Care Home: St Johns

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What the care home does well People are happy living at the home. They are supported to make choices and live individual lives. They are valued and respected by staff. The staff feel well supported and trained and are happy working at the home. People live in an attractive purpose built home. What has improved since the last inspection? This was the first inspection of the service. What the care home could do better: There needs to be improvements to the way in which medication is stored and managed to make sure people are not put at risk. People always need to have their food purchased with money from their placement fees. The staff need to make sure they act on any risks identified during health and safety checks and that this is recorded. Key inspection report Care homes for adults (18-65 years) Name: Address: St Johns 1 Ferry Road Teddington Middx TW11 9NN     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: Sandy Patrick     Date: 0 4 0 5 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 26 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 26 Information about the care home Name of care home: Address: St Johns 1 Ferry Road Teddington Middx TW11 9NN 02089777574 02089777574 manager.stjohns@orioncare.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Sons of Divine Providence T/A Orione Care Name of registered manager (if applicable) Mr Cedric Leroy Bourne Type of registration: Number of places registered: care home 6 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: 6 The registered person may provide the following category 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 Johns House is a home for up to six adults who have a learning disability. The home was registered in 2009. People are supported to make choices and learn skills that meet their needs and interests. The home is staffed 24 hours a day. The home is managed by Orione Care, a Catholic charity. People who live at the home are supported to follow any faith that they have chosen. Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 6 Brief description of the care home The home is located close to shops, transport links and other community facilities. The fees are individually assessed according to needs. 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 inspection included an unannounced visit to the home on 4th May 2010. We met with people who live there, staff on duty and the manager. We spoke to people about their experiences and observed how people were supported and cared for. We looked at the environment and the records. We wrote to the manager and asked him to complete a quality self assessment. We wrote to people who live and work at the home and asked them to complete surveys about their experiences. We looked at all the information we had received about the service since it was registered. Some of the things people said about the home were: Care Homes for Adults (18-65 years) Page 6 of 26 They offer support in a person centred way and have friendly staff. Everyone seems to have settled in well and it is a pleasure to work there. I like the dinner and the staff. I like it here. They look after my relative so well, the staff are lovely people easy to talk to and they listen to any concerns I have. The residents day to day care is good and I am happy to know my relative is in their care. Care Homes for Adults (18-65 years) Page 7 of 26 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 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. People are given the information they need to help them make a decision about moving to St Johns House. They have their needs assessed to make sure these can be met and the home is the right place for them. Evidence: The organisation have created guides to help people understand about the services and facilities at the home. The majority of people who live at the home moved in when it first opened. They moved from another home a few doors away which was also managed by Orione Care. That home closed when the new St Johns House opened. The people moving were involved in planning the way the accommodation was decorated and where their bedrooms would be. The majority of staff who worked with them at their old house moved to the new house as well and this helped them settle in. Two new people have moved to the home who were not previously living with the others. We saw that their needs were assessed and that they had opportunities to Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: spend time at the home getting to know others and the routines. They visited the home for over night stays and other activities. One person moved to the home shortly before the inspection. They told us that they had settled in well and liked their new home. People told us that they had enough information about their home to help them make a decision about moving there. Care Homes for Adults (18-65 years) Page 11 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. People have their needs recorded in a clear and accessible way so that they can have the most appropriate support. They make choices about their lives and their views are listened to and valued. Evidence: Everybody has their needs recorded in a care plan which tells the staff about their care and support. The staff have created records which can be understood and used by the people they are about - using photographs and simple words to help explain about their needs. People have been involved in creating their own plans. We thought that these were good, however some of the language and terms used to describe peoples weight need to be changed as the current language is quite negative. The risks that people face have been assessed and recorded and these assessments are regularly reviewed. People are supported to make choices about their everyday lives, activities, food and Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: the home. They have meetings with each other and with their support staff. Their choices and wishes are recorded. We spoke to people who live at the home who told us that they make decisions about the things that they do and how they spend their time. Care Homes for Adults (18-65 years) Page 13 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. People are supported to learn and develop skills that meet their needs and wishes. They have full and active lives and have relationships within the wider community. Evidence: People are supported to learn new skills and take part in a range of different activities according to their abilities, needs and wishes. Some people are involved in budgeting and planning their own menus, others help with the preparation of food and some people help with keeping the house tidy and laundry. Everyone has a plan of regular activities which suit their needs and choices. These include attending different groups, organised events and college. People also have free time with allocated workers to chose different individual activities and entertainment. People use the local community, shops, leisure facilities and clubs to have full, varied Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: and active lives. Everyone is supported to go on a Holiday of their choice. The manager told us that they planned house events such as barbeques and parties. People have developed friendships and relationships outside of the home and the staff support them to maintain these. People are supported to attend places of worship if they want. Families and visitors are welcome at the home and people visit their families when they want to. Families of people who live at the home told us that they were made welcome there and that they were well informed about peoples wellbeing and changes. The staff treat people with respect and showed genuine affection towards them. There is a varied menu which is chosen each week by the people who live at the home. The kitchen was well stocked with fresh food including fruit and vegetables. We saw from peoples care plans that they are supported to understand healthy eating. Care Homes for Adults (18-65 years) Page 15 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. People are supported to stay healthy and have their personal needs met. There need to be improvements to the way in which peoples medication is managed to make sure they are kept safe at all times. Evidence: People have their personal and health care needs recorded. We saw that their health is monitored daily and that consultations with health care professionals are recorded. Everyone is registered with a GP and other health care professionals as needed. There are health action plans to support the staff to understand about each persons health needs. Peoples preferences for support with personal care are recorded. People told us that the staff supported them as they would like. There are suitable procedures for the administration of medication. However, medication was not stored appropriately. At the time of the inspection the cabinet designed to store medication was not secured to the wall and medication was kept in a locked filing cabinet. Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: The medication storage was disorganised and medication which had expired and was no longer in use was stored alongside current medication. There was no record of the amount of some types of medication being held. There was no record of PRN (as required) medication so we could not audit how much of this there should be. One person is supported to store and administer their own medication. The staff need to make sure this person has a secure and locked place to keep their medication. There needs to be a record of when their medication is received and handed to them. Medication profiles detailing the medication each person has been prescribed need to be updated as some of these were inaccurate. Some of the medication records were not clear. For example the staff had used their own symbols and codes to describe administration rather than following the approved coding. Some records were unclear and messy. The amount of one persons medication did not tally with the records of the amount being held. The staff had administered this medication from two different supplies making it difficult to make sure they had received the correct dose. Care Homes for Adults (18-65 years) Page 17 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. People are able to make complaints and know what to do if they are unhappy about anything. There are procedures in place designed to protect people and help keep them safe. Evidence: There is an appropriate complaints procedure and people have been given copies of this. Everyone told us that they knew who to speak to if they were unhappy about anything. We saw that the staff and manager were welcoming and responsive when people who live at the home spoke to them and that people felt relaxed and comfortable in their company. There are appropriate procedures for safeguarding people and whistle blowing. The staff have had training in these. The staff support people to manage their money. We saw that records of this were accurate and appropriately maintained. Balances of any money held on behalf of people are checked each day. Two people who live at the home have been purchasing food from their own money. This practice is not appropriate because part of their placement fee from the local authority is for the food and drink they eat. Care Homes for Adults (18-65 years) Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an attractive, well designed and well maintained environment which meets their needs. Evidence: The home was registered in 2009 and the building was converted and refurbished to suit the needs of the people who live there. The home is attractively decorated and designed and is light and airy. Everyone has their own en suite shower and toilet. Bedrooms have been decorated to suit individual tastes and have been personalised. There are well furnished communal areas including a modern kitchen. The home is equipped with televisions and music systems. There is a well kept garden. People told us that they like the building and that it is clean. One of the communal rooms was used for storing furniture at the time of our visit. The manager told us that they were in the process of buying furniture and fittings to make this room usable. We found that the home was clean and fresh throughout on the day of our visit. 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. People are cared for by well trained and supported staff who have been appropriately recruited. Evidence: People who live at the home told us that they like the staff. The staff told us that they were well supported and trained. There is information for staff on their roles and responsibilities. There are appropriate procedures for recruiting staff including checks on their suitability. We saw that staff files contained records of thorough recruitment. There is a planned programme of individual and team meetings with the manager and these are recorded. There is a planned programme of training for staff to help develop their skills and abilities. The staff told us that they had received thorough inductions into their roles and that they were well trained. Care Homes for Adults (18-65 years) Page 20 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. People live in a well managed home and feel confident that it is run in their best interests. Evidence: The manager ran the previous home where people lived before they moved to St Johns House. He knows the people who live there and the staff well. He is appropriately experienced and qualified. The staff told us that they found the manager approachable and supportive. The organisation employs senior managers who offer support and visit the home. The manager has set up systems for monitoring the quality of the service and peoples experiences. There are regular meetings for people who live at the home and staff so that they can feedback their views. Some of the records used to support the smooth running of the home could be better Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: organised. For example records for staff recruitment. The manager told us that he was in the process of organising these records. There are appropriate checks on health and safety, including fire safety. We saw that these were recorded. The checks on hot water temperatures showed that on several occasions hot water exceeded safety levels. The records did not indicate that any action was taken to remedy this problem. Records must show what action is taken if a health and safety risk is identified. Water temperatures should be adjusted to reduce the risk of scalding. Care Homes for Adults (18-65 years) Page 22 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 23 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 1 20 13 The registered person must make sure medication is appropriately stored, recorded and administered and that old or unused medication is returned to the pharmacy for disposal. 31/05/2010 2 23 13 The registered person must 31/05/2010 make sure people do not use their own money to purchase food that has already been provided for within their placement fee. The registered person must make sure staff act on risks identified during health and safety checks and that this action is recorded. The registered person must make sure hot water is delivered within safe temperatures to reduce the 31/05/2010 3 42 13 4 42 13 31/05/2010 Care Homes for Adults (18-65 years) Page 24 of 26 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 risks of people being scalded. 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 The manager should make sure the language and terminology in care plans is always positive and reflects what the individual would like to say about themselves. The manager should make sure all records required by regulation are well organsied and information is clear and accessible. 2 41 Care Homes for Adults (18-65 years) Page 25 of 26 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). 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