Care Home: St Michaels

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What the care home does well There are good, clear assessments of need for individuals. Each person has a person centred plan that they have been involved in. The plans are colourful, have pictures, printed photos, symbols and clear writing to describe what is important to each individual, what they like to do, what they do not like, how they like to be supported, what they want in the future and how they plan to achieve it. There are some good positive behaviour support guidelines so that staff are able to assist each person to choose their lifestyle. There are good support strategies to enable service users to participate in activities in the community. Individuals are supported well to go on a holiday of their choice.The people living in the home are supported to maintain contact with their families. The people living in the home are supported to express their views and concerns and say what they want to do. They are also well supported to develop their confidence in social situations. The company has a good staff training programme to reinforce positive behaviour support. What has improved since the last inspection? The environment has improved. Damage that had been caused by one of the people living in the home has been repaired. The home has recently been painted to brighten some areas up. The overall range of training in the company is good and the manager has put in place a structured follow up to check for staff competency and confidence. First aid training has been attended by the manager and four staff so that it is possible to make sure there is always someone in the home with sufficient training. The manager has given surveys to the people living in the home to gain their views of the service. He used the company`s new quality assurance surveys. He did not feel that the surveys were very effective at gaining accurate views from the people and they have gone to be re-designed. The manager felt that the one-to-one meetings held with each person are a better way of including their views in their lifestyle and the service provided. The manager has a general plan of action to support individuals and manage the home. The company have a development plan. This is currently being reviewed. CARE HOME ADULTS 18-65 St Michaels 166 London Road Temple Ewell Dover Kent CT16 3DE Lead Inspector Julie Sumner Unannounced Inspection 23rd June 2008 10:00 DS0000023580.V365575.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 DS0000023580.V365575.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. DS0000023580.V365575.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michaels Address 166 London Road Temple Ewell Dover Kent CT16 3DE 01304 823017 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) stmichaels@hqls.org.uk www.hqls.org.uk High Quality Lifestyles Ltd Mr Duncan Robert Wood Care Home 7 Category(ies) of Learning disability (0) registration, with number of places DS0000023580.V365575.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 7. Date of last inspection 27th June 2007 Brief Description of the Service: St Michaels is a home for people with learning disabilities and communication difficulties who present challenging behaviour at times. High Quality Lifestyles a private company owns the home. The companys philosophy is to support people who have displayed behaviour that has caused them and others difficulty and has limited ordinary/usual kinds of life opportunities, by positive guidance and a specialised environment. The current fees for the service at the time of the visit range from £1885.00 to £3110.00. Information on the home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. The e-mail address for the home is stmichaels@hqls.org.uk. And for the company is www.hqls.org.uk. St Michaels is registered to provide accommodation for up to 7 people. It is the companys intention for 5 people or less to live in the home in order to provide a high quality level of support to each individual. At present 2 people live in the home. St Michaels is a detached home in the village of Temple Ewell near to the town of Dover. There are basic amenities within walking distance of the home and the town of Dover is approximately 15 minutes drive. There are reasonable public transport links near to the house and there is the facility for service users and staff to use the house car. DS0000023580.V365575.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 3 stars. This means the people who use this service experience excellent quality outcomes. This report is based on information received about St. Michaels including an annual quality assurance assessment (AQAA) completed by the registered manager and an unannounced visit to the home lasting just under 5 hours. Information was gathered for this inspection in a variety of ways both prior to and during the visit to the home. The visit included talking with people living in the home, the manager and staff. General observations were made during the day of how people are supported. There was a tour of the building and various records were inspected. The people living in St. Michaels were able to participate in the inspection by having conversations about their lifestyle and showing us what they have been doing using photos and recent projects. All the requirements and recommendations have been acted on since the last inspection visit. None were made as a result of this visit. What the service does well: There are good, clear assessments of need for individuals. Each person has a person centred plan that they have been involved in. The plans are colourful, have pictures, printed photos, symbols and clear writing to describe what is important to each individual, what they like to do, what they do not like, how they like to be supported, what they want in the future and how they plan to achieve it. There are some good positive behaviour support guidelines so that staff are able to assist each person to choose their lifestyle. There are good support strategies to enable service users to participate in activities in the community. Individuals are supported well to go on a holiday of their choice. DS0000023580.V365575.R01.S.doc Version 5.2 Page 6 The people living in the home are supported to maintain contact with their families. The people living in the home are supported to express their views and concerns and say what they want to do. They are also well supported to develop their confidence in social situations. The company has a good staff training programme to reinforce positive behaviour support. What has improved since the last inspection? 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. DS0000023580.V365575.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 DS0000023580.V365575.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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The assessment process is effective at identifying needs. EVIDENCE: No one has moved into the home since the last inspection visit. One person has moved out. The manager explained that the future of the home is being considered. There are no further admissions planned for this home. DS0000023580.V365575.R01.S.doc Version 5.2 Page 9 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Individuals are encouraged to make their own decisions and choices. The people living in the home know that their personal goals are reflected in their individual plans. EVIDENCE: Each person has a person centred plan. One person designed his own on the computer. A sample of 2 person centred plans were viewed and discussed with the manager. The manager has reviewed the plans. The guidelines that were previously only contained in the original service user plan have been simplified and included in the person centred plan. This plan now forms the main point of reference for support for each individual. The original service user plan is still in place and contains more detailed guidance and risk assessments. The manager explained that some of the goals set by each individual have been reached. The home uses a positive active support approach. It was evident that the goals had been reset to move on from those achieved and DS0000023580.V365575.R01.S.doc Version 5.2 Page 10 people were progressing with their skills and level of independence. One of the people was happy to discuss the contents of his plan. He had other project books from courses he has attended and talked about current interests and achievements. The guidelines for behaviour interventions have been reviewed within the company with the consultant and the person centred team. The representative from the funding authority have been updated. Risk assessments have been designed to highlight areas that need prevention to increase staff awareness and give them clear guidelines of how to support each person. The manager reviewed the risk assessments and guidelines as part of the person centred planning process. The intervention guidelines need to be signed as agreed with relevant professionals outside the organisation as they include restraint. The manager agreed and said this would be done. DS0000023580.V365575.R01.S.doc Version 5.2 Page 11 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment to enabling the people living in the home to develop their skills, including social, emotional, communication, and independent living skills. The people in the home have been fully involved in the planning of their lifestyle and are supported to maintain important relationships. EVIDENCE: One of the people living in the home talked about his lifestyle. He has a timetable of planned events which are scheduled throughout the day. He has written the main events himself in his diary. The timetable is flexible. Some activities are structured and some are chosen on the day from a range of options the person likes that have previously been agreed. The people living in the home require the support of two staff when in the community. The staffing level is sufficient to support this. DS0000023580.V365575.R01.S.doc Version 5.2 Page 12 The staff team support individuals to go on holiday if they wish. One person was away on holiday at the time of the visit. Individuals are supported to maintain contact with their families. How they are supported is written in their individual plans. One person spoke about his experiences. The manager said there is good contact with families and the home. There is free access to the kitchen, staff supervise, but the people living in the home make drinks when they feel like one and participate in meal preparation depending on their interest and skill development. One person said he enjoys cooking and has been going to college for cookery classes. He had a folder with recipes, which we looked at and he read out some of his favourites. He said he does join in with the main cooking and cooking and baking is also included in his activities timetable. DS0000023580.V365575.R01.S.doc Version 5.2 Page 13 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 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home receive good personal and healthcare support using a person centred approach. They are active and healthy. EVIDENCE: The people living in the home are supported by the staff using a person centred approach. One person was participating in a review of his plan on the day of the visit. He said he likes joining in the planning of his support. Each person is supported to attend health care appointments. A sample of records was viewed including health care records with a record of appointments. The chiropodist sees each person monthly. One person goes to a specialist afro-Caribbean hairdresser. A health support part has been added to the person centred plan. The manager plans to expand this by introducing health action plans so that there is more detail of the support staff need to give to assist individuals to manage their health. The manager said this has been discussed in the individual reviews. DS0000023580.V365575.R01.S.doc Version 5.2 Page 14 The manager and four of the staff team have attended the extended first aid training to make sure that staff are have the skills to manage possible accidents. This was a requirement at the previous inspection visit so has been responded to appropriately. The consultant psychiatrist reviews the medication. All staff are trained to administer medication. The manager audits the medication administration. The administration records were checked. There are guidelines for giving medication when required. Staff need to seek approval for this first from the manager or an on call manager. The manager said he has an interview with staff when there has been an incident of behaviour intervention and if it has been necessary to give this additional medication to monitor it. The manager said as part of one person’s support plan they were considering how to support him to manage his own medication. DS0000023580.V365575.R01.S.doc Version 5.2 Page 15 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has an open culture that allows the people living there to express their views and concerns in a safe and understanding environment. Training in the area of safeguarding including managing challenging behaviour is made available to staff as needed. EVIDENCE: There have been no complaints about the service provided. The home has a service user friendly complaints procedure. The people in the home have opportunities to raise concerns in one-to-one meetings. All staff have attended safeguarding adults training. The company have recently reviewed the training to make sure that it is giving the staff the right skills and knowledge. The training matrix was viewed to see that there is an ongoing programme of training. There are clear guidelines in the individual plans for staff to respond to each person. Staff have previously experienced the safeguarding processes and are aware of the need to follow procedures and guidelines and also of what actually constitutes abuse. The people living in the home are supported individually. They prefer not to socialise too much together. This keeps the atmosphere in the home calmer and one of the people living in the home confirmed this. DS0000023580.V365575.R01.S.doc Version 5.2 Page 16 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the needs of each person. Sometimes there is a slippage of timescales for maintenance and improvements. EVIDENCE: Major building work that had been required in the home had been completed. The new entrance has been completed including the handrail. This gives an alternative entrance for staff so that they can pass essential information to each other between shifts, before meeting the people living in the home. Improvements were made last year mainly to repair and replace parts of the home that had been damaged by a person’s destructive behaviour. Parts of the kitchen have also been refurbished. DS0000023580.V365575.R01.S.doc Version 5.2 Page 17 The manager said that the maintenance team had all left this employment and they had to contract out if they needed work to be done. Overall the home looks better than it did at the previous inspection visit last year but it is still in need of improvements to make it homely. The bathrooms are in need of refurbishment. Improvements are needed to make the home more comfortable. Furniture and carpets are worn in some areas. One of the people participated in the inspection visit by talking about his lifestyle, part of the time in his bedroom. He has arranged his furniture how he likes it and has lots of personal belongings. He says he likes his room and likes to spend time in it as well as the rest of the house. His room is comfortable and homely. The staff were giving the home a good clean at the beginning of the visit while one of the people is on holiday. They have attended infection control training. The laundry is adequate for this size home. DS0000023580.V365575.R01.S.doc Version 5.2 Page 18 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 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has plentiful staff available at all times to support the needs, activities and aspirations of the people using the service in an individualised and person centred way. EVIDENCE: Staff spoke about their role. The duty rota was viewed and discussed with the manager. There are 3 staff on shift each day and the registered manager. One person needs the support of two staff and one person needs the support of one member of staff to go out. They are both able to pursue an active lifestyle and there is no restriction on them going out. There have been no new staff since the last inspection visit. The home have a thorough recruitment policy that includes protection of vulnerable adult checks (POVA) and criminal records bureau (CRB) checks to safeguard the individuals living in the home. DS0000023580.V365575.R01.S.doc Version 5.2 Page 19 Staff training is ongoing. Specific training is given to staff in all aspects of person centred support and autism. All staff have a national vocational qualification (NVQ) to at least level 2 apart from one. There is a timetable of staff supervision which the manager is up to date with. The manager interviews staff if there has been an incident. This is partly to support staff to make sure they have the skills and competency to manage the situation. The manager also looks at training needs to see how the situation could have been prevented and what could have been done better. DS0000023580.V365575.R01.S.doc Version 5.2 Page 20 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has a clear understanding of the key principles and focus of the service based on the organisational values and priorities. The views of the people living in the home are acknowledged and effort is made to organise the service around their needs and wishes. EVIDENCE: The registered manager has a substantial amount of experience working with people with learning disabilities who present challenging behaviour at times. He has the national vocational qualification to level 4 in management and care and also has the registered managers award. He is currently studying an undergraduate diploma in positive behaviour support. DS0000023580.V365575.R01.S.doc Version 5.2 Page 21 The surveys for the quality assurance system have been completed with the people who live in the home. The manager said they were not really effective at getting the true views of the people in St. Michaels because they seemed to answer yes to most questions and did not expand on this. He felt they were really just saying what they thought they should say rather than anything meaningful. The company training and quality manager is reviewing them. The one-to-one meetings with each person give a clearer reflection of their views and have been taken into consideration with the manager’s planning. The manager has a basic development plan for the home. This is planned for the short term as the company is considering options for the future of the home and service provided to the people living there. The manager now has an office in a room that was previously a bedroom. This is a more accessible place for everyone. There is good space and records were well organised. All staff have attended training for safe working practices like first aid, fire safety and infection control. The home is maintained so that it is essentially safe. The new entrance to the basement for staff and visitors has been completed and the hand rail is fitted. This formed part of the advice from the fire safety officer. Regular maintenance checks are made on the equipment and services into the home. DS0000023580.V365575.R01.S.doc Version 5.2 Page 22 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 x 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 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 x 3 x 3 x x 3 x DS0000023580.V365575.R01.S.doc Version 5.2 Page 23 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. 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 DS0000023580.V365575.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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