Care Home: St James House

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What the care home does well We found that the peoples needs are fully assessed before they move into St James so that they begin to receive appropriate support straight away. We found that a comprehensive and personalised plan of care is developed with the person and other appropriate people such as social workers and relatives so that all can contribute to the information in care plans. We found that people have their risks assessed and strategies put in place that will help to reduce these risks. We found that people at St James are provided with support and opportunities to develop new skills and participate in educational and recreational activities that are meaningful to and enjoyed by them. We found that the routines at St James is flexible enough to suit the needs of the people who lived there. We saw that meals and mealtimes promoted good nutritional health and promoted independence and the development of skills in this area. We found that people at St James were supported to access health care that promoted good health and ensured that health concerns were treated and monitored in keeping with current good practise. We found that adult protection is promoted through use of a robust policy that is understood by staff. We found that staff working at St James are qualified to work in a social care setting. Comments about what St James did well included: `The service helps the service user to maintain their Independence and skills factor to carry out their daily living to their capabilities.` People using the service also expressed satisfaction and told us: `It does very well- it`s very clean and I have no complaints.` What has improved since the last inspection? Since the previous inspection only black ink pens are used to write on the medication record sheets. What the care home could do better: The registered person should consider developing the homes complaints procedure in a variety of formats to make it more accessible to people who use the service. The registered person should consider ensuring that the complaints and concerns procedure is periodically explained to individuals, this is so they can be confident that each person is aware of the subject. The registered person should prioritise the development of the homes Deprivation of Liberty safeguards (Dols) strategy to ensure that people are always offered support within the current legal framework. The registered person should introduce systems for monitoring and dealing with staff who have disclosures on their CRB`s, this will help to develop a staff team with integrity and also safeguard against employing unsuitable people. Key inspection report Care homes for adults (18-65 years) Name: Address: St James House Danes Road Rusholme Manchester M14 5JT     The quality rating for this care home is:   three star excellent 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: Michelle Haller     Date: 1 4 0 4 2 0 1 0 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 31 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: St James House Danes Road Rusholme Manchester M14 5JT 01612256999 01612249355 sjh@standwalk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Standwalk Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: A manager with qualifications, agreed as appropriate by the Commission for Social Care Inspection, will be employed to manage the day to day running of the home at all times. In the absence of the manager, day to day running of the home will be the responsibility of a senior member of staff who has substantial experience at a senior level and/or qualifications relating to care of people with a learning disability and associated challenging behaviour. A maximum of 14 service users will be accommodated. Accommodation will be provided in three separate units. Night care provision will consist of a member of staff on waking duty per unit. Staffing levels must be commensurate with the needs of the services users and must be sufficient to allow for them to be escorted outside the building on a one:one or two:two:one basis, as per their assessment. The home will not accommodate:- (i) people who have a criminal conviction, (ii) those people whose risk assessment inidcates that they are likely to pose a risk to the general public (iii) sexual Offenders, (iv) people with a history of sexualised behaviour, unless a full risk assessment has been carried out and it is clear that the behaviour is either situation speficic or can be controlled in other ways Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 14 The home will only provide a service to people whose primary need for care arises from a learning disability with associated challenging behaviour. Date of last inspection Brief description of the care home St James House is a registered home providing 24-hour care and accommodation for 14 persons with a learning disability and associated challenging behaviours. The home is situated in the Rusholme area of South Manchester, close to local amenities and transport routes. The home is a converted church sited in a residential area within its own grounds. It is accessed directly from a residential street and has adequate parking and an extensive and well-managed garden. The home is divided into three separate areas, offering a range of facilities to cater for people with varying levels of support needs. Bedroom accommodation is provided on the ground, first and second floors. The ground and second floor bedrooms are single with en-suite facilities and a selfcontained flat. The first floor contains three self-contained flats and three single rooms. The building is fully accessible and there is lift access to all floors. There are a variety of communal areas on each floor including lounges, kitchens, laundry facilities, a well-equipped sensory room, and hydrotherapy pool and gym room. The fees charged by this home are calculated according to the assessed needs of people using the service. Care Homes for Adults (18-65 years) Page 5 of 31 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: three star excellent 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: We conducted this inspection by visiting the St James without informing the manager before hand, and we looked at all of the most important or key Care Homes for Adults (18-65) National Minimum Standards (NMS). This is called a Key Inspection. The inspection involved looking at the information we had received about the service during the previous year and before visiting the home. This included notifications or events that the manager has told us about, information from other sources such as social services, health workers or people using the service. We also considered the outcome of the previous key inspection we conducted in 2007. We received five completed Care Quality Commission (CQC) surveys from people who live at St James and six surveys from staff. We visited St James and looked around the home and checked through written Care Homes for Adults (18-65 years) Page 6 of 31 information, including service user care files and staff employment records. We read through policies, guidelines and other documents concerned with running the home. We talked to residents and staff working at the home. We observed the interactions between service users and staff at the home. We interviewed one of the registered providers. The manager returned to us the CQC Annual Quality Assurance Assessment (AQAA). The information requested included data about staff training, development of policies and procedures and compliance with health and safety checks. This information also influenced the outcome of the inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The registered person should consider developing the homes complaints procedure in a variety of formats to make it more accessible to people who use the service. The registered person should consider ensuring that the complaints and concerns Care Homes for Adults (18-65 years) Page 8 of 31 procedure is periodically explained to individuals, this is so they can be confident that each person is aware of the subject. The registered person should prioritise the development of the homes Deprivation of Liberty safeguards (Dols) strategy to ensure that people are always offered support within the current legal framework. The registered person should introduce systems for monitoring and dealing with staff who have disclosures on their CRBs, this will help to develop a staff team with integrity and also safeguard against employing unsuitable people. 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 9 of 31 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 10 of 31 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. People moving into St James have their future wellbeing promoted because needs and aspirations are fully assessed before they receive a service, therefore people can be assured that these needs can be met at the home. Evidence: We read through the records for three people living at St James and case tracked the support they received from the time of their admission to the day of this key inspection. We chose to look at a person who was recently admitted to the service, a person with complex needs and person who has lived at St James for a number of years. We saw that in each case a preadmission plan and assessment was in place. We saw that assessments had been developed through liaison with the person and people who knew them well. The information in the assessments covered, accommodation needs, interests and activities, family contact, identification and management of risks, personal needs such Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: as faith or cultural preferences, physical and mental health needs, communication requirements and social needs. In addition other health professionals or specialist personnel who have been involved in offering support. The assessments also included a description of how a persons diagnosed condition may effect their abilities and the actions needed to reduce these effects. We found that peoples needs were assessed in sufficient detail to identify whether these could be effectively met at St James. Care Homes for Adults (18-65 years) Page 12 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at St James House have their wellbeing and autonomy promoted through through systems that ensure that their individual needs and choices are understood and met. Evidence: We looked in detail at the service users plan and other documents such as letters, daily diaries and activities calenders for three people living at St James. We saw that each care plan was individualised and provided information that was specific and centred on the individual. We noted that different aspects of need or areas of support were highlighted in keeping with the individual assessment. We found that the service user plans were reviewed on a monthly basis and that changes were made in keeping with how the person had responded to the support. We noted that some plans were prepared using pictures, this assisted the service user in understanding the information, and so they were more able to make some decision Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: about how their support was provided. We found that the service plan identified areas of risk and these were fully assessed and risk mitigation plans were put in place. We saw that where action is taken to minimise risk, this is fully discussed and planned in a multidisciplinary team, and we saw that the persons perceived wishes and preferences are respected. We noted that risk assessments looked at the likelihood of an event occurring and the seriousness of the consequence, should the event occur. We discussed the Mental Capacity Act (MCA 2008) and Deprivation of Liberty safeguards (DoLs) with the registered provider. We found that the organisation is at the early stages of reflecting this legislation and the guidelines in the policies and procedures of the home. We noted from the training matrix that senior staff have received initial training. We discussed this issue with the registered provider and stressed that it is important that a protocol for meeting the requirements of the MCA 2008 legislation, including policies, procedures and guidelines and provide associated training is put in place. This is so that people are always supported in a way that is lawful. Care Homes for Adults (18-65 years) Page 14 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Actions taken at St James ensures that people experience a lifestyle that meets their individual needs. Evidence: We read through information in peoples daily records and activities plans. We also observed what people did during the day and we talked to staff and service users about the lifestyle and culture at St James. We found that people were provided with opportunities to access education and other occupation. We saw that people continued attending college. Staff arranged or provided transport to different venues.And staff ensured that people were prepared for participating activities through, developing picture calenders, talking to people about what they would like to do and reminding people about the events planned for the day. This was done in keeping with each persons individual care plan. Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: We found that staff worked hard to support people to succeed and enjoy whatever leisure pursuit they chose or that had been introduced to them. Records confirmed that people at St James enjoyed a varied timetable of pastimes and hobbies that took place within their home, the local community and further afield. These included: arts and crafts, playing a choice of musical instruments and listening to music, needlework, watching DVDs, baking, letter writing, filling in sticker albums, playing board games, completing jigsaws and other puzzles, using the hydro-pool, gym or multi-sensory room in St James or playing football and basket ball in the grounds. Peoples timetables also included walks in local park, shopping, use of the local Library, visits to various museums, dance session, evening discos and socials in Benchhill and Longsight and drives out. We were informed that day trips were usually at the weekend and these had included going to Liverpool and Southport. We saw photographic records of people currently living at St James enjoying events such as a disco, birthday party, Christmas events and a day trip to Blackpool. We also noted that routine chores and events were also recorded on personal calenders. These included completing domestic tasks such as personalising and cleaning their bedrooms and family visits that were agreed would happen at a particular time. Records indicated and we were informed by staff that families were made welcome and that there was a good rapport with staff. The attendance lists in relation to care plan reviews confirmed that family members were able to attend and their view valued and taken into account. We saw that a communication book was used when people spent time away from St James so that staff could be updated on how people have progressed during the change in accommodation. We saw that peoples dignity was preserved and they were treated with respect and care by the majority of staff. We noted that staff gave people clear instructions about the day ahead and what was planned. Staff were, in the main, jovial and helpful and the required boundaries were kept. People were happy and seemed confident to approach staff, we saw that the routines in the home such as bedtimes, meal times and times for completing personal care needs were negotiable but always remained in keeping with peoples behavioural Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: management and risk management plans. This is important because keeping to these plans means that people are able to have positive experiences and function well in other aspects of their lives. Meals are prepared by staff and the people living at St James. There is a four week rotation. The meal choices appeared varied and people could chose what they wanted if they didnt like the set meal. Lunch was generally a light meal such as baked potatoes with a choice of filling, burgers, omelet, soup and sandwiches. The evening meals included spaghetti bolognase, pork chops, chicken pie, egg and chips and roast dinners. A new menu is been planned to reflect seasonal changes. We saw that the people living at St James had attended a meeting at which this was discussed. They have said that they would like shepherd pie, fish and chips and curry to be included. Take-away meals are also enjoyed on occasion. We found that people were referred to the dietitian and appropriate steps taken to deal with excessive weight loss or gain. We saw that the instructions were followed in full or modified slightly to meet the individual preferences. We saw that fresh fruit and vegetables was readily available and people were offered snacks such as crisps and biscuits in line with providing a balanced and healthy diet. We talked casually to people during the period of the inspection. We met all but one of the residents living at the home on the day in inspection. Each person was for the most part relaxed and those who commented were positive about their experience of living at St James. They said I love this place. One person was asked if they were Ok and they gave the thumbs-up sign and smiled. And The girls are OK. Care Homes for Adults (18-65 years) Page 17 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at St James receive personal and health care support that fully meets their needs. Evidence: We found that people were offered personal support in keeping with their care plans and their privacy and individuality promoted. The home operates a designated keyworker sytem that hepls to ensure consitance and conytinuity of support. We found that people at St James have effective aceess to all healht care professionals they need. We found that people were supported to attend specialist clinics and receive routine health checks such as medication reviews, dental care and optical examinations. We noted that a vital inofrmation form is ready and completed in each persons file so that this can be taken should hospitalisation be required. We were informed that if service users required hospital care then members of staff would be released to remain in attendance. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: We saw that the staff worked with the resdients to help to try and reduce phobias such as fear of needles. Records and reports confirmed that the health of the residents is montired and remidial treament sought quickly. We found that medication management at St James ensures that medication is stored securly. We examined a number of medication adminstraion record (MAR) sheets and found that people were given the correct medication, at the correct time and in the correct dose. We note that all entries on the MAR sheets were in black ink. The training record indicated that all staff had received training in how to administer medication sytem used at St James. This is a metered dose system where the pharmacist provides medication packaged for individuals. Items that could not be dispensed in metered doses, such as liquids or as required medication, were provided and stored individually. Care Homes for Adults (18-65 years) Page 19 of 31 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. People at St James are protected from harm though a robust adult safeguarding policy that is fully understood by staff. Evidence: We found that the concerns and complaints policy was available and if followed would enable people to have their concerns and complaints and concerns fully investigated. We assess that an improvement in this area would be the production of the policy in different formats to make it more accessible to people who do not read well. We also assess that this area could be improved if the service could confirm that the policy has been explained and highlighted to people on a regular basis. We found that St James uses the Safeguarding of Vulnerable Adult policy that is endorsed by the local authority and other statutory services. The training calender indicated that all staff have received adult protection training since the last inspection. This training has been provided in-house by St James staff and also from the Manchester City Council training unit. We discussed the issues of adult protection with staff. They appeared to understand the issues and their role in protecting vulnerable people. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The registered person informed us that, since the previous inspection, no adult protection investigations had been conducted at St James. Comments from staff included: We discussed different types of abuse and the procedure for whistle-blowing- yes I feel it has prepared me for dealing with the issue. Care Homes for Adults (18-65 years) Page 21 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at St James benefit from living in a clean and pleasant environment that meets their individual needs. Evidence: The environment at St James is excellent. The building is set in well kept grounds that have developed to meet the interests and needs of the people using the service. There is an enclosed soft-land basketball court. There is space for people to walk and sit, play football or develop an interest in gardening. The service has recently purchased a greenhouse. The home ramped access and there is sufficient parking. We assessed that, in general the internal fixtures and fittings were clean and pleasant to use. The furniture in the communal areas was homely. We found that there are sufficient communal areas to meet the needs of the 14 people living at St James. On the ground floor there are two lounge areas, and a multisensory room that was very clean and inviting. On the top floor there is also a large lounge. From the main lounge downstairs there is a large attractive sensory garden which is walled. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: The communal bathroom and toilet areas were clean and there was hand washing and drying facilities. The bedrooms that were entered were clean and in the main free from unpleasant odours. On the day of inspection deodorising was occurring in some of the rooms. We noted that the furniture and fittings in some peoples bedrooms was unconventional, however, discussion with staff indicated that was in keeping with the persons plan of care. We also found that the manager needs to re-negotiate with people in respect of their need to replace some items of furniture, particularly mattresses, that appears unhygienic and damaged. On the day of inspection we noted that people were been supported to go shopping for items to personalise their rooms. We heard staff discussing with people the items they might like to purchase and what might be useful in keeping with their interests. Another facility at St James is a hydrotherapy pool. This was clean and kept securely locked when not is use. We saw people mobilising around the home independently with hindrance. The home is bright and airy and an appealing place in which to spend time. Care Homes for Adults (18-65 years) Page 23 of 31 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. People at St James are supported by staff who receive training and support to do their jobs well, however the systems in place do not fully promote the employment of people who are suitable to work in this sector. Evidence: We observed the interaction between staff and people living at St James, we saw that in the main interactions were positive, encouraging and in keeping with the instructions in care plans. Staff have received specialist training in Autism to assist them in their work. Five members of staff returned surveys to us and each confirmed that they received training that kept them up to date with new ways of working and prepared them for their role. Staff we interviewed stated that the management was very supportive and provided guidance about how to best work with individual people. In the AQAA returned to us the manager confirmed that over 50 of staff had achieved National Vocational Qualification Level 2 or above in Care. Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: We examined the training matrix and found that training was provided on the following topics: Health and Safety; People Handling (manual handling); use of hoist and sling; Food Hygiene; First aid; Control of substances hazardous to health; Medication administration; Safeguarding Vulnerable Adults; Fire safety; Autism; Communication and Infection control. We found that the manager devises workshops and specific training around the needs of the individual people using the service. Each session is approximately a days duration and covers everything concerning the persons individual care and support needs. This includes the personal plan, diagnosis, behaviours and risk management, specialist assessments, activities, communication, personality the progress made since their residency at St James and the people from outside of St James involved in providing support. We looked at the recruitment records for 4 members of staff and examined all Criminal Record Bureau (CRB) certificates. We found that staff were selected through a process that included an interview, receipt of two references, the supply of additional proof of identity and confirmation concerning peoples residency status in the United Kingdom. An improvement in this area would be for the registered person to tighten up the recruitment procedure in respect of dealing with CRBs disclosures. We found that there was no record of the action taken to further check the integrity of the staff involved. We discussed this matter with the registered provider and highlighted the need for a risk assessment and additional or ongoing monitoring. We also assess that introducing a probationary period would enable the manager to consider whether to offer a permanent contract if the incident was not disclosed on the job application form as requested. It is essential that the registered person can be confident that the staff team working at St James are honest and have integrity. And this not fully possible through the current employment and disciplinary practises at the home. Staff were very complimentary about working at St James. They told us that what the service did well included: We help lots of people, everyone who lives in this home is happy, Im always talking to them and most of them said I like this place its very good to live. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: And We take good care of needs of service users, give them opportunities to learn lots of new stuff. The home puts the needs of the service users first and everyone is nice to work with. Care Homes for Adults (18-65 years) Page 26 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems in place concerning the conduct and management of St James, promotes the continued wellbeing of those involved with the service. Evidence: We found that service users benefit from a well run home in which effective management systems are embedded, therefore enabling people to receive the service they expect even in the absence of the Registered Manager and Provider. On the first day of inspection the registered manager and other senior staff were unavailable, however the registered provider was contactable by phone. The inspection process was assisted by the senior carer on duty. We found that this person was knowledgeable about the running of St James and the needs of the service users and staff on duty. We saw that people continued to receive support in keeping with their care plans. We noted that this senior carer was competent and had the authority and skills Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: required to ensure the continued smooth running of the home. We found that there are quality monitoring systems in place. We saw that a quality assurance questionnaire had been completed by people using the service and that this information was used to influence changes to the service. We also found, through reading the minutes, that people are able to make their views known at Residents meeting. We noted that staff are encouraged to take an interest in the quality of the service provided at St James through reading the Care Quality Commission inspection reports and they returned five surveys to us. We were also informed that staff have been actively involved in ensuring that St James maintains its Investors in People status. And in the information returned to us the manager said that St James had been attained a Certificate of Excellence as a provider unit by Manchester City Council Social Services. We found that safe working practises are promoted at St James. In the information returned to us the manager confirmed that all equipment and services at St James had been checked and maintained by appropriately qualified technicians and in keeping with the relevant recommendations. We looked at the accident and incident records. We were informed that these were monitored by the registered provider. We reminded the registered provider to be mindful of incidents that might need to be reported to CQC under Regulation 37 of the Care Standard Act. Care Homes for Adults (18-65 years) Page 28 of 31 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The registered person should prioritise the development of the homes Deprivation of Liberty safeguards (DoLs) strategy to ensure that people are always offered support within the current legal framework. The registered person should consider developing the homes complaints procedure in a variety of formats to make it more accessible to people who us the service. The registered person should consider confirming that the complaints and concerns procedure is periodically explained to individuals, this is so they can be confident that each person is aware of the issue. The registered person should introduce systems for monitoring and dealing with staff who have disclosures on their CRBs, this will help to develop a staff team with integrity and also safeguard against exploitation. 2 22 3 22 4 34 Care Homes for Adults (18-65 years) Page 30 of 31 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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