Care Home: St Luke`s Close (6)

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What the care home does well Staff continue to work well to ensure that people who use the service are supported in an individualised way. The level of staff training is good, and updated training is provided when necessary. People who use the service are consulted about how they spend their time and what they wanted to eat. Records were well maintained. The home involves independent advocates where necessary. What has improved since the last inspection? The manager is now registered with the Commission. The home has no-one outside its conditions of registration. Records show that staff are adequately supervised. What the care home could do better: Not all information required in relation to recruitment of staff is on personnel files seen during this inspection. This means that people who have respite in the home are not protected by the homes procedures. A report on the homes review of care must be supplied to the Commission and made available to those using the service so that improvements to the quality of the service can be seen. Alterations made on the medication administration records should remain legible to ensure the changes can be verified where necessary to ensure the safety of those living in the home. Policies and procedures should be reviewed and updated regularly to ensure best practice is maintained. The home would find it advantageous to be connected to the computer system used by the local authority to ensure up to date information, policies and procedures are available for the benefit of those who use the service. The home has vacancies for three support workers, one night support worker and one senior support worker, which means an increased use of agency staff. CARE HOME ADULTS 18-65 St Luke`s Close (6) Ambury Road Huntingdon Cambridgeshire PE29 1JT Lead Inspector Alison Hilton Unannounced Inspection 31st January 2008 08:15 St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Luke`s Close (6) Address Ambury Road Huntingdon Cambridgeshire PE29 1JT 01480 456941 F/P 01480 451883 annika.short@cambridgeshire.gov.uk www.cambridgeshire.gov.uk Cambridgeshire County Council Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Kim Vivian Lacey Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Only 2 rooms measuring 14.5 square metres to be used for wheelchair dependent service users No service user will be accommodated for more than 6 months at any one time unless a service user is experiencing exceptional circumstances outside their control. 23rd March 2007 Date of last inspection Brief Description of the Service: 6 St. Luke’s Close is a local authority respite care home for up to 6 adults with learning disabilities. People using the service may also have a physical disability. Although the usual pattern of visits is for planned short stays, the home also has one bed that is used for emergency placements and may accommodate them for up to six months. 6 St. Luke’s Close is a short walk from Huntingdon town centre which has a range of shops and leisure facilities. The home is a purpose built single storey bungalow, with a large entrance hall, lounge, dining-room/kitchen, laundry room, six single bedrooms, a large assisted bathroom, a large assisted shower room and two offices (one of which is used as the sleep in room incorporating shower and toilet facilities). The home does not take private referrals. People are allocated respite through the Local Authority Learning Disability Team, who deal with the fees for the service. Copies of the inspection reports are available in the home. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We, the Commission for Social Care Inspection (CSCI) carried out an unannounced inspection of 6 St Lukes Close, Huntingdon on Thursday 31st January at 08:15 hrs using the Commission’s methodology described below. This report makes judgements about the service based on the evidence we have gathered. An Annual Quality Assurance Assessment (AQAA) was requested together with menus and staff rotas. These were sent to the Commission prior to this inspection. Surveys were sent to six staff and three were returned prior to the inspection. Information from the last report was taken into consideration, together with an unannounced visit to the home and speaking to staff, the manager and people living there. The Registered Manager was present for the whole of the inspection. Three people had used the service overnight. One person remains in the home (since 2006), one person had come to the home as an emergency two weeks earlier and one was in overnight and was going to the day service later that morning. What the service does well: What has improved since the last inspection? The manager is now registered with the Commission. The home has no-one outside its conditions of registration. Records show that staff are adequately supervised. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is good. The home provides information, that allows people who might use the service, to judge if it will meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA showed that regular and emergency respite is offered, focusing on the individual. New users of the service are introduced through visits and day activities. Staff work with challenging situations. The home has improved its relationship with the Community Nursing Team (CNT) in relation to people having respite who have complex needs. A representative from the CNT attends staff meetings so that joint decisions can be made. The manager said this is working well. There was a requirement from the last inspection that the home must ensure that conditions of registration are not breached. The home applied for a variation to the conditions, which resulted in a new condition allowing a person to be accommodated for more than six months in exceptional circumstances. This was looked at during this inspection and the variation means that the home is now acting within registration requirements. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 9 Prospective residents needs had been fully assessed prior to admission, which provided a full and comprehensive picture about the service user’s and their need for support. Information from placing authorities and other professionals was also seen on file. All referrals for the respite service come through the Learning Disability Partnership. Recent changes have been made whereby new users of the respite service are being allocated about 22 days per year (dependent on need). Currently some people have up to 70 days per year. The manager is concerned that the disparity may cause some friction. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good. People who use the service are supported to make decisions, which promote their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for people accessing respite at the home were detailed and showed that the person and their carers were consulted and part of the process. On one file it was noted that the person had looked at their care plan with assistance and “understood some of what I see but not all of it”. Care plans are reviewed and evidence of this was seen on files during the inspection. There were detailed risk assessments recorded to support people using the service to be as independent as possible. On speaking to one person living in the home, they confirmed that they made choices about their day-to-day care and activities. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 11 Staff on duty understood the need to support people as well as encouraging them to make decisions and choices. There was evidence that specialist services were accessed when needed and family contact was promoted. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is good. People in the home are encouraged to continue with their daily routines and take part in activities that are appropriate and suit their abilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA showed that the home had a choice of menu and the people having respite in the home participated in preparing meals. Menus were sent to the Commission prior to this inspection and they showed that meals were balanced and varied. During the inspection one person said she had chosen what she wanted to eat and it was cooking in the oven. She said she sometimes helped prepare meals as well as cooking cakes and other things. Information provided in the AQAA showed that staff have undertaken a nutritional awareness training course. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 13 There was evidence on file that family visits and telephone calls are made especially in relation to the person who has been living in the home since 2006. Staff have use of a mini bus for activities, which include shopping, rides out, sport weekends and other choices made by people having respite. One questionnaire received commented that more staff need minibus training as there are only a limited number of staff who are currently trained which has an impact on the possibility of going out. The transport also needs a tail lift to ensure all people having respite have the opportunity to go out (especially if using a wheelchair). Some of those who stay overnight attend the adjacent day centre facility. Information in the AQAA showed that the manager would like to introduce pampering weekends. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is good. People living in the home have their physical and emotional needs met through the support of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information in the AQAA showed that all staff have attended medication training and a competency framework is now in place. During the inspection the medication administration record (MAR) sheets were seen. It was discussed with the manager that all information on the MAR sheets should be readable and where information had changed it should be crossed through with the correct information written alongside. A recommendation has been made. In the case of one person it was not clear when Warfarin should be taken and the manager said she would start a new MAR sheet just for the Warfarin, as it was likely to change regularly. Records showed that people attend appointments with health professionals in or away from the home as appropriate. It was also evident that the home was St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 15 accessing support from other professionals including the District Nurse and an occupational therapist. It was discussed with the manager about what would happen in the event of the death of someone in the home. She said this was unlikely as it was a respite facility and if someone was terminally ill they would be unlikely to use her service, but if it did occur then those in the home would receive support from staff and other professionals if necessary. Staff would also get support. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. Those living in the home are protected by the homes policies and procedures for safeguarding adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no concerns or complaints made to the Commission. The complaints book was seen and there have been no complaints made since the last inspection, when the complaints procedure was found to meet the standard. The manager said that there had been several verbal compliments made about the service provided and it was discussed that these should be recorded to provide evidence of good practice and support provided by the home. Information provided in the AQAA showed that the home is working with lead Protection of Vulnerable Adults personnel in the local authority and Policy Action for Justice. All staff have received training in safeguarding adults and those spoken to during the inspection confirmed this. The home has all the local authority policies and procedures for safeguarding adults and whistle blowing. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,30 Quality in this outcome area is good. The home provides people using the service with safe and comfortable surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a purpose built single storey bungalow, with a large entrance hall, lounge, dining-room/kitchen, laundry room, six single bedrooms, a large assisted bathroom, a large assisted shower room and two offices (one of which is used as the sleep in room incorporating shower and toilet facilities). Details provided in the AQAA showed that there is a corporate maintenance programme, which is 3 yearly for interior decoration (or when necessary). There are annual checks on equipment including hoists and records seen during the inspection confirmed this. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 18 There are cleaning checklists compiled to ensure tasks are completed. These were seen on the bedroom doors during the inspection. There were no unpleasant odours in the home and all areas were clean and tidy. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is adequate. The homes recruitment process does not protect those who use the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has vacancies for three support workers, one night support worker and one senior support worker. There are two senior support workers, two support workers and eleven relief workers currently on the rota. The number of staff on duty depends on the needs of those staying overnight. The home also has to provide care for at least two people during the day. There is one waking night staff and one person sleeping in, however this person has to cover emergencies in the supported living houses adjacent to 6 St Luke’s Close. On the day of inspection the manager was in the home, together with two care support workers. One was a regular agency worker and the other was a relief worker. Both said they had received appropriate training and were clear about their roles within the respite setting. The manager said that from Monday 4th February she will no longer be able to request staff to cover shifts in the home St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 20 directly from an agency, but will have to ‘phone a central office who will try and arrange care. They will let her know the outcome of her request, but she feels there is room for errors to be made and she will not have direct contact with agencies to ensure the staff they intend to send are who she wants. Staff receive an induction and mandatory training as well as other courses to ensure people using the service have their needs met. The staff have training in areas such as dealing with challenging behaviour; person centred planning; PoVA; epilepsy awareness, buccal midazolam and rectal diazepam; Makaton and communication; staff supervision and food hygiene. The recruitment procedure was commented on in the last inspection where there was no photographic identification on one file. Two files were seen during this inspection. One had all the required information including an updated enhanced Criminal Record Bureau check. The other did not have photographic identification or any proof of identity. The manager was spoken to about this and she confirmed the information was not on the file although there was a photograph of the staff member that was used in the home to identify who was on duty for the service users staying overnight. A requirement has been made. Files showed that staff had been supervised on a regular basis and this meets the requirement from the last inspection. The home has staff meetings and the minutes from the last one on 17 December 2007 were seen. There are also senior staff meetings but these cover all the services supervised by the manager of 6 St Luke’s Close. Information given in the returned questionnaires showed that staff have a full induction and regular training. They attend staff meetings and are updated through e mails and use of communication books. All felt supported by the manager and said they had regular supervision. There was some concern about the level of sickness and the resulting use of agency staff, but the manager is aware of this and will be advertising vacancies as soon as possible. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. The manager is providing clear leadership and support to staff which ensures the welfare of those using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was appointed in November 2006. She has substantial experience of working with adults with learning difficulties and is competent to run the home. The home manager was registered with the commission in November 2007 and confirmed that she had completed her RMA and NVQ Level 4. Ms Lacey is also the registered manager of a domiciliary care agency attached to the care home. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 22 There is a system in place to monitor the operation of the home and records connected to health and safety were provided at the inspection. The manager said that questionnaires are sent to people who use the service and their relatives but nothing is done with the information that is returned, as most people are satisfied with the service they receive. It was discussed that the home needs to use the responses to formulate a development plan that can be reviewed annually to ensure the service improves the quality of care it provides. A requirement has been made. The policies and procedures in the home are corporate being supplied by the Learning Disability Partnership (Local Authority) however the AQAA showed that some had not been reviewed since 2002. These should be monitored, reviewed and amended regularly. St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 2 X X 3 x St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA34 Regulation 19 (5) (d) Schedule 2 Requirement Timescale for action 14/02/08 2 YA39 24 (2) The information detailed in Schedule 2 must be on all staff recruitment files to ensure the safety of those using the service. The timescale for action of 31/05/07 has not been met. A report on the homes review of 14/04/08 care must be supplied to the Commission and made available to those using the service so that improvements to the quality of the service can be seen. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations Alterations made on the medication administration records must remain legible to ensure the changes can be verified where necessary to ensure the safety of those living in the home. Policies and procedures should be reviewed and updated regularly to ensure best practice is maintained. 2 YA40 St Luke`s Close (6) DS0000032579.V358851.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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