Care Home: St Georges Residential Care Home

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What the care home does well The service provides a homely, well maintained and safe environment for the people who use the service. We saw some positive interactions between staff and the people who live there. The owner knows the needs of the people who use the service and how to meet them. People`s religious, cultural and language needs are fully met at the service. People receive a varied menu that meets their religious and health needs. Good clear records are kept of individual finances. What has improved since the last inspection? This is the first inspection of the service since it was registered in August 2008 and when people started to move in during July 2009. What the care home could do better: There are a number of areas to develop to improve the services provided. Care plans could be more person centred to include more information about individuals life history and activities they enjoy. Work should be done with individuals to develop goals which they are helped to achieve. The owner is assisted by members of her family to provide care and support to people. Staff files do not evidence that adequate checks have been carried out on family members to comply with regulations. There must be a staff rota available at the home. The owner should complete training in the Mental Capacity Act and Deprivation of Liberties Safeguarding, to ensure she has a full understanding of the effects on the service. Key inspection report Care homes for adults (18-65 years) Name: Address: St Georges Residential Care Home 30 St Georges Road Mitcham Surrey CR4 1EB     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: Emma Dove     Date: 2 0 1 1 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 22 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 22 Information about the care home Name of care home: Address: St Georges Residential Care Home 30 St Georges Road Mitcham Surrey CR4 1EB 02086875896 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Afra Siyab care home 3 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: 3 The Registered Person may provide the following categories of service only: Care home only - Code 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 - Code LD Date of last inspection Brief description of the care home St Georges Residential Care Home is a registered home for up to three adults with learning disabilities. Two people are currently living there. The service is owned and managed by a private individual. The home is a two storey house in a residential road in Mitcham. There is off street parking at the front and parking in the road. It is a short walk from local shops, leisure facilities and public transport links. The weekly fees are from £950.00 to £1,300.00 per week. Care Homes for Adults (18-65 years) Page 4 of 22 Over 65 0 3 0 9 0 7 2 0 0 9 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: This unannounced inspection was carried out over four hours on the 20th November 2009, by one regulation inspector. We spoke with people who use the service, staff and the owner and looked at records. We received an annual quality assurance assessment (AQAA) from the owner in June 2009. This contained some good information about the service and what it does well. We also looked at other information received from the service since it was registered in August 2008. Care Homes for Adults (18-65 years) Page 5 of 22 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 6 of 22 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 7 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service understands the importance of having sufficient information when choosing a care home. Admissions are only made after a full assessment has been completed, to ensure the service is appropriate for the individual. Evidence: We saw the service has developed a Statement of Purpose and Service Users Guide which detail information about the home, the services provided and who the service is for. This information is currently available in written format. The owner told us they could get the Statement of Purpose and Service Users Guide translated into other languages if required. It would be good for the Service Users Guide to be more accessible for people who use the service. We saw referrals contain assessments from placing social workers. The owner told us she goes to visit prospective new people for an assessment, to ensure they are able to meet the persons needs before they offer someone a place. We saw the owners assessments in case files. Care Homes for Adults (18-65 years) Page 8 of 22 Evidence: The manager told us prospective new people are invited to visit, look around, meet people currently living there and staff as a part of the admission process and to help them decide if the home is right for them. Care Homes for Adults (18-65 years) Page 9 of 22 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service or their representatives are involved in developing and reviewing care plans. Risk assessments are in place. Evidence: The owner told us they develop care plans from assessments with the individual or their representative. We saw care plans have been signed by the individual or their relative and are kept under review. Care plans cover mobility, personal care, communication, continence, eating, health, education and cultural needs. These documents could be more person centred and include more information about the individuals life history and activities they enjoy. This would ensure that all staff have detailed knowledge of the individual and how to meet their needs. Staff said they had enough information to meet peoples needs. We saw risk assessments have been completed and kept up to date. Care Homes for Adults (18-65 years) Page 10 of 22 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. People who use the service have the opportunity to maintain and develop important family and personal relationships. Staff help with communication skills. The service provides a varied menu to meet peoples preferences and religious, cultural and medical dietary needs. Evidence: The owner told us that all people who use the service have a right to personal, social and intelectual development and must be given the opportunity to achieve their potential. We saw that people who use the service attend college and day centres, go out shopping and leisure facilities to meet their social and education needs. We saw that people are supported to maintain contact with family and friends. The owner told us that visitors are welcome. We saw that relatives have visited. Care Homes for Adults (18-65 years) Page 11 of 22 Evidence: The owner told us they provide good wholesome home cooked meals. We saw a record of food is kept and up to date. This identified people have a choice of meals to meet their needs and preferences. We saw people enjoy a meal during our visit. One person confirmed that they like the food. Care Homes for Adults (18-65 years) Page 12 of 22 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. People receive person centred support with personal and health care. Peoples health care needs are well met. Medication is well managed with records up to date and signed by staff. Evidence: The owner told us that every person who lives at the home has the right to receive high quality personal support that repsonds to any changing needs. We saw the service is small, with the owner and four family members available to provide care and support to individuals. We saw peoples privacy and dignity maintained during our visit. The owner told us they provide same gender care where it is specified in assessments and care plans. Records are kept of health appointments and any actions to be taken. We saw behaviour guidelines for one person. The owner said there has not been a referral to a psychiatrist and this should be done to ensure the individuals health needs are fully met. Care Homes for Adults (18-65 years) Page 13 of 22 Evidence: We saw medication is securely stored with records signed by staff. The count of medication for two people balanced with the amount of medication administered. We saw one person has medication as required the details for when staff should give this and the dose was not clear. This information must be clearly recorded in the care plan and in the Medication Administration Record Sheet to ensure the persons health needs can be fully met. Care Homes for Adults (18-65 years) Page 14 of 22 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 service has a clear complaints procedure which is included in the Statement of Purpose and Service Users Guide. Appropriate policies are in place for safeguarding and the owner has completed training in safeguarding through the local authority. Good systems are in place to monitor peoples finances. Evidence: The owner said that people who use the service should find it easy to make a complaint or raise a concern. She said that they welcome complaints and will look upon them as an opportunity to learn. No complaints have been received at the home. The Commission has not received any issues or concerns about the services provided. The owner has completed training in safeguarding vulnerable adults through the local authority and is aware of her responsibilities. One allegation has been made, which was investigated by the local authority. In the event of an allegation being made, the owner must ensure that the Commission is informed. We looked at the records of finance for one person, it clearly details money received, money spent and any change. The balance was up to date and correct. The owner told us that the finance records are made available to placing social workers and relatives at reviews and when requested. Care Homes for Adults (18-65 years) Page 15 of 22 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 appropriate to meet the needs of the people who live there. People have their own bedrooms. The home is well maintained and kept to a good standard. Evidence: People have access to a lounge/dining room with doors to a fairly large garden, a kitchen and a shower room with toilet on the ground floor. We saw that the kitchen is locked when not being used, the owner said this was to protect the people who use the service from harm. People who use the service are able to access the kitchen with staff supervision. Bedrooms are single and we saw they have been personalised to the individuals taste with pictures and photographs. We saw the upstairs windows open fully, restrictors should be fitted to ensure people who use the service are protected from harm. There is a shower room with toilet on the ground floor and a bathroom with toilet on the first floor. We saw all areas of the home to be clean and tidy. Care Homes for Adults (18-65 years) Page 16 of 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is a small family run home with the owner supported by four family members to provide care and support to people who use the service. Staff recruitment is not currently in line with regulations, with more checks required to ensure people who use the service are protected from harm. The owner and staff have access to appropriate training to help them carry out their role. Evidence: We saw enough staff to meet peoples needs. There is no staff rota and one must be completed noting the staff on duty each day. We looked at staff files for the four family members, a POVA first check had been completed for three and a Criminal Records Bureau (CRB) check had been completed for one. The owner must ensure that a POVA first and CRB check are completed for all, and an employment history and references must be sought for all staff. The owner told us staff have access to training through the local authority and have completed training in food hygiene and are due to complete safeguarding training. Care Homes for Adults (18-65 years) Page 17 of 22 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 owner has the experience needed to run the home. Quality assurance systems are in place, although they are not fully operational due to the short time the service has been running. Health and safety is well managed with clear records and checks up to date. Evidence: The owner has previous experience as a nurse and working in a registered care home with people with learning disabilities. Quality assurance systems are in place although the owner told us they have not started to use annual surveys due to the service only operating for five months. The owner said they have had reviews for people using the service when they have asked for feedback on the services provided. Health and safety is well managed with clear records showing the gas safety and electrical supply are tested annually. The fire alarm was serviced in July 2009 and is tested weekly by the owner. Care Homes for Adults (18-65 years) Page 18 of 22 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 19 of 22 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 1 24 13 The windows on the first floor must be fitted with restrictors. To ensure the health and safety of the people who use the service. 23/02/2010 2 34 19 The owner must ensure that appropriate recruitments checks are completed for all staff, including a clear enhanced Criminal Records Bureau check, references and a full employment history. To ensure that people who use the service are protected from harm. 26/03/2010 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 6 Care plans could be developed to be more person centred Page 20 of 22 Care Homes for Adults (18-65 years) 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 and to include more information about individuals life history and leisure preferences. 2 19 Prompt referrals should be made to psychologists or psychiatrists where there are concerns about the behaviour of an individual, to ensure their helath needs are fully met. Where people have as required medication, clear guidelines for when it shoul dbe given must be recorded from the prescribing doctor, this will ensure that people receive the amount of medication they require. 3 20 Care Homes for Adults (18-65 years) Page 21 of 22 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. 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