Care Home: St Andrews Lodge

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What the care home does well St Andrews Lodge is providing people who experience long-term mental health problems with a stable and consistent level of care. It is a small home where people said they felt comfortable and were able to live quite independent lives. People have access to the types of activities and day courses they prefer and they are encouraged and supported with their daily living skills. What has improved since the last inspection? Three requirements were made during the last inspection and the home has completed these. The procedures for responding to suspicion or evidence of abuse or neglect have been expanded to better protect residents. The home has produced a maintenance and renewal programme checklist for the home and the results of past service user surveys have been compiled into a report. The manager is now intending to carry out resident satisfaction surveys twice yearly instead of annually and resident meetings will be held on a regular basis. What the care home could do better: Three requirements have been made. The home must ensure that risk assessments are formally recorded in each person`s care plan. There is still some further work that the home needs to carry out in regards to the safeguarding adults policy and procedure, as some information that it contains is incorrect. The home also needs to continue its redecoration and refurbishment programme and replace worn bedding as required. One recommendation was made and this was for the home to seek feedback from visiting professionals and stakeholders for inclusion into the homes quality assurance programme. CARE HOME ADULTS 18-65 St Andrews Lodge 39 St Andrews Road Burgess Hill West Sussex RH15 0PJ Lead Inspector Merle Blakeley Unannounced Inspection 11th March 2008 10:00 St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Andrews Lodge Address 39 St Andrews Road Burgess Hill West Sussex RH15 0PJ 01444 236805 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) standrewslodge@tiscali.co.uk Mr Mohammad Feizal Ruhomally Mrs Beebee Zareenah Ruhomally Mrs Beebee Zareenah Ruhomally Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2007 Brief Description of the Service: St Andrews Lodge is a care home registered to provide accommodation and personal care for up to seven service users in the category mental disorder (MD) between the ages of eighteen and sixty five years. The registration includes provision for up to three service users over the age of sixty-five years. St Andrews is a two storey detached house situated in a residential area of Burgess Hill within easy access of the town centre and its facilities. Private accommodation is provided in one double and five single bedrooms located on the ground and first floors. Communal areas include two lounges and a dining room located on the ground floor. There is also a large garden to the rear of the property. The registered providers are Mr and Mrs Ruhomally. Mrs Ruhomally is also the registered manager and is responsible for the day to running of the care home. As of 11th March 2008 the current fees range from £307.00 to £345.00 per week. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 2 Star. This means the people who use this service experience Good quality outcomes. This unannounced inspection was carried out on 11th March 2008. As well as this site visit, information was also gained from a returned Annual Quality Assurance Assessment (AQAA) and feedback surveys from five service users and four relatives. During the visit we were able to talk to three residents, the registered manager/co-proprietor and the other co-proprietor who also works full time in the home. We also looked at three care plans and all the supporting documentation such as risk assessments and healthcare information and a check was carried out on how medications are being stored and administered within the home. Records of how complaints and safeguarding issues are dealt with were discussed. We also viewed staff recruitment procedures and staff training. The homes quality assurance programme, how people’s finances are managed and health and safety procedures were also viewed and discussed. The feedback surveys from residents did not include any comments, however the three relative surveys did and people said that they felt the home was providing a good level of care and that is was a “home from home” and “the residents enjoy being taken out for day trips”. What the service does well: What has improved since the last inspection? Three requirements were made during the last inspection and the home has completed these. The procedures for responding to suspicion or evidence of abuse or neglect have been expanded to better protect residents. The home has produced a maintenance and renewal programme checklist for the home and the results of past service user surveys have been compiled into a report. The manager is now intending to carry out resident satisfaction surveys twice St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 6 yearly instead of annually and resident meetings will be held on a regular basis. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 7 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 Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments are carried out prior to a person moving into the home. EVIDENCE: The home ensures that they can meet a person’s needs before they move into the home. The registered manager carries out a pre-assessment of their needs with information provided by a social services care plan. The manager stated that they have to be very particular about who moves into the home, as it is a small family type environment for only seven people who do not have a high level of need. Prospective residents are able to visit the home and are offered overnight stays to see if the home will meet their needs. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are involved with their plan of care and they are able to make their own choices and decisions. Risk assessments are carried out and reviewed. EVIDENCE: We looked at three sets of care plans, which detailed how people’s care needs are being met. All of the current residents are independent and they are all involved with their care plans and reviews. All three care plans had been reviewed in February and March 2008. The local community mental health team are also involved with reviewing people’s care plans As people are independent they make their own choices and decisions about their daily lives with support from the staff. People are able to take risks and this is done within a risk assessment framework. One of the newer residents needs to have his risk assessments formally recorded into his care plan and this has been made a requirement. The manager stated that she was intending to complete these very soon. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in appropriate activities and they are out and about in the community on a daily basis. Residents visit and stay in touch with family and friends. All residents are offered a well balanced diet. EVIDENCE: All residents are involved in attending work projects, day centres and activities, which they choose themselves. One person has two small paid jobs during the week and others attend local day care centres and clubs. All residents are encouraged to participate in daily living skills, which involve washing up, making beds, assisting with meals, shopping and general house cleaning, as this helps them with confidence and self esteem. Most people are out and about in the local community on a daily basis. All but one of the current residents has family members. Residents are supported and encouraged to go and visit family members and several have St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 11 overnight stays each week. People are also able to keep in contact by phone. Advocacy services are available for people to use at their day care centres. The home offers a well balanced diet, which includes light lunches and an evening meal. There are choices available and other diets can be catered for. Residents are able to provide input into the weekly menus and they are able to make drinks for themselves and others when they wish. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents manage their own personal care and their healthcare needs are being met. Medication is being appropriately administered and recorded. EVIDENCE: All the current residents are independent and do not require personal care to be provided, however staff assist people with prompting and support for bathing and hair washing. Resident’s healthcare needs were discussed with the manager and records showed that people have access to local GP’s, psychiatrists, community psychiatric nurses, dentist and chiropodists. The manager stated that everyone is presently is in good health. Medication records were checked and were found to be in order. Medicines are kept in a locked cabinet in the kitchen. The manager stated that everyone has his or her medication reviewed on a three monthly basis by a consultant psychiatrist. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has produced a complaints policy and procedure. The homes safeguarding document needs to be updated. People’s finances are protected. EVIDENCE: The home has produced a complaints policy and procedure, which is displayed on the notice board in the hallway. The complaints log was viewed and no complaints had been made. The home has a safeguarding policy and procedure, which has been expanded so that the home can better respond to suspicions or evidence regarding abuse or neglect. This policy still requires some further updating, as some of the information in the document is incorrect and a requirement has been made regarding this. Training in safeguarding adults was discussed and the manager stated that she and another staff member had registered to enrol in the course and were waiting for a date to be confirmed. There have been no safeguarding referrals made. The home looks after some of the resident’s finances and two of these were checked and found to be in order. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some areas of the home still require redecoration. The home is kept reasonably clean and tidy. EVIDENCE: During the last inspection the home was required to devise a programme of maintenance and renewal and although this has been done there are still areas within the home that require attention. There is wallpaper peeling off the wall in the hallway and the redecoration of the smoking lounge needs to be completed. It was also noted that some of the bedding needs to be replaced, as some of the sheets and duvet covers were looking rather worn in places. A requirement has been made regarding this. Overall the home was found to be clean and tidy on the day. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a small but very stable staff team. The home carries out suitable recruitment procedures. Some core skills training courses need updating. EVIDENCE: St Andrews Lodge is run and managed by a husband and wife team who provide the vast majority of care to the people who live there. There are also two part-time staff that work weekends and nights. With such a small staff team of four, the manager was asked as to how the home would manage in the event of an emergency or illness. The co-proprietor stated that ‘back up’ qualified support staff would be available if needed and if it was necessary agency staff could also be used. He said that in the seven years that they had been managing the home there had not been an instance where any additional staff had been required. The co-proprietor is a qualified mental health nurse and the registered manager holds the equivalent of a NVQ Level 4 qualification in Care. A new part-time relief staff member has just recently been employed for holiday and nighttime cover and his recruitment file was viewed. The home is St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 16 currently awaiting a CRB clearance check for this person before he can commence employment. Training needs were discussed with the manager and the co-proprietor and all of the required core skills training courses have been completed, however both the manager and the co-proprietor need to update their food hygiene training. The manager is also waiting to receive a confirmed booking for the safeguarding adults course. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A qualified and experienced manager runs the service. The home seeks feedback from residents. The home carries out health and safety checks. EVIDENCE: The registered manager/co-proprietor has been running the home with her husband for the past seven years. She has gained a qualification in Advanced Management in Care, which is equivalent to the NVQ Level 4. She has also recently attended a course in Drugs and Alcohol Awareness and she is also hoping to attend training in the new Mental Health Capacity Act. Two residents who were spoken to during the day stated that they got on well with the owners and would go to either of them if they had any issues or concerns. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 18 During the last inspection the home was required to publish the results of service user surveys, which they have done. The manager stated that they would also be carrying out service user satisfaction surveys twice a year, as opposed to just once a year. It would also be recommended that the home seek feedback from visiting professionals and stakeholders. The manager is also intending to introduce regular residents meetings, so that people can discuss any issues or concerns they may have. Health and safety issues were discussed and it was reported that fire drills are carried out every three months with the fire alarms and emergency lighting being checked monthly. The last fire drill was carried out on the 1st March 2008. The home is waiting to receive a fire risk assessment, which will be carried out by an external company. All staff have received fire safety training. The home maintains an accident book, which was viewed and there have been no entries since 2006. St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 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 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 23(2) Requirement To update the policies and procedures for safeguarding adults. To ensure that the new residents risk assessments are formally recorded in his care plan. For the home to continue its redecorating and refurbishment programme and to replace bed linen where required. Timescale for action 30/04/08 2. YA9 13(4) 30/04/08 3. YA24 16(2) (c) 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA39 Good Practice Recommendations For the home to seek feedback from visiting professionals and stakeholders St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Andrews Lodge DS0000014727.V359455.R01.S.doc Version 5.2 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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