Care Home: St James` Care Home (12)

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What the care home does well 12 St James provides a homely and safe environment for people to live in. The internal environment is comfortable and support is given to residents to personalise the home as they wish. People who use the service make choices about their day to day life including meals, activities outings and holidays. Staff reported that they endeavour to empower residents to do what they want to do. As a staff team they worked well together to provide a high standard of care and support to the people living in the home. What has improved since the last inspection? The statement of purpose is in a more service user format. There is more evaluation of residents needs with the introduction of a monthly key working session. There is a visual/pictorial weekly menu available. All staff have attended Person Centered Planning training and the organisation is introducing a new care planning system which links in to person centered care. What the care home could do better: The manager must ensure that written confirmation has been received from the agency that any staff sent to the home have had all the required checks carried out. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St James` Care Home (12) 12 Old Hospital Close, St James`s Drive London SW12 8SS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Davina McLaverty     Date: 1 4 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: St James` Care Home (12) 12 Old Hospital Close, St James`s Drive London SW12 8SS 02087677937 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Metropolitan Support Trust Name of registered manager (if applicable) Patricia Sylvia Lewis Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: 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 (maximum number of places: 5) Physical Disability - Code PD (maximum number of places: 1) The maximum number of service users who can be accommodated is: 5 Date of last inspection Brief description of the care home St James Care Home, 12 Old Hospital Close is a semi-detached house, providing a service for persons with learning disabilities. The home can accommodate up to five tenants in single rooms. One of the rooms has ensuite facilities. The accommodation is provided over two floors, with one room being wheelchair accessible. There is a communal lounge and a dining area situated near the kitchen. The aim of the home is to promote independent living skills within a safe environment. The fees charged are #1084-64 per week. Care Homes for Adults (18-65 years) Page 4 of 26 care home 5 Over 65 0 0 5 1 Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good outcomes. The inspection included an unannounced visit to the service on the 14th October. We met all five residents, the manager,and deputy manager and two support staff. We also looked at a number of records, which included three resident’s files, staff files, care plans, health and safety records as well as the environment. In addition, the inspection took account of information received about the service since it last inspection. Care Homes for Adults (18-65 years) Page 6 of 26 We asked the manager to complete an Annual Quality Assurance Assessment (AQAA), which is a self assessment of the service and is also referred to in the report and helped us to form some of the judgments made. Communication with the majority of residents was not possible due to the level of their learning disability. Two residents said that they liked it at the home. Residents were observed to be very much at home and at ease with the staff who supported them 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has good written information that would enable potential residents and their advocates to make a choice about whether they would like to move to the home. No new resident would be admitted without a through assessment to ensure that the home can adequately meet their needs. Evidence: There is a statement of purpose and service user guide that describes what new residents can expect from living at 12 St James and the aims of the service. Since the last inspection no new resident has moved in to the home. Existing residents have lived in the home for many years. The AQAA states that Annual reviews are held to assess service users changing needs together with network meetings as and when required. Evidence of these meetings were seen on the fies examined. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and regular reports of key worker sessions are in place. The care planning system is person centered and aims to ensure that individual needs are being met.Risk taking is acknowledged by staff as part of developing an independent life and individual assessments are carried out to support this. Evidence: Three care plans were examined. Care plans are well maintained and cover all aspects of personal and social support and health care needs. The standard of recording is good. Staff try to involve residents as much as possible in their care plans.Care plans include reference to equality and diversity and address any needs identified in a person centered way. Staff have sufficient skills and ability to support and encourage residents to be involved in the ongoing development of their plan.Goals are identified and worked towards. Residents are supported to participate in the community on a regular basis. Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: Some residents are able to make decisions and take reasonable risks, in order to maintain and develop independent living skills.Risk assessments were seen to be in place and are regularly reviewed and updated. All residents are encouraged to do as much as they can for themselves. Action is taken to minimize identified risks and hazards and service users are given advice about their personal safety , to avoid limiting the service users preferred activity or choice. Changes in need are documented in the care plans following reviews which take place six monthly. The home operates a key worker system and documentation of regular meetings between key worker and resident was seen. The AQAA states that the home plans over the next twelve months to produce support plans and risk assessments in a more appropriate format for service user. The home also wants to develop its communication systems to enable more resident involvement in all aspects of the running of the service as well as to work with WAndsworth advocacy partners to promote residents independence. Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to maintain good links with the community, which enriches residents lives. The home provides a very good environment for people to develop their social skills as far as they are able. Staff continue to encourage and support residents to be as independent as possible. Evidence: All residents attend a day center Monday to Friday. At weekends and public holidays residents are supppored to attend a range of community based activities eg meals out, discos, cinema, bowling , shopping and visits to local parks. Residents make full use of the local transport system with staff support. The AQAA states hat some service users regularly take days off from their day center to take part in activities with their key worker. Holidays are also encouraged and supported by staff at least annually if the person wishes to go. Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: The staff team help with communication skills, both within the service and in the community, to enable residents to fully participate in daily living activities. Residents are able to maintain contact with their friends and family. On the day of the inspection one resident was taken out by their brother for the day. Throughout the day, staff were observed to treat residents with respect. For example, staff were seen to get down to eye level to talk to one resident, and was seen to be very patient with another resident who could communicate verbally. On return from day center residents are encouraged to wash their hands before having a drink/snack. The menu showed that residents are offered a good range of foods. Staff reported that most meals are prepared from fresh by snack. Residents are encouraged to assist depending on their level of functioning eg setting the table, getting ingredients from the fridge/cupboards or taking their plates to the sink. One resident was seen helping themself to what they wanted from a cupboard. Staff reported that special diets can be catered for. AS stated earlier the residents have lived in this home for many years. The staff group is stable and staff are very familiar with residents likes and dislikes which are always accommodated when a meal is being prepared. Staff were sen to be sensitive to the needs of those residents who find it difficult to drink on their own and were seen to provide support at the pace of the resident making them feel comfortable and unhurried. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal support, which meets their physical and emotional needs. An appropriate system is in place for the safe administration of medication. Evidence: As previously stated the majority of residents are non verbal or find it difficult to discuss their needs in detail. Staff through their experience and length of time working with the residents have identified their needs through their body gestures, sounds made and where residents who are able through signing. In discussion with staff they stated that personal care is carried out in a sensitive way to maximise the persons privacy, dignity and independence. Everyone is encouraged to do as much as they can for themselves. The AQAA states that the home would like to employ more male staff to support male service users with personal care. Daily records are kept on each resident, and these were seen to be of a good standard and Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: give a clear picture of each persons day. The AQAA states that all residents are registered with a good GP who understands the needs of the person. Evidence was seen on the files examined of contact with the GP and other health care professionals eg opticians, dentist as well as specialist support as and when needed eg speech therapists, occupational therapists and psychologists. Service users all have an annual health check. Residents continue to be protected from harm by clear guidance and procedures that are in place for medications. Medication records examined had no gaps i recording of administration of medicines. Medicine reviews are evidenced as being carried out. Each medication record had a current photograph of the resident and details of any allergies. There were clear instructions for when as required medications were to be given and information leaflets on the medications that tenants have been prescribed. Evidence of staff training on administering medication was seen. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Organisational policies and procedures are in place to protect residents from abuse as well as to support residents who are not happy and wish to make a complaint. Evidence: The manager stated that there had been no formal complaints received since the last inspection. The Commission for Social Care had also not received any concerns about the service. Staff are mindful of residents methods of communication and stated that the can usually tell from the gestures used if someone is not happy. Complaints are now an agenda item on the monthly key working meetings with residents. The records of these sessions was seen. Policies and procedure are in place for the protection of vulnerable adults. A copy of the local authority procedure is available in the home. Two staff spoken to were aware of the Protection of Vulnerable Adults procedure as well as Whistle blowing. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was found to be clean on the day of the inspection , although some areas require decorating to maintain its homeliness. Evidence: The premises are homely in appearance and blend into the environment and is not easily identifiable as a care home by members of the public. However in discussion with staff due to the homes location on a housing estate the local community are very aware that no 12 is a care home and the young children on the estate can be a problem targeting residents when out. Staff have involved the police to talk to the young people who tend to congregate under the homes car port. The manager also have tried to address this with the local youths. The home was seen to be well maintained and is homely in appearance. The manager reported that the communal areas are due to be decorated over the next year. All five bedrooms were seen and each one was personalised and reflected the residents personality and needs. Residents are encouraged to see the home as their own. One bedroom is wheelchair accessible with en suite facilities. There is a large kitchen/dining Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: room as well as a good size lounge with appropriate furnishings. Staff have adequate sleep in accommodation. A separate laundry room is available on the ground floor, as well as a separate toilet. The organisationn has a good infection control policy in place. Bathrooms are fitted with appropriate aids and adaptations to meet the needs of the people who use the service. The garden is also a good size and is well maintained and is well used by the residents in the warmer months. Due to the organizations merger with Metropolitan Housing repairs to the home have tended to take longer to be addressed. The home has a system in place for trying to ensure that things get addressed promptly which has helped . The manager in her AQAA is looking to appoint a member of the staff team to take the lead with dealing with maintenance issues. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are appointed following an appropriate recruitment and selection procedure. Staff have access to training appropriate to their roles. Evidence: The inspector met, two members of support staff, the deputy and manager during the inspection. All staff were very helpful and knowledgeable about the service and the residents needs. The home operates with two members of staff during the core hours when residents are at home and then it varies depending on needs but during the day there is usually just one staff on duty. These staffing levels were seen to be sufficient to meet peoples needs. The rotas showed well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. We saw good interactions between people who use the service and staff. We saw people who use the service to be comfortable and relaxed with staff. WE saw good policies and practices for recruiting staff. Staff files seen contain a copy of the application form, two written references, a Criminal Records Bureau check and Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: proof of the individuals s identity. As already stated the majority of staff have worked at the home for many years. Currently there are ??? vacancies and agency staff are used occasionally to cover shifts where current staff or bank staff are not available. The manager was advised obtain written confirmation from the agencies that any staff they send to the home that they will have taken up references and that the person has a current CRB check. Staff have access to regular training relevant to their role. Support staff confirmed that they have good training opportunities with courses that help them improve their practices and do their job well. The manager said that staff have regular supervision. Three staff confirmed that they get supervision and records were also seen. Staff meeting take place regularly and a record is maintained. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has the experience to run the home. The manager and staff operate in a person centered way. A quality assurance system is in place as well as attention being given to to making sure that the health , safety and welfare of residents is promoted and maintained. Evidence: The manager is now registered with the Commission for Social Care. Prior to that she was the acting manager. The manager stated that she is hoping to start her NVQ level 4 and managers award this year. The manager leads and supports a Strong staff team who have been recruited and trained to a high standard. The AQAA contains clear, relevant information that is supported by a wide range of evidence . The AQAA lets us know about changes they have made and where they still need to make improvements. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: Residents meetings do take place but due to the level of communication 1 to 1 key working sessions are seen as more effective. We saw records of monthly staff m,eatings, in which staff are given the opportunity to discuss practice issues and to discuss residents needs given information about training, updated on changes to people who use the service and changes within the oganisation as well as providing a forum where they can discuss issues which they deem to be important. Copies of monthly regulation 26 visits were seen in the home. The manager stated that a quality assurance system is i place, which seeks the views of residents, relatives and other stakeholders. Questionnaires are sent out annually on return, collated and necessary changes made. We saw evidence of good health and safety policies, practices and records of weekly fire alarm tests, water checks, landlords gas safety records and portable appliance tests. COSHH assessments were in place. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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