Care Home: St Margaret`s House

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What the care home does well St Margaret`s House runs well. It has good leadership and a staff team who are committed to supporting residents to make the most of their lives. Residents spoken with all said they are happy at St Margaret`s House and they like the staff. Residents are supported and encouraged to take control of their life as much as possible, to make decisions and work towards their individual goals. Residents take an active part in deciding what happens in their home; including planning and helping to prepare meals and deciding what activities they wish to do. What has improved since the last inspection? Since the last inspection the shower room has been completely refurbished in the main house and a new fridge and freezer have also been purchased. Some of the carpet tiles near the kitchen and the dining room have been replaced. A staff-training matrix has been developed to improve recording. Creative person centred files have been developed with photographs showing personal preferences and life history. This has fully engaged residents with their key-worker in setting goals and agendas for the future. CARE HOME ADULTS 18-65 St Margaret`s House 187 London Road Old Fletton Peterborough PE2 9DS Lead Inspector Andy Green Key Unannounced Inspection 16th September 2008 10:00 St Margaret`s House DS0000072014.V371313.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 Margaret`s House DS0000072014.V371313.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 Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Margaret`s House Address 187 London Road Old Fletton Peterborough PE2 9DS 01733 555008 01733 340241 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) Hereward Care Services Limited Mrs Janet Lowther Care Home 11 Category(ies) of Learning disability (11) registration, with number of places St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of homeonly: Care Home only - Code PC to homeusers of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of homeusers who can be accommodated is 11 2. Date of last inspection 14th November 2006 Brief Description of the Service: St Margarets House is a detached 1930s period built house on two floors that has been extended to provide accommodation for nine adults with learning disabilities. The house has three bedrooms on the ground floor and six bedrooms on the upper floor, a lounge, a dining room, a conservatory, a bathroom, a shower room and toilet, as well as a kitchen, a laundry and a reasonably sized garden. St Margaret’s House includes a nearby small terraced house that offers two people the opportunity to live semi-independently. This smaller house has two single bedrooms and a bathroom on the first floor, and a lounge, diningkitchen, utility room and cloakroom on the ground floor as well as its own small garden. St Margarets House is in a residential area on one of the main roads into Peterborough, and there is a bus stop outside the front gate. Local shops are a few minutes walk away, and the leisure facilities, shops and restaurants of the main city of Peterborough are within a short bus ride or drive. All of the residents at St Margaret’s House are funded by local authorities/care trusts. The fees range from £550.07 to £1743.71 per week, based on the amount of care and support needed by each person. A copy of the inspection report is available in the home. St Margaret`s House DS0000072014.V371313.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 home is 3 stars. This means the people who use this home experience excellent quality outcomes. CSCI undertook an unannounced inspection on 16th September 2008. We inspected a number of records including care plans, training records and staff files. We met a number of residents to gain their view regarding the care and support that is provided. Three members of the care staff were also spoken with. The Annual Quality Assurance Assessment (AQAA) was completed by the home. This a self assessment process that focuses on how outcomes are being met for people who use the service. Comment cards were also received from residents and staff. What the service does well: What has improved since the last inspection? What they could do better: St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 6 Decoration and refurbishment of the premises in two areas need to be undertaken. (See ‘Environment’ section of this report) 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 Margaret`s House DS0000072014.V371313.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 Margaret`s House DS0000072014.V371313.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): 2,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Prospective residents have their needs assessed to ensure they receive appropriate care and support. EVIDENCE: Assessments continue to be undertaken by the manager and a senior carer who visit the prospective resident to assess their needs. The assessments continue to give a detailed account of the person and the way they want to be supported in areas of their life. Each informal visit made to the home is recorded regarding how each visit proceeded, and selections of these were seen during the inspection. There is a trial period to ensure that the home can effectively meet the resident’s needs. Relatives are involved where possible and they are invited to provide background information to aid the home’s knowledge of the prospective resident. Informal visits are arranged so that the prospective resident can ‘test drive’ the home prior to moving in. There is a trial period to ensure that the home can effectively meet the resident’s needs. The home continues to use an assessment tool, which shows the way each person is progressing in various areas of their assessed needs throughout the year. This is shown in the form of a bar graph. Three resident files were seen St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 9 and a graph was in place on each of them giving a clear picture of how each person is progressing. St Margaret`s House DS0000072014.V371313.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): 6,7,9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the home. Care plans give clear guidance to ensure that resident’s needs are being appropriately met. EVIDENCE: Three care plans were inspected and they gave detailed information about the support needed by each person. Care plans gave details regarding personal care, finances, communication, social skills, activities, healthcare appointments, eating and contact with family and friends. Staff clearly support and encourage residents to make decisions about as many aspects of their lives as possible. Creative person centred files have also been developed with photographs showing personal preferences and life history. This has fully engaged residents with their key-worker in setting goals and agendas for the future. There was evidence of regular six monthly reviews. Additional reviews are arranged if needs have changed. Staff spoken to during the inspection stated that they are fully involved in the care planning process and they ensure that they remain up to date with any recorded changes to care and support. New St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 11 staff also gain thorough knowledge of residents support needs as part of their induction. The manager stated the home is continuing to develop communication skills in the home. This is achieved through the continuous contact with the local speech and language therapy team (SALT), and almost all the staff are able to use Makaton, which is a form of communication using signs and pictures. The manager stated that the home’s Statement of Purpose and HomeUser Guide are being developed in a pictorial form to aid residents understanding. House meetings continue to take place take place and they are recorded in an easy-to-read style, including pictures and symbols. During the day many of the residents are out at a variety of day care activities but it was clear from observations that staff are busily supporting residents at home with either their personal care or social care needs. One resident was being assisted with a hairdressing appointment and another resident was undertaking a shopping trip with a member of staff. Detailed risk assessments have been completed, covering all of the risks identified for each resident when in the home and accessing the community. Examples included; eating and drinking, using electrical equipment, medication, swimming, domestic skills, using the shower, finances, transport, and going out into the community alone. Risks are regularly reviewed throughout the year to ensure they remain up to date. The risk assessment process clearly evidences that residents are encouraged and supported to safely live their lives as independently as possible. St Margaret`s House DS0000072014.V371313.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): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents are supported to lead full and active lives. EVIDENCE: Residents continue to be supported to make decisions about their lives and are helped to work towards their goals. Opportunities for developing independent life skills are provided to residents in house and within the community. A number of residents attend day activities organised by other organisations, each person going to a different place. Examples include services provided by the Thera Trust, Kingfisher centre, The Gloucester Centre and local colleges. Three residents have one to one sessions day activities to be arranged by the staff at St Margaret’s House. One resident has had some involvement at day centres but prefers to spend her time happily at home. St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 13 Staff proactively research ways in which residents can access the community, either on a regular basis or as one-off events. Residents go to local pubs and restaurants for meals out, church visits for those who wish to, local library, post office, banks, cinemas and shopping centres. The home has a vehicle, which is used for trips that are needed including shopping and daytrips to the city and local towns. Residents are supported by staff, if needed to use the local buses, which stop outside the house. Residents also walk or use taxis to local shops and the pub if they want to. Holidays are organised throughout the year and recent examples included trips to Wales, Suffolk and Lincoln. All holidays are risk assessed to ensure resident’s safety. Families and friends are welcome at the home whenever residents want to see them. When needed, staff support residents to keep in touch with, and visit, their friends and families. Residents are fully involved in the choices of meals and a menu is organised to include personal preferences as much as possible. An alternative meal is offered if anyone does not like what is on the menu. Residents are encouraged to help with the preparation of the meal and washing up afterwards. A rota board is filled in each day to show whose turn it is to help with which task and photographs of the person doing the task, for example washing up or vacuuming, are displayed so that the board is easily understood. St Margaret`s House DS0000072014.V371313.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents’ personal and healthcare needs are appropriately met. EVIDENCE: Residents are assisted with personal care in the way they want and need. Resident files have separate sections to show that people are supported well by the staff to attend appointments with healthcare professionals, including GPs, nurses, optician, dentist and chiropodist. Residents are weighed regularly with records kept in each care plan. At present none of the residents in the larger house manages their own medication. Medication administration records were inspected and were accurate. Comments received from relatives included; “If there are any problems with my brothers health I am always contacted” “The home seems well run and the staff are always very pleasant” St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 15 “I do not believe that there is any thing that could improve and we are very happy with the care provided for my sister and feel sure that this will continue” “My sister is well looked after at St Margaret’s. She has never been so happy as she is now. She is allowed a full and happy life” “Perhaps more information about what my son does while he is there” Residents made the following comments; “Its fine here and clean, I like to wash up and I like the people I live with. I like my room and like to clean it” “ If I was not happy I would speak to my social worker, my sister, my key worker and the staff” St Margaret`s House DS0000072014.V371313.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. This judgement has been made using available evidence including a visit to the home. The home has a satisfactory complaints process to ensure that concerns are dealt with appropriately. EVIDENCE: The home ensures that all concerns are fully investigated and dealt with appropriately. There has been one complaint since the last inspection, which is being appropriately dealt with via Protecting Vulnerable Adults procedures. A record is kept of all concerns raised by residents, and the way in which these have been dealt with. CSCI has not received any complaints since the last inspection. It was also clear from conversations with staff that they understand their responsibilities and would have no hesitation in reporting any incident or allegation of abuse. Records of training show that care staff have undertaken safeguarding training. St Margaret`s House DS0000072014.V371313.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): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The environment meets the needs of residents. EVIDENCE: Both St Margaret’s House and the adjacent two bedroomed house are comfortably furnished and feel very homely. There a number of communal lounges and residents are provided with television and DVD facilities. There is also an activities room in the main house. All bedrooms are for single occupancy and have a hand basin. Residents are able to choose the decoration for their room and they can personalise their room with items of furniture and personal belongings to meet their own preferences. Since the last inspection the shower room has been completely refurbished in the main house and a new fridge and freezer have also been purchased. Some of the carpet tiles near the kitchen and the dining room have also been replaced. St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 18 There is still damage to walls in the corridors where the cat has damaged some of the wallpaper. The manager stated that these areas are due to be redecorated in the hall. The handrail in the parking area also needs to be refurbished and redecorated. The manager stated that she would raise all maintenance issues with the providers estates department for further action. Staff and residents work together to do the housework in both the main premises and in the smaller house and both houses are well presented and are kept clean and tidy. St Margaret`s House DS0000072014.V371313.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 good. This judgement has been made using available evidence including a visit to the home. The home’s recruitment and training processes ensure that residents are safe and protected from harm. EVIDENCE: Staff rotas show that there are sufficient numbers of staff on duty depending on what residents are doing during the day. There are four care staff in the morning and in the afternoon and two staff at night time. The manager works mainly 9-5 shifts during the week. Staff shifts overlap so that staff get the opportunity to discuss resident and house issues in the handover meetings between shifts. Staff records show that all staff are offered training in a number of topics. All staff have received training in manual handling, food safety, fire safety, first aid, infection control, cultural awareness and Protection of Vulnerable Adults. Staff have also had opportunities for specialised training such as communication and autism. NVQ (National Vocational Qualification) training is also well established in the home. There is now a training matrix, which shows training achieved and dates for updates/refreshers. St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 20 Staff spoken to confirmed that they had received an induction, ongoing training and regular supervision. Three staff files were inspected and they contained all the relevant recruitment information. There was evidence of two references, an application form and satisfactory Criminal Records Bureau checks (CRB to ensure that residents are protected from harm. Comments received in staff surveys included; “I feel very well informed and also feel confident to ask about areas covered in the induction if I have any problems” “I see my manager during most shifts that I work in the home” “We provide excellent individual and inclusive care” “The training and supervision I am offered is very relevant and useful to my work in the home” “Sometimes there are staff shortages but this has improved lately” St Margaret`s House DS0000072014.V371313.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 excellent. This judgement has been made using available evidence including a visit to the home. The home is well managed and the manager provides supportive leadership and guidance to staff to ensure that residents receive good quality care. EVIDENCE: This home continues to be well run and the manager provides good leadership to the staff team who remain committed to providing a high standard of care and support for residents in the home. Staff members spoken to confirmed that they felt fully involved in the home and that the manager was supportive and encouraged their participation in the development of the service. Comments in the AQAA, completed by the manager, confirmed that the homeis forward looking and seeks proactive ways in which to enhance resident’s lives. Residents clearly have more involvement in the care planning process to ensure that care and support is provided in the way they prefer. This includes the promotion of healthcare and increased lifestyle choices. St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 22 It was clear from conversations throughout the inspection that the manager and staff work hard to support residents in making choices about their lives as much as possible and to do what they want to do during the day. A representative of Hereward Care Homes continues to make visits to St Margaret’s House on a monthly basis to ensure management processes and care are well delivered. Reports of these visits are held on file in the office, these were not inspected on this occasion. The fire records seen showed that the fire alarms and emergency lighting continue tested by the staff on a weekly basis. A contractor also tests the fire system at regular intervals during the year. Accident/incident records are completed when there is an accident or incident, and are kept on each person’s file. Staff receive training in topics related to health and safety. St Margaret`s House DS0000072014.V371313.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 X 2 3 3 X 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 X 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 3 X St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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. Extracts may not be used or reproduced without the express permission of CSCI St Margaret`s House DS0000072014.V371313.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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