Care Home: St Michael`s House

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What the care home does well The ethos of St Michael`s House is that each person`s views are valued, and they are able to make decisions about what they do and the support that they receive. Everyone can discuss their care plan and make changes to it if they want to. There are residents` meetings where people can discuss any concerns that they have, and make suggestions for improvements in the home. The home has a good system for quality assurance that includes asking the people who stay there for their views, and the home`s action plan shows their input. For example, the action plan for 2009/10 included a more structured activity programme, and tables for potting areas for the garden project. In the AQAA the manager stated, "We feel that we constantly try to reevaluate the service to ensure that we develop as necessary." The AQAA showed understanding of the importance of promoting equality and diversity in the service, and an honest awareness of areas where the service hopes to improve. The people who stay in the home have opportunities for a wide range of activities that suit their own interests, both in the home and in the local area. This makes each person`s respite or assessment stay in the home an enjoyable and rewarding experience. The EBE reported: "Service users and providers have a very good relationship and this helps with the smooth running of the home. People can come and go as they please, but there is also plenty of staff around to help if there is a problem. To sum up this care home there was one comment from resident which said it all: When I was told that I had to go to a respite home I was very worried. I didn`t want to go to a place that was a prison. But this place is absolutely brilliant!" The staffing levels ensure that there are sufficient staff to support respite clients to enjoy their choice of activities, and to support assessment clients with their programmes for daily living skills. The care staff who we spoke to were enthusiastic about their work, and said that they have a good level of training and support to enable them to meet the needs of the people who use the service. One person who completed a survey stated, "St Michael`s is a brilliant place. The staff are very hard working and amazing. Nothing is too much trouble for them." What has improved since the last inspection? The home has restructured the services that it offers. One unit has closed, and there are now ten respite beds and four assessment beds. The services offered have been redefined as, "short term stays to adults with physical disabilities from the age of 18, who live in Hertfordshire." The number of referrals has increased, and the services for both respite and assessment are very well used. The areas that we assessed as excellent in the last inspection report remain excellent, and the good practice that we found then, in personal and healthcare support, lifestyle, staffing and management, has been consolidated and further improved. The procedures for medication ensure that people can retain responsibility for their own medication, or have confidence that the care staff will look after and administer their medication in a safe and responsible way. The activities available have been restructured, and respite clients have the facilities to be fully occupied throughout the day, or to spend time on their own. The staffing levels ensure that there are sufficient staff to support people in their choice of activities. We saw additional evidence as described above that the views of the people who use the service are valued, actively sought, and used in the development of the service. In addition, we have assessed the area of Individual Needs and Choices as excellent. The care plans (ISPs) are person centred, and used as working documents so that the care staff have the most up to date information on each person`s needs and wishes. Staff show respect and non-judgemental attitude to views of the residents and there is a philosophy that promotes equality and diversity. The views of the people who use the service are genuinely sought and valued, and have driven the improvements in the service. What the care home could do better: The AQAA stated: "We feel that we constantly try to re-evaluate the service to ensure that we develop as necessary." We are confident that the management team will continue to be proactive in ensuring that the home meets the changing needs of people who use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: St Michael`s House Holwell Road Welwyn Garden City Herts AL7 3SF     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: Claire Farrier     Date: 2 2 0 3 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 30 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 30 Information about the care home Name of care home: Address: St Michael`s House Holwell Road Welwyn Garden City Herts AL7 3SF 01707320273 01707393499 sarah.nicholas@hertscc.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hertfordshire County Council Name of registered manager (if applicable) Sarah Elizabeth Nicholas Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accommodated is: 14. The registered person may provide the following categories of service: 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: Physical Disability - Code PD. Date of last inspection Brief description of the care home St Michaels House is owned by Hertfordshire County Council (HCC) Social Services Department. It was opened in the 1980s and provides accommodation and care for up to 14 people with a physical disability. St Michaels House provides respite care and short term assessment for a maximum of twelve weeks. The home does not provide long stay or permanent accommodation. The home is situated in a residential area of Welwyn Garden City, in easy reach of local Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 14 Brief description of the care home shops and amenities. There is an accessible bus service to the town centre. St Michaels House is a single storey building arranged in three units with shared communal areas. The assessment unit has its own kitchenette and laundry facilities for the residents to use. All the bedrooms are single, and none have en-suite facilities. The room sizes do not meet the minimum standard, but they provide acceptable accommodation for short term stays. Each unit has toilet and bath or shower that are suitable for people with physical disabilities. The home and courtyard garden are fully accessible for wheelchair use. All prospective clients are referred to the home by HCC Social Services. The Statement of Purpose and Service Users Guide provide information about the home for the referring social workers and prospective clients. The current charge for respite or assessment is £1246.21 per week. Care Homes for Adults (18-65 years) Page 5 of 30 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: This unannounced inspection was carried out over one day. The focus of the inspection was to assess all the key standards, and some additional standards were also assessed. We were helped by an Expert by Experience (EBE). This is a person who has a physical disability. He talked to some of the people in the home and gave us a report of his observations. One member of staff and five people who use the service completed surveys before our visit to the home, and we have used some of their comments in this report. These give a representation of what the people who stay at St Michaels House for respite or assessment think about the home. We also talked to some of the staff and the manager and we looked around the home. We looked at some of the records kept in the home. We also looked at a sample of care plans so that we could see how people are involved in planning their own care and support. Care Homes for Adults (18-65 years) Page 6 of 30 The home sent some information (the Annual Quality Assurance Assessment, or AQAA) about the home to CQC before the inspection, and their assessment of what the service does in each area. The AQAA is a self-assessment that focuses on how well outcomes are being met for people who use the service. It also gave us some numerical information about the service. Evidence from the AQAA has been included in this report. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? The home has restructured the services that it offers. One unit has closed, and there are now ten respite beds and four assessment beds. The services offered have been redefined as, short term stays to adults with physical disabilities from the age of 18, who live in Hertfordshire. The number of referrals has increased, and the services for both respite and assessment are very well used. The areas that we assessed as excellent in the last inspection report remain excellent, and the good practice that we found then, in personal and healthcare support, lifestyle, staffing and management, has been consolidated and further improved. The procedures for medication ensure that people can retain responsibility for their own medication, or have confidence that the care staff will look after and administer their medication in a safe and responsible way. The activities available have been restructured, and respite clients have the facilities to be fully occupied throughout the day, or to spend time on their own. The staffing levels ensure that there are sufficient staff to support people in their choice of activities. We saw additional evidence as Care Homes for Adults (18-65 years) Page 8 of 30 described above that the views of the people who use the service are valued, actively sought, and used in the development of the service. In addition, we have assessed the area of Individual Needs and Choices as excellent. The care plans (ISPs) are person centred, and used as working documents so that the care staff have the most up to date information on each persons needs and wishes. Staff show respect and non-judgemental attitude to views of the residents and there is a philosophy that promotes equality and diversity. The views of the people who use the service are genuinely sought and valued, and have driven the improvements in the service. 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 9 of 30 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 30 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 who stay at St Michaels House for respite or assessment have good information about the services that the home provides, and know that their stay will be both productive and enjoyable. Evidence: The Statement of Purpose and the Service Users Guide provide information on the services that are provided for respite care and assessment. They describe the services offered by the home: St Michaels House offers short term stays to adults with physical disabilities from the age of 18, who live in Hertfordshire. The maximum stay on the respite unit is four weeks; however the usual stay is one or two weeks. Assessments last from six to eight weeks if required, and up to twelve weeks can be offered. There is an information pack in each bedroom that includes the Service Users Guide. The people who completed a survey for this inspection said that they received enough information about the home so they could decide if it was the right place for them. The sample files seen included a comprehensive assessment from the referring social Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: worker and the homes assessment completed at the planning meeting. Information from the assessment is then transferred to the persons Individual Service Plan (ISP). There is an induction programme for each new resident that includes meeting all the residents and staff and explaining the licence agreement and the homes policies and procedures. The number of weeks that each person can stay at St Michaels House is agreed by Social Services at the beginning of each year, and varies between a long weekend, a week six times a year, or a longer period for specific needs. Following the initial assessment, social workers can book respite care for their clients on-line, and regular clients can book their preferred weeks for themselves. There is a good range of activities available that make the respite stays an enjoyable experience. These include a special interest week for under 30s, and another for over 30s. A planned programme of independent living skills is put in place for each person on assessment. The staff who completed surveys said that they have sufficient information and training to enable them to meet peoples needs. All six people who spoke to the Expert by Experience (EBE) said that the service meets their needs and gives their main carers a well earned rest. One person said, This place is absolutely fantastic! Another person said Brilliant. The number of beds in the home has been reduced, there are now four assessment beds and ten respite beds. The Annual Quality Assurance Assessment (AQAA) stated, Staffing levels stayed the same as before so service users are benefiting from this reduction. Care Homes for Adults (18-65 years) Page 12 of 30 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. The people who live in the home are actively involved in their own care planning and are consulted on every aspect of community life in the home. Evidence: Each resident has an individual support plan (ISP) that is drawn up following an assessment planning meeting. The Annual Quality Assurance Assessment (AQAA) stated, Service users care plans are reviewed and updated each stay. The care plans are detailed regarding the amount of support a person needs and how they wish it to be done, and are written in a way that demonstrates the person has been involved and expressed their point of view. We saw four ISPs, three for respite clients and one for an assessment client. The sample included people with a range of needs. They all provide good details of the support that each person needs, and they are written clearly and from the persons point of view. An example for a person with high needs is, X likes to get up at 8 am and needs guidance, eg showing X where things are, layout of room etc. X needs to be informed that it is 8 am and time to get up. The ISP for a person who is very independent states, XX will make staff aware when they Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: are going to have a shower and will ask for support needed. They say they take quite a while in the shower as they do all themself. The focus of the ISP is on supporting each person to be as independent as possible and, for assessment clients, on improving their skills for independent living. There is a skill development programme for each assessment client, and details of the likes and dislikes of each respite client. The staff record daily events, and this recording is relevant to the ISP. All residents have a moving and handling assessment as part of the pre-admission procedure. There are appropriate risk assessments that provide procedures and safeguards to enable people to take part in their choice of activities safely. With regard to equality and diversity the manager stated in the AQAA that people are asked at the planning meeting stage if they have any religious beliefs, preference of gender of staff they would like to support them, or any cultural needs. We have continued to offer the specialist activity weeks to take into account the age mix of the service users that use the service. After feedback from our two activity weeks, we feel an over 30s week and under 30s week would better suit our service users group, as all ages would be catered for. We have made information available for service users on different local cultural facilities, events and services. One person who completed a survey said that the home Respects diversity, choice. Everyone said that they are involved in planning their stay in the home, and they have a lot of choice in what they do and how they receive the support that they need. There is a weekly residents meeting, when they discuss what they want to do during the week. The Annual Quality Assurance Assessment (AQAA) stated, Service users meetings are to share information, ask people about any activities they may like to happen whilst they are here and any issues they may have. Staff liaise with service users informally about concerns they may have or about anything they wish to take part in. The AQAA stated that as a result of listening to people, We have purchased lots of craft materials. We have also provided a disabled parking bay after having feedback form a carer. We have had overhead tracking installed in wing 2 bathroom. There is a new smoking area and this seems to be more suitable for the service users. Care Homes for Adults (18-65 years) Page 14 of 30 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. People are able to take part in their own choice of activities, which makes each persons respite or assessment stay in the home an enjoyable and rewarding experience. Evidence: All the people who completed surveys said that there are activities arranged by the home that they can take part in. Everyone who we spoke to during our visit was very happy with the social life in the home, and this is a major part of each persons stay. The EBE (expert by experience) reported, The service users tend to go their separate ways after communal mealtimes. Some people do painting and drawing, others play board games, while others go out to the shops. There are a few organised trips in the year which are put together in consultation with the residents. These are called activity weeks, and they seem to be enjoyed by the people that take part, but they are not compulsory. Some of the outings are to places of interest like Hatfield House, Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: Bletchley Park, while others like the dog track racing. The staff contact the clients for whom they are link workers before their booked respite break to discuss any particular interests they have and to plan their stay. They can also book a variety of massages and treatments with an aromatherapist who visits the home every week, for which they pay and additional charge. Every Monday there is a residents meeting. This is a social time and introduction for new clients, and a chance to discuss what is happening during the week for people who have stayed in the home before. The programme of activities covers all seven days of the week, and includes games, quizzes, a film night, cookery, gardening and arts and crafts. The home has Sky TV so that people who wish to can watch sport, and a Wii games console has recently been installed. During our visit some people were playing bowling on the Wii, very skilfully. One person who completed a survey said, I enjoy the arts and crafts group. There are two themed activity weeks each year, one for under 30s and one for over 30s. As described above by the EBE, these are very popular, and have recently included trips to see Queen and Abba tribute bands. Some people are able to go out independently, and information leaflets are available in the communal areas about local facilities and events. One person told the EBE, I can go out when I want. I leave my key at the office and just go. The home does not have their own transport, but they hire suitable vehicles from HAD (Hertfordshire Action on Disability). This means that activities and outings can be organised for both individuals and small groups. Respite stays are usually for one or two weeks, and assessment is usually between six and eight weeks, with a maximum of twelve weeks. The residents maintain their family and social relationships during this time. Many of them enjoy meeting friends who are staying at the home at the same time. One person told the EBE, My relative comes to see me twice a day and he is always made welcome. The EBE reported, Relatives sign in and are made welcome with refreshment when they come. There is a relaxed atmosphere when people visit. A relative spoke to me and said that it is an amazing place. During the day the assessment clients have an individual programme for improving their skills for living independently. There is a kitchenette in the assessment unit where they can prepare their own food as part of their daily programme, and they are given their food budget to buy their own food. The menus show a choice of two cooked meals or a salad at lunchtime, and a light meal in the evening. There is a cooked breakfast every day. We saw evidence that people can ask for options that are not on the menu, such as soup or omelette. All the meals are freshly made. Staff and Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: residents eat lunch together, and the EBE joined them for lunch during the inspection. Everyone said that they enjoy the food. Comments on the surveys we received include, They do good meals. And, Meals are of good quality, they try to cater to specific requirements. Atmosphere in dinner hall is good, staff and clients mix well. There is a water cooler and fruit juice available in the dining hall that people can help themselves to at all times. Care Homes for Adults (18-65 years) Page 17 of 30 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. The home has an experienced and enthusiastic team of staff, who have the training and skills to provide a good quality of care for the people who live in the home, and to ensure that individual needs, choices and preferences are met at all times. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, We compile good details of each persons personal health and care needs. Staff encourage service users to maintain independence whilst staying at St Michaels as well as supporting those who need varying degrees of assistance. If a service user presents with more specialised care needs, we arrange training to support the staff with this. We now have many of the staff trained and confident in assisting clients with PEG machines. After pursuing training around specific disabilities such as MS, diabetes awareness, the majority of staff have attended the training courses and have found these to be of benefit to them. In the next 12 months we plan to arrange in-house training with regard to catheter care. The care plans (ISPs) that we saw provide good details of each persons personal care and health care needs, and we observed a good relationship between the staff and the Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: people in the home. The staff are fully involved in the homes ethos of supporting people to be as independent as possible. The care plans are written from each persons view of the support that they need (see Individual Needs and Choices). Everyone who completed a survey for the inspection said that they receive the support that they need for personal and health care. One person said, Standard of personal care very good. Staff are good at communication. And another commented, Take care of me in every way, eg. washing, feeding, activities. One person wrote to the home following their stay, I feel I have had more rehabilitation and benefited more in eight weeks at St Michaels House than at any hospital rehab units. In the report of the last providers monitoring visit to the home, it was reported, Advice was recently sought from the infection control nurse as a service user had a urine infection. No changes to practice were recommended and the standard of recording was described as excellent. All respite clients are registered with a local surgery during their stay, and district nurses come to the home when they are needed, for example to change dressings. Moving and handling assessments are in place for each person. There are track hoists in three of the bathrooms, and electric hoists for use in the bedrooms. Many of the respite clients look after their own medication. They have facilities in their rooms to store medication securely, appropriate risk assessments are in place, and there is a list of each persons medication in their file. These procedures ensure that they are able to take responsibility for their own medication and the risks to any other person in the home are minimised. For those who are unable to look after their own medication, the medicines are supplied in the original packaging, and the home has robust procedures for administering, recording and checking that the medication is administered properly. Care Homes for Adults (18-65 years) Page 19 of 30 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 who stay in the home are encouraged and enabled to make their views and concerns known, and appropriate procedures are in place to ensure that they are protected from abuse and neglect. Evidence: The Annual Quality Assurance Assessment (AQAA) stated, Service users are informed during their planning meeting and throughout their service user induction of the opportunity to complain confidentially. They are also informed as to who to approach, ie the management team, or the duty officer if none available. Complaints information is given to service users on admission which explains how to make a complaint. Everyone who completed a survey for the inspection said that they know how to make a complaint. The homes record of complaints shows that all concerns are investigated and responded to appropriately. There are HCC (Hertfordshire County Council) policies on safeguarding adults (adult protection), whistle blowing, aggression to staff, harassment and codes of conduct. A leaflet on responding to allegations of abuse is given to each resident. The staff who we spoke to showed good knowledge and understanding of these policies. The manager is aware of the principles of the Mental Capacity Act and the Deprivation of Liberty Standards (DOLS), which protect people from restraints that may be in place without proper authorisation. No-one living in the home is currently subject to a Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: deprivation of liberty authorisation, and no-one currently has their liberty deprived without an authorisation. Care Homes for Adults (18-65 years) Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and well-maintained environment for the people who stay there, which the staff maintains to a good standard of cleanliness and hygiene. Evidence: St Michaels House is a single storey building arranged in three units with shared communal areas. All the bedrooms are single, and none have en-suite facilities. All the bedroom doors have been fitted will automatic closing devices in case of fire, and residents can have a key for their room if they wish. The size of the bedrooms does not meet the standard of 12 sq m for an existing home for people who use wheelchairs, and bedrooms are not large enough for the bed to be placed with access from both sides, but they provide acceptable accommodation for short term stays. The bathrooms provide a variety of equipment for people with physical disabilities, including an Arjo bath with a track hoist, a level access shower and static and mobile hoists. The kitchenette in the assessment unit has wheelchair height units, and the vanity units in the respite bedrooms are height-adjustable. The expert by experience (EBE), who is a wheelchair user, reported, The environment is clean, tidy and free of offensive smells. There are no en-suite bathrooms in this building but there plenty of large toilets on each wing near the bedrooms. Some of the bedrooms are a little cramped for large electric wheelchairs when there is a bed and chest of drawers. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: One unit is no longer in use for residents, and the rooms there provide spacious and well organised storage for equipment, activities and crafts materials and administration requirements. There is now one unit for assessment and two for respite. The kitchenettes in the respite units have been removed and replaced with quiet sitting areas. Smoking is not permitted inside the home, but there is a covered smoking area accessed from the main hall. The home appeared to be clean and well maintained, and appropriate policies and procedures are in place for the maintenance of hygiene and control of infection. The central laundry meets the standards for control of hygiene. There is also a domestic style washing machine and tumble dryer on two units so that residents who are able to can do their own laundry. Care Homes for Adults (18-65 years) Page 23 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are supported by a stable staff team who have the experience and training to understand and meet their needs. Evidence: The home has a team of experienced and well trained staff who are competent to meet the different needs of the people who stay in the home each week. There is a good level of staffing, with three or four support workers throughout the day, and two during the night. There were twelve people staying in the home at the time of the inspection, and the staffing levels are sufficient to meet their needs. If the numbers increase to the maximum, or a number of people have high needs, extra staff can be brought in. One person who spoke to the EBE (expert by experience) during the inspection said, The staff are absolutely fantastic, and there are plenty of staff around a night. One client who completed a survey said, The staff are very hard working and amazing. Nothing is too much trouble for them. Other people commented that the staff are helpful, and good at communication. All staff complete a HCC (Hertfordshire County Council) induction programme, and a comprehensive induction into care services that meets the Skills for Care guidelines. HCC provides a thorough training programme that includes regular updates of all mandatory training and training specific to the needs of the residents. We received a Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: survey from one member of staff, who said that they have the training, support and information that they need to meet the needs of the people who use the service. The staff who we spoke to said that they receive very good training and support, with regular supervision, appraisals and team meetings. One person was completing their induction, and said that it was thorough and gave them confidence in the policies and procedures for working in the home. Three members of staff are qualified trainers and assessors for moving and handling, and the training for the staff is carried out in the home using the equipment that is used in the home. 50 of the support workers have completed NVQ qualifications at level 2 or 3. All staff are expected to apply for the course when they have worked in the home for a year, and experienced staff are encouraged and supported to take further qualifications. We saw the files of three members of staff who have recently started to work in the home were inspected. They showed evidence of a thorough recruitment procedure, including comprehensive application forms, references and notes of the interviews. One person had no reference from their last employer, an agency. Personal references were checked and approved by Hertfordshire, due to the difficulty in getting a response from the agency. This person had worked in the home for some time as an agency worker, and so the quality and reliability of their work was known. Photographs of the staff are displayed on a board in the entrance hall, to aid identification and so that respite clients can know who is on duty at any time. Care Homes for Adults (18-65 years) Page 25 of 30 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 home is well managed, and the management team actively seeks the views of the people who use the service and other involved people in order to ensure that a good quality of care is provided. Evidence: The manager has been in post for nine years. She communicates a clear sense of direction and leadership, and some responsibilities, such as activities, medication and training, are delegated to senior members of staff. The management style is to value and support the staff, and to be available to the people who live in the home. The manager completed the Annual Quality Assurance Assessment (AQAA) with all the information that we requested. It showed understanding of the importance of promoting equality and diversity in the service, and an honest awareness of areas where the service hopes to improve. The ethos of the home is to provide a person centred service for the people who use the service, both for respite and for assessment and rehabilitation. The staff see their role as supporting people to take decisions about their stay in the home, and to be as Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: independent as possible. The responses to surveys from the people who stay in the home, the information in care plans, observation of the staff and residents, and discussions with staff and residents, all confirmed that everyone is encouraged to make their views and wishes known. The improvements in good practice and in the environment of the home that we observed during our last inspection have continued, and the result is a service that provides an enjoyable and rewarding experience for the people who stay in the home. The home has a sound quality assurance system in place that meets the needs of the service. The area manager carries out monthly monitoring visits to the home that include talking to the people who live there. In the latest report the area manager commented, Two ladies made a point of telling me how happy they were with the service and how attentive, professional and kind the staff were. One lady told me she wished her family carers were as skilled in personal care. There are weekly residents meetings, and questionnaires for respite clients to complete after each stay. Hertfordshire County Council (HCC) carries out regular audits of the service. The Annual Quality Assurance Assessment (AQAA) stated, We have regular review meetings and service users are part of this meeting. They are encouraged to feed back about positive and negative aspects of the service. We saw the homes action plan for 2009/10. It follows the HCC priorities, for example Confident Citizens, Personalised Services, Safe and Secure Neighbourhoods, with actions for achieving these outcomes in the service. The actions for Personalised Services showed the input of people who use the service, and included a more structured activity programme, and tables for potting areas for the garden project. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff generally follow the homes policies and procedures. There was an environmental health inspection of the kitchen in February 2010, with some minor recommendations about recording and storage. There are regular fire drills, at different times of the day and night so that all staff are involved in them. The water temperatures of wash basins in the bedrooms are checked on a random monthly basis, but we were told that showers and baths are not tested because their temperatures are regulated at a safe level. We hand tested a sample of water outlets and the temperature displayed on the Arjo assisted bath was satisfactory. However it would be good practice to check all water outlets regularly, to ensure that the temperature regulators are operating efficiently. Care Homes for Adults (18-65 years) Page 27 of 30 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 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 30 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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