description of the care home well-kept garden and is located close to the local village shops and is a short distance from Epsom town centre, which has a good range of shopping and leisure facilities. The home has its own vehicle to transport the Service Users. The physical standard of the Home is exceptional and it continues to offer an extremely high level of care to its Service Users. Weekly fees range from 762.78 to 958.03 pounds sterling. Care Homes for Adults (18-65 years) Page 5 of 26 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 peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is a TWO STAR rating. This means that people who use the service experience GOOD quality outcomes. This was a key inspection. The inspector Kenneth Dunn arrived unannounced at 09:30.am on 09th June 2009. Only one resident was at home during the sites visit, two other residents were attending day care centres. A part tour of the premises was undertaken which consisted of only the communal areas the one resident at home requested that no one was to go into her bedroom. A random sample of records relating to the care of the residents and the management of the home were examined. Some samples include care plans, medication records, risk assessments, menus, staff employment files, staff training records, and health and safety procedures. Care Homes for Adults (18-65 years) Page 6 of 26 It was possible to meet one residents living in the home who was relaxing in the lounge. There was an opportunity to have a discussion with the member of staff on duty. An Annual Quality Assurance Assessment (AQAA) was completed by the manager and sent to the Care Quality Commission prior to the inspection. This provided us with detailed information regarding the home and some numerical information we also require. The CQC would like to thank the manager, residents, and the staff for their assistance, and hospitality during this inspection process. Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 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 9 of 26 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. Prospective residents have the information they need to help them make a decision about where they live. All residents have needs assessments undertaken prior to admission to establish if the home is suitable to meet their individual needs Evidence: The service has a basic statement of purpose and service users guide the information that both documents provides is limited. A good practise recommendation was made to ensure that a full review of both should be undertaken to ensure that the residents have the ability to access appropriate information. The service has not admitted any new residents since the previous inspection 07/06/2007. A review of the three current residents files was undertaken and it was noted that residents received a needs assessment prior to moving into the home. Furthermore, it was stated by the manager that the first four weeks of any new resident is used as a trial period, to ensure the new resident is comfortable on all counts in the home. It Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: The admissions policy was reviewed and updated in April 2009. Care Homes for Adults (18-65 years) Page 11 of 26 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. Care plans are in place and maintained to a good standard. They are person centred and reflect residents needs and goals. Residents are supported to make choices enabling them to be as independent as possible. Good risk assessments promote independence at home and within the community. Evidence: Individual care plans are in place. These are person centred and include all aspects of daily living. Care plans are written on information gathered from the needs assessment, with input from residents, information obtained from relatives and advocates, and reports from the multidisciplinary team. All three residents care plans were sampled they contained daily records and provided evidence that they are reviewed regularly and updated accordingly. The care plans in all three instances were complicated and contained information that is irrelevant or out of date, this was discussed with the manager at the time of the site visit and a good practise recommendation has been made. Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: Residents are encouraged to make decisions regarding all aspects of their daily lives. Risk assessments are in place for all identified risks both within the home and for community participation. Risk assessments form part of the care plan and are written to promote independence. They do not restrict residents in anything they do. Risk assessments are reviewed and updated regularly however the service uses several different risk assessment form this was discussed with the manger and a good practises recommendation was made. Care Homes for Adults (18-65 years) Page 13 of 26 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. Residents are supported to take part in appropriate activities that meet their individual and collective needs. Family and community links are maintained, and the diverse needs of residents are supported. Dietary needs are being met and residents choose a menu that is nutritious, and flexible to meet their lifestyle. Evidence: Individual activity programmes are in place and form part of the care plan. Two of the residents attend a day care centre and follow an agreed time table and one resident is retired. The manager stated that the resident who is retired enjoys a more relaxed and flexible time at the service accompanying the staff shopping or being taken out for lunch or outing. Activities are based on interests and hobbies and include trips to the coast, going to the pub, shopping and picnics. Holidays are arranged by the Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: service this year the residents selected to go to return to Spain for a week with staff. Family links are maintained and residents are supported to visit their family and friends. Visitors are welcome in the home at any reasonable time. Relatives are invited to reviews of care when appropriate, and are consulted for their views as part of the quality assurance process. The manager stated that one resident has no family but that they are making an application for a independent advocate to support her. Menus are planned by the residents usually at residents meetings. Staff support residents to choose fresh produce and food that is in season. Care Homes for Adults (18-65 years) Page 15 of 26 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. Residents receive support with personal care as agreed in individual care plans. Appropriate arrangements are in place to meet individual health care needs. The medication policy in place should protects residents living in the home. Evidence: Staff provide flexible personal support for residents as agreed and outlined in individual care plans. Privacy and dignity is observed and residents are treated with respect at all times. The manager stated that the residents are well cared for and require minimum assistance with personal care. Residents are registered with local GP surgeries, and said that they can make appointments to see their doctor when necessary. Arrangements are in place for chiropody and dental care. Specialist support is available on referral by the GP. The home has a medication policy in place reviewed and updated April 2009. Staff undertake training in medication safety awareness prior to undertaking this task. Risk assessments are in place for self medication. All medication administrated by staff is recorded on Medication Record Sheets (MAR) and a review of the MAR sheets Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: provided evidence of the policies were fully implemented and no gaps were evidenced. It was apparent that the staff have a great understanding of the medical needs of the residents however there was no sample signature sheet of staff who are involved in the administration of medication. A good practises recommendation was made. Care Homes for Adults (18-65 years) Page 17 of 26 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. The complaints procedure and the safeguarding vulnerable adults procedure in place protect the residents living in the home. Evidence: The home has a complaints procedure in place this was reviewed April 2009. This forms part of the residents guide and is available to all residents and their relatives on admission. . There have been no complaints since the last inspection. The home also has a copy of Surreys Multi Agencies policies and procedures on Safeguarding Vulnerable Adults in place. The manager and all staff members have attended training in these procedures. The member of staff on duty confirmed this training and would not hesitate to report an incident of suspected abuse if necessary. The Care Homes for Adults (18-65 years) Page 18 of 26 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 suitable for its stated purpose. Residents live in a safe, clean and comfortable environment. Communal facilities are good providing residents with ample space to meet their assessed needs. Evidence: A tour of the communal areas was undertaken as part of the site. The areas of the home that were toured appeared to be well maintained, and decorated to a good standard, providing residents with a comfortable and safe environment to live. The individual bedrooms of the residents were not seen during this site visit, two residents were off site at day care and the one resident who was at home stated that she did not want her bedroom visited as part of this visit. Communal facilities include a comfortable lounge, which was well furnished and displays of personal items in cabinets and contained a small dining table for the residents. In addition the residents can take their meals in the kitchen dining room. The was well equipped and domestic in style. The service has a small rear garden and terrace area which is well maintained and fully accessible to the residents There are laundry facilities available in a garden annexe and is suitable for the requirements of the home. Infection control policies and procedures are adhered to. Care Homes for Adults (18-65 years) Page 19 of 26 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. Residents are supported by a competent, committed and stable staff team. The staff area skilled and in sufficient numbers to meet the assessed needs of the current resident group. The staff recruitment procedure protects the residents living in the home, who also benefit from a well supervised staff team. Evidence: The service has a very stable and dedicated staff group all of whom have worked with the residents for some considerable time. Staff are employed in sufficient numbers with the skills necessary to meet the assessed needs of the current residents. The manager stated that as a result of the resident vacancy within the service the staffing arrangements have been reduced. The manager further stated that when the service is fully occupied the staffing will be increased. At the time of the site visit there is one member of staff on duty throughout the day with additional staff allocated to meet individual activities and specific events. There is also one member of staff that sleeps in. Staff were able to confirm during discussion the training they had undertaken. The service has a high commitment to the National Vocational Qualifications (NVQ) with members of staff holding both level 2 and level 4s. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: Staff recruitment procedures are in place. These have been reviewed since the last inspection April 2009. The manager stated that there has not been any new staff employed since the previous inspection 07/06/2007 and further stated that the majority of staff have worked in the home for several years. Two staff employment files were seen. These are well maintained and include a completed application form, two written references, an employment history, and a current CRB (Criminal Records Bureau) disclosure. Arrangements for formal staff supervision are in place staff on duty confirmed that they have received regular supervision. A sample of staff records confirmed that a programme for supervision was being conducted regularly. Care Homes for Adults (18-65 years) Page 21 of 26 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 well managed by an experienced manager/provider in the best interest of the residents. The health, safety, and welfare of the residents is observed to protect the people living in the home and to promote safe working practise. Evidence: The home is managed by the registered manager who is a Registered General Nurse for people with learning disabilities, in additions the manger holds a NVQ Level 4, and a Registered Managers Award (RMA). The has the support of an experienced staff team. During the site visit it was apparent that policies, procedures, care plans and information storage is only designed for the current staff group. The documentation contained all relevant information and details but it was not in a format that was easily accessible to someone outside of the established groupings. A good practises recommendation was made. Systems are in place to monitor quality assurance. Residents are encouraged and assisted to air their views and help plan home events, and any other issues concerning Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: life in the home discussed. Quality questionnaires are distributed to the residents and where they known their relatives to gain feedback about the service. The surveys that were seen during the site visit were positive and contained good feedback and comments from the residents and their relatives. It was discussed with the manger the need to open up the quality questionnaires to all relevant people who play a role in the life of the residents including health care professionals, care mangers, and day care staff. A good practise recommendation been made. Health and safety is observed. All staff undertake health and safety training as part of their induction course. Discussion with staff confirmed the training they had undertaken. COSHH procedures are observed. The AQAA indicated that all the required safety certificates are in place and updated when necessary. The service has had all electrical equipment tested certificate dated 16/10/2008. The manger stated that all required safety checks have been undertaken, a random sample of certificates was seen these included ,landlords gas certificate dated 25/03/2009 and equipment maintenance checks 26/03/2009. Fire safety is observed and all staff undertake fire safety awareness training. Accident and incidents are recorded and The Care Quality Commission notified accordingly. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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 24 of 26 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 Requirement 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 Requirement Timescale for action 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 1 It is recommended that the service undertakes a full review and update of both the statement of purpose and service users guide, to ensure that the information they contain are current and accurate. It is recommended that all care plans are reviewed and the information the contain should be relevant and current. It is recommended that risk assessments are reviewed and the service introduce one risk assessment tool. The manager should ensure that a full list of sample signatures of staff involved in the administration of medication is available at all times. It is recommended that the quality questionnaires is opened to all relevant people who play a role in the life of the residents including health care professionals, care mangers, and day care staff, It is recommended that the manager reviews all policies, procedures, care plans and all additional documentation to ensure that they are fully accessible and open. 2 3 4 6 9 20 5 39 6 41 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!