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Care Home: St Andrews House, Exmouth

  • St Andrews Road Exmouth Devon EX8 1AS
  • Tel: 01395223737
  • Fax: 01395278076

St. Andrews is one of more than 20 projects managed by Christian Alliance Housing throughout the United Kingdom and is registered to care for up to six adults who may be suffering from past or present mental illness, drug or alcohol dependency and find themselves in a position where they can no longer live alone. The property is a converted former church in a central residential area of Exmouth. The residential home is situated on the ground floor of the building. All rooms are for single occupancy. There is a communal smoking room, lounge, kitchen and dining room. There is also a small laundry for residents use. There are car-parking facilities on site. Also managed on the same site, but physically separated, are two sheltered housing units - one on the first floor of the main building and one in an adjacent bungalow. CSCI reports are available on request from the office.St Andrews House, ExmouthDS0000022035.V378635.R01.S.docVersion 5.3

  • Latitude: 50.617000579834
    Longitude: -3.4210000038147
  • Manager: Mrs Ruth Brinsden
  • Price p/w: £390
  • UK
  • Total Capacity: 6
  • Type: Care home only
  • Provider: Christian Alliance Housing Association
  • Ownership: Voluntary
  • Care Home ID: 14322
Residents Needs:
Past or present alcohol dependence, Past or present drug dependence, mental health, excluding learning disability or dementia

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for St Andrews House, Exmouth.

Key inspection report CARE HOME ADULTS 18-65 St Andrews House, Exmouth St Andrews Road Exmouth Devon EX8 1AS Lead Inspector Vivien Stephens Key Unannounced Inspection 25th November 2009 11:00 St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 1 This report is a review of the 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. 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 home adults 18-65 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. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 2 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 St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service St Andrews House, Exmouth Address St Andrews Road Exmouth Devon EX8 1AS 01395 223737 01395 278076 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) Christian Alliance Housing Association Mrs Ruth Brinsden Care Home 6 Category(ies) of Past or present alcohol dependence (6), Past or registration, with number present drug dependence (6), Mental disorder, of places excluding learning disability or dementia (6) St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th November 2008 Brief Description of the Service: St. Andrews is one of more than 20 projects managed by Christian Alliance Housing throughout the United Kingdom and is registered to care for up to six adults who may be suffering from past or present mental illness, drug or alcohol dependency and find themselves in a position where they can no longer live alone. The property is a converted former church in a central residential area of Exmouth. The residential home is situated on the ground floor of the building. All rooms are for single occupancy. There is a communal smoking room, lounge, kitchen and dining room. There is also a small laundry for residents use. There are car-parking facilities on site. Also managed on the same site, but physically separated, are two sheltered housing units - one on the first floor of the main building and one in an adjacent bungalow. CSCI reports are available on request from the office. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Several weeks before this inspection took place we asked the home to complete an Annual Quality Assurance Assessment. They returned the form when we asked for it and it gave us very good information about the way the home is run and the services they provide. We also asked the home to distribute survey forms on our behalf. We received four completed forms from people who use the service. Their responses have helped us to form the judgements we have reached in this report. This inspection took place over one day beginning at approximately 11am and finishing at approximately 6pm. The manager was absent at the time of this inspection and instead we talked to four project workers who were on duty that day. We also spoke to one of Christian Alliance Housing Association’s senior managers on the telephone. On the day of this inspection there were four people accommodated. We talked to them all during our visit. We also looked at the communal areas, kitchen, laundry, toilets and bathrooms, and two bedrooms. We looked at some of the records the home is required to maintain including assessment and care plan files, staff recruitment, training and employment records, medicine administration records, policies and procedures and health and safety records. What the service does well: There is a stable staff group, many of whom are highly qualified and experienced. The majority of people who have stayed at the home have found it has provided them with a safe haven to help them rebuild their lives, with support from the staff team. Many aspects of the admission procedure are good. People have usually been given plenty of information and opportunities to visit and get to know the home before they decide to stay there. People are encouraged to eat a healthy and balanced diet. There are good stocks of food available and people are supported to make their own breakfast and lunch, and to be involved in the planning, shopping and preparation of the evening meals. Special dietary needs will be accommodated. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 6 The home has maintained good relationships with external specialists and health professionals and people are supported to obtain any medical treatment they need. The accommodation has been well maintained and is comfortably furnished. People have a good sized single bedroom that has been furnished to a good standard. People’s views have been actively sought to check that the home continues to provide a good quality of services. The home has taken a range of measures to minimise the risk harm to people’s health and safety. What has improved since the last inspection? What they could do better: The continued absence of the registered manager over the last year has resulted in some important tasks not being carried out properly. The staff team have worked hard to try to cover as many of the management tasks as possible, but where we found failings, many of these should have been addressed promptly if there had been a suitable management structure in the home. The assessment of new people to the service has been process driven but not particularly personalised. In some instances it has been unclear why people needed residential care, or if they met the criteria for St Andrews House. The care plans did not explain how the staff team would meet the person’s personal care needs, or how they would support people particularly when people become distressed, angry or upset. The level of regular activities offered by the home has improved slightly in the last year but they could do more to help individuals find opportunities for personal development and provide interesting things for people to do. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 7 We found some potentially serious errors and omissions in the medicines administered by the home. There were unexplained gaps in the administration records, and some medicines had not been given out as prescribed. The home had failed to carefully assess the risks individuals may face if they held and administered their own medicines, and they had failed to draw up an individual plan to help people move towards safely managing their own medications. 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. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 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 Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have usually been given plenty of information and opportunities to visit and get to know the home before they decide to stay there. However, the home has failed to focus on their intended purpose and at times may have admitted people for whom the service is not entirely suitable. The admission of new people to the service has been process driven but not particularly personalised. EVIDENCE: During our visit we looked at the care plan files for the four people who were staying in the home that day and we also talked to those people. We also talked to two members of staff to find out how they assessed people who had enquired about the service to find out if the home could meet their needs. The home gave told us in their Annual Quality Assurance Assessment about their admission procedures before a new person is admitted: “Prospective service users are usually referred by their care manager. We St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 10 send out an initial application form and request that this is returned with a current cpn care plan and risk assessment. Once we have these items we can then arrange an interview. We inform the service user that they may bring an advocate along with them. This is usually a family member, carer or care manager. We promote choice, individuality and independence through our service. Prospective service users are invited to look around the unit before interview if they wish to get a general feel for St Andrews.” We looked at the care plan files of the four people who were staying there at the time of this inspection to find out how the home had assessed each person’s needs. We also talked to the four people. We found their needs and experiences were very different. Before each person had moved in an assessment checklist had been completed. This was a tick box style form with some spaces for short narrative. This form guided the person carrying out the assessment to look at a range of support needs and potential areas of risk. Each file also held a copy of a care plan document completed by the person’s health or social care professional who had helped them arrange the service. These documents usually provided some detailed and useful information about the person’s health, their family and home situation, and the reason why they were referring them to St Andrew’s. While this information was generally very good, the brief checklist completed by the home failed to provide a similar level of detail to show that the person met the home’s admission criteria, and to show that the home would be suitable and able to meet the person’s needs. One person we talked to had stayed at the home for several short periods of respite in the past. They told us the home provided exactly what they needed – a safe haven. They were completely satisfied with the information they received before they used the service for the first time and they felt the home had met their needs. However, when we looked at the assessment files we could not find any information in the assessment documents to explain why the person needed residential care. The person did not appear to require support from the staff with personal or health care needs. There was no information about the support the person might need with mental health problems, and no clear agreement about how this would be provided by the staff team. Another person we talked to said they had been admitted in an emergency and they told us they had not received any information about the home or opportunity to visit before they moved in. They did not know why they were there and wanted to return to their own home. While the care plan file provided information to show why the person had been admitted, there was very little information about the support the person would need to help them to return to their own home successfully. The assessment did not demonstrate that there had been any detailed consideration about the range of different needs the person had, or how they wanted the staff team to support them to overcome those needs. For example, the home had decided to hold the St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 11 person’s medication, but there was no risk assessment to show why this had happened, or if it was necessary. Three people who completed a survey before this inspection told us it was their choice to stay at St Andrews House. They said they had received enough information to help them decided if it was the right place for them. We talked to the Area Manager on the telephone at the end of our visit and discussed the admission procedures. We heard that the registered manager had been absent from the home for most of the last year and admissions had been dealt with by the staff team, or by an agency person who temporarily worked in the home as Acting Manager. The staff team had done their best in difficult circumstances to keep the service running as smoothly as possible, but the home may have suffered from the lack of manager with a clear understanding of the purpose of the service and the needs of the people they aim to support. We saw copies of letters that have been sent to people after their assessment to let them know if they could offer to accommodate them. The letter explained some of the most important conditions of their stay. They had also been given a contract of residence. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has usually met the care and support needs of the people who have stayed there. However, they have failed to demonstrate a clear understanding of those needs through the care planning process. EVIDENCE: At our last inspection we found that the care plans did not give sufficient detail about the range of support needed by each person or how these would be met by the staff team. There were no agreed strategies to be followed by the staff if the person became angry, anxious or upset. We asked the home to improve their care plans. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 13 During this inspection we looked at the care plan files of the four people staying at St Andrews on the day of this inspection. Two people were there on a longer term basis and two people were there for respite care. We talked to the four people to find out about the support they had received. Our findings were that the level of information in the care plans remained inadequate. The care plan files were neatly filed and divided into sections that were clearly indexed. Each file contained essential personal information including home address, next of kin, date of birth, and other health and social care professionals who regularly supported them. Each person had been allocated a link worker from the care staff team. The files contained good records of each link worker session. There was also a document called a support plan. These were pre-printed forms in a table form. The tables had been filled in by hand using brief sentences that outlined a few of the main care needs. There was no explanation of how those needs would be met. There were no strategies the staff should follow to help each person with specific problems. The files did not provide any detailed advice or guidance from the community psychiatric nurses or other specialists on specific strategies to help people. We talked to the people staying in the home about their care plans. Some people had a weekly timetable that set out the things they wanted to do every day and they thought this was their care plan. When we asked if they had seen any other documents about their stay or if they had been involved in any discussions about how the staff would support them they said no. Most of the people we talked to said the home offered a safe and peaceful refuge where they could regain their health and self–confidence. They were happy with the support they had received from the staff. This means that the outcomes for people are usually good. As already explained in section 1 Choice of Home, one person said they wanted to return to their own home and did not understand why this was not possible. There was no documentation in the care plan file to show how the staff team were supporting the person to help them return to their home. Three people completed a survey form before this inspection and told us they had been able to make choices and decisions about the things they wanted to do every day. One person told us, in answer to the question, What does the home do well? “Encouragement when I decide to do things.” Each care plan file contained risk management plans. These had been regularly reviewed. The risk assessments had been completed using tick box checklists. Where risks had been identified there were brief statements about how the risks should be controlled. The statements did not provide evidence of the discussions and consultations that had been reached with the person and with any health of personal care professionals who were involved in their care. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 14 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): This is what people staying in this care home experience: 12, 13, 14, 15, 16, 17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of regular activities offered by the home has improved slightly in the last year but they could do more to help individuals find opportunities for personal development and provide interesting things for people to do. People are encouraged to eat a healthy and balanced diet. EVIDENCE: St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 15 At our last inspection we found that the level of support provided by the home to help people find interesting and fulfilling things to do was low. During this inspection we looked at the things they had done to try to improve this. Two people who had been staying at the home for a longer period showed us a weekly timetable that had been drawn up to help them plan the things they wanted to do every day. This demonstrated an improvement from our last inspection. The timetables showed housework tasks such as cooking cleaning and laundry, planned sessions with their key worker, and attendance at local clubs or social events. However, the plans showed that much of the week people were left to follow the weekly timetable with little input from the staff team. The overall level of stimulating or fulfilling activities each week organised by the home and involving the staff team remained fairly low. People have been encouraged to attend a local day centre in Exmouth run by an organisation known as Rethink. They have also guided people to seek careers advice and find out about local voluntary work opportunities from agencies such as Work Ways, Sidekick and the Kennaway Centre. We talked to one member of staff, and looked at a file that had been compiled to provide evidence of the activities organised by the home. We heard that in the last year some group outings had been provided – these activities have also been offered to those people who live in the sheltered accommodation also on the same site. The outings have included a trip to the Sidmouth Folk Festival, Exeter underground passages, a firework display, and a trip on the river Dart. A fortnightly walking group has been started and we heard that this had proved to be very popular. Art facilities have been provided in a central communal area. Some people have enjoyed playing board games such as scrabble. A new large screen television has been purchased in the last year and they have a selection of DVD’s. A questionnaire was sent out to people who regularly use the service a few months ago to find out what things they would enjoy doing. A range of suggestions were made but we could not see any evidence to see what had been done to take up these suggestions and make them happen. The home is situated close to the centre of Exmouth and it is easy for people to going out and about in the town. There are shops, seafront and local transport facilities all within very easy walking distance. Every person who stays at St Andrews has been given a front door key so that they can go out and come in whenever they want. One person who was staying at the home for one week respite said they enjoyed go out for a walk every day, and did not want to join in with any group activities. They were happy organising their own day and did not need support from the staff team to find things to do. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 16 We talked to a member of staff about the meals provided in the home. Menus for evening meals have been discussed once a week, usually during an evening meal while everyone is together. Each person has been encouraged to help plan, prepare and cook at least one evening meal each week. We looked at the meals provided in recent weeks and found they were varied and balanced. We heard that there are always good stock of food in the home providing plenty of choice and alternatives. People are expected to make their own breakfast and midday meals, and also their own drinks throughout the day. Information about individual dietary needs has been gathered when people have arrived at the start of their stay. The home has catered for all special dietary needs. They have also taken into consideration any cultural or ethnic dietary needs. We talked to the people staying in the home about the meals provided and they said the food was always good and to their liking. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has maintained good relationships with external specialists and health professionals and they ensure that people receive the help, support and treatment they need. There are weaknesses in the procedures for storing and administering medicines and people may be at risk of harm from possible medicine errors. The home should do more to help people retain control of their own medicines. EVIDENCE: At the time of this inspection none of the people living at St Andrews needed help from the staff team with personal care tasks. If help is needed with physical tasks this will be provided by a domiciliary care agency. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 18 All of the people living/staying in the home have been linked to local health services such as GP’s and dentists. The home does not provide counselling for people, and instead people usually receive this from external professionals and specialist organisations. People usually received regular support from their local Community Psychiatric Nurses (often referred to as CPN’s). We looked at the administration and storage of medicines in the home. They use a monthly monitored dosage system provided by a local pharmacy. For those people who have been assessed to need help with their medications the home asks them to arrange for a prescription to be sent to the home in advance of their stay. The home then ensures that they receive they have the correct medicines from the pharmacy ready for when the person arrives at the start of their stay. At the time of this inspection one person held their own medicines in a locked drawer in their room. Another person who was staying for one week respite said they were happy for St Andrews to look after their medicines while they stayed there as a member of their family helped them with this when they were in their own home. Another person said they wanted to return to their own home and thought they would be able to manage their medicines without assistance. Despite this we heard that their medication was held by the home. When we looked at their care plan file we could not see a risk assessment to show why the home had decided to look after the person’s medicines, or what strategies they had put in place to help the person begin to look after and manage their own medicines. Medicines held by the home were stored in a secure cupboard in the main office. There were secure facilities for any controlled medicines or drugs that needed to be kept cool. People were expected to go to the office to receive their medicines. We felt this practice was institutional and did not demonstrate an individual approach to supporting people with their medicines. We looked at the records of medicines administered by the home for three people staying there. We found that over the last month there were a number of unexplained gaps. In most instances there were also tablets remaining in the blister packs showing that the people had not received the correct medications. We saw a few entries on the back of the medicines administration records to explain why the person had not received their medicines, but on a number of occasions there were no explanations, and no evidence to show any action that had been taken to follow up on the gaps in the records, or to make sure that it was safe for the person to miss their medicines. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 19 We talked to the staff on duty, and also to the Area Manager about the failure to make sure people received their medicines safely and we heard that one possible reason had been the absence of a registered manager over the last year to monitor medicines management. We asked the Area Manager to take steps as soon as possible to prevent further potential errors or omissions. We were told that all staff had undertaken training on the safe administration of medicines, and a further training session was planned for the following day. The care plans provided a list of the medicines each person was receiving at the time of their admission. There was no further information about each medicine, for example, any special administration instructions or guidance on side effects. At the last inspection we found that the home’s policy on the safe administration of medicines was not comprehensive. The staff we talked to did not know if the policy had been amended. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 has some good measures in place to protect people who may be vulnerable from the risk of abuse, neglect or self-harm. EVIDENCE: The home has a clear and simple complaints procedure. Every person has been given a welcome pack when they have moved in and the complaints procedure is contained in this pack. Two people who completed a survey before this inspection said they knew how to make a complaint but one person said they did not know about the home’s complaints procedure. The home told us in their AQAA that they recognised they could do more to make sure every person is told about the complaints procedure at the time of their admission and they understand where to find more information if necessary. They also told us that staff and people staying in the home had recently attended a complaints training session organised by the providers. Regular meetings have been held between staff and people staying in the home once a month. People have also been encouraged to raise any concerns or complaints during their weekly key worker session. People have been encouraged to hold their own money/valuables in their rooms. Each room had a lock on the bedroom door and also lockable storage St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 21 in the room so that people could keep their money and belongings safe. The home has policies in place that set out the procedures for handling money and valuables where people want the home to store these or support them to manage their money. The home told us that staff have received training on POVA (Protection Of Vulnerable Adults). St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Andrews provides a clean, well maintained and comfortable place for people to stay. All areas were clean and odour-free. EVIDENCE: St Andrews is a converted church within easy walking distance to the centre of Exmouth and the beach. The residential part of the home is on the ground floor. On the first floor there are bed-sitting rooms for people who live more independently and there is also a bungalow next door providing supportive accommodation (these areas have independent access and are not registered by the Care Quality Commission) St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 23 People staying in the residential unit can visit the unit upstairs for leisure activities such as pool or art if they wish. However, the occupants of the upstairs unit may only visit the ground floor if they are invited. The home has a planned maintenance and renewal programme. In the last year a number of improvements have been made to the accommodation including ramped access to the home, and disability aids have been provided to help people who may have difficulty using the bath or shower. Three CCTV cameras are located in the entrance areas of the home. These are for security purposes and do not impinge on the privacy and dignity of the people staying at St Andrews House. During our visit we saw two bedrooms, a bathroom, shower room and toilet, the office, lounge, kitchen and dining room and the laundry room. We found all areas were in good decorative order, comfortable, homely and well maintained. The home employed cleaning staff to keep the communal areas clean. People living in the home were responsible for keeping their own rooms clean (with support and guidance from the staff if needed). People were also responsible for doing their own laundry. There was a domestic washing machine and tumble drier, and also washing lines outside if people wanted to dry things naturally. We found all areas were clean, tidy and free from any odours. The home told us in their AQAA that staff had received training on infection control. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 People using the 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 are supported by sufficient numbers of carefully recruited, well trained and highly qualified staff team. EVIDENCE: On the day of this inspection there were 5 care workers in the building covering both the residential unit and the sheltered accommodation. We were told that the staff team worked across both areas, although on the day there were 2 care staff allocated specifically to work with the people in the residential unit. They also employed a cleaning person. At night there was a member of staff sleeping in the building. There were 4 people staying in the residential unit on the day of this inspection and with 2 care workers allocated specifically to support them this represented a good level of staffing. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 25 At the last key inspection we found that the home had not followed safe recruitment procedures and we told them they must make sure they obtain satisfactory references and Criminal Records Bureau (CRB) checks in future. During this visit we looked at the recruitment files for 2 staff employed in the last year. We found that at least two satisfactory references and a Criminal Records Bureau (CRB check had been obtained for each member of staff before they were confirmed in post. This demonstrated good practice. The home told us that all staff had received induction training to meet nationally recognised standards. Once staff had completed their induction all staff had undertaken a core training programme and regular updates on subjects relevant to their work including mental health, support and recovery, domestic abuse, benefits, and medications. They had also received regular fire prevention training and drills. The AQAA completed by the home before this inspection gave information about the qualifications of the staff team – “Over 50 of all staff at St Andrews House working in the care unit have qualifications at the level of NVQ level 2 or above. Qualifications include NVQ level 4 Managers Award,BSc (Hons) Occupational Therapy, BA (Hons) Socia Sciences (with psychology), BA English Language and Sociology, M(ed) English Language Training, Diploma in Applied Social Studies, BA Education Studies Disabilities, BA (Hons) Early Childhood studies, BA Arts Therapies and Certificate in Health and Social Care,Diploma in Nutirition and pyschology, Certificate in Housing Aid and Advice. Permanent staff are currently studying for Certificate in Abnormal Psychology, , BA (Hons) Mental Health, and Assessing Quality in Social Care Diploma.” Two members of staff completed a survey form before this inspection and they indicated they were happy with the way they were recruited, and the training and support they had received. On staff member told us about the things the home does well, “Good communication between residents and staff. Good professional relationships. Individual care plans and support packages.” Staff meetings have been held in the home every Wednesday. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The continued absence of the registered manager has resulted in some important monitoring tasks not being carried out effectively. People’s views have been actively sought to check that the home continues to provide a good quality of services. The home has taken a range of measures to minimise the risk harm to people’s health and safety. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 27 EVIDENCE: At the last inspection the registered manager had been absent since July 2008. A person was appointed on a temporary basis as acting manager, but an application to register them was not submitted to the Commission and therefore we were unable to determine if they were suitably qualified or competent to hold this position. The registered manager returned to work a few weeks before this inspection and the acting manager then ceased to work at St Andrews. At the time of this inspection the registered manager was once again on sick leave. We discussed this situation with the area manager by telephone who agreed they would take action to make sure the home is properly managed as soon as possible. We were told that they were planning to recruit a deputy manager in the near future. While the acting manager and the staff team had clearly done a very good job keeping the home running as smoothly as possible, the failings already covered in other parts of this report, including poor care planning systems and failure to ensure people receive their medications safely, indicated that key procedures in the home have not been monitored closely and that the home has lacked a strong and competent permanent leader. The home has sought the views of people who have stayed there by asking them to complete an exit questionnaire at the end of their stay. They have also held weekly resident’s meetings. People have also been asked to give their views in meetings with their link workers. The completed AQAA showed that the home has policies and procedures in place on all topics relevant to the home. Most had been reviewed in the last year but a few had not been reviewed for several years and therefore may be out of date. On the day of this inspection a specialist company were visiting to complete a fire risk assessment. We also looked at the fire log book and found that all safety checks and routine maintenance had been carried out as required. The home told us that all electrical systems and equipment, including the heating system, have been serviced and maintained regularly. They have written assessments on all hazardous substances. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 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 3 2 2 3 2 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 x 2 x 3 x x 3 x Version 5.3 Page 29 St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc 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 YA6 Regulation 15 Requirement Each care plan must clearly explain how staff are expected guide and support the person with their daily social, emotional and physical needs. The plans must give enough detail to ensure all staff work in a consistent manner and fully understand the support and assistance each person needs and wants with their daily lives. This is the second time this requirement has been made Suitable arrangements must be made for medicines to be stored and administered safely. The home must have a clear and robust policy that covers all aspects of medicine ordering, receipt, storage, administration and disposal. The home must ensure that the staff team follow this policy at all times. Records of medicine administration should provide clear evidence of all medicines administered by the staff. If medicines have not been St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 30 Timescale for action 01/01/10 2 YA20 13 (2) 01/01/10 3 YA37 9 administered the records must provide clear evidence of why this has not happened, and the actions taken by the home to ensure the person will not suffer any harm as a result. Actions must be taken promptly to investigate any instances where the home has failed to give people their medicines as prescribed and to ensure the person is not at risk of harm as a result. The home must be properly 01/01/10 managed by a person who is suitably qualified and experienced. The providers must inform us in writing how they will ensure there is a satisfactory management structure in place. This is to ensure that the staff team are managed by a competent and knowledgeable leader who will ensure the home meets all legal requirements. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA2 YA3 YA9 Good Practice Recommendations Before people move into the home they must be fully assessed to ensure their needs are in line with the home’s intended purpose. People must be certain that the home will be able to meet their needs, and that the home is suitable, before any agreement to move in is made. The home should assess and document any potential risks each person may face, and any strategies that have been agreed to minimise or eliminate those risks. The home should review the level of support they give people to help them lead an interesting and stimulating DS0000022035.V378635.R01.S.doc Version 5.3 Page 31 4 YA12 St Andrews House, Exmouth lifestyle. The home should identify each person’s goals and help them work towards further education, obtaining a job, or developing new skills or interests. The home should also consider ways of increasing the level of regular organised activities they provide on an individual or group basis. 5 YA20 The home should review their policy on the receipt, storage and administration of medicines to ensure it covers all aspects of medications in line with national good practice guidance. The staff team should receive regular supervision, monitoring and support to ensure they are carrying out all tasks required of them in accordance with their job description and in accordance with the home’s policies and procedures. 6 YA36 St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 32 Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. St Andrews House, Exmouth DS0000022035.V378635.R01.S.doc Version 5.3 Page 33 - 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!

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