Care Home: St Moritz

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What the care home does well People know that they will have their needs assessed, and their dreams and hopes for the future supported. The assessments seen had involved the person and the people who were important to them. The manager had made sure it was satisfactory for a person aged over 65 to live in the home before they were offered a place. The manager is developing a person centred planning system with the resident. They are going to use a digital camera to fill in information. The care plan has been written with the residents input and clearly says how they wish to be supported, and what extra support is needed to do activities safely. The resident said that he gets to do lots of activities that he has chosen. He enjoys a particular place to eat, so this is built into the weekly planner. Education and learning is still a big part of the residents` lifestyle. A personal tutor has been employed to help the person learn about their laptop computer. Health and welfare has been carefully assessed and documented. The individual feels that they are in good health and know they can ask to see the doctor if they feel unwell. The resident said that they have a say in what goes on in the home. They know that the house is for sale and know that changes are taking place. What has improved since the last inspection? At the last inspection, the home did not have any service users as it was just occupied by the managers. There were no improvements to be made. CARE HOME ADULTS 18-65 St Moritz 8 Mitten Road Bexhill-on-sea East Sussex TN40 1QL Lead Inspector Lois Tozer Key Unannounced Inspection 3rd December 2007 12:20 St Moritz DS0000021382.V356056.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 Moritz DS0000021382.V356056.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 Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Moritz Address 8 Mitten Road Bexhill-on-sea East Sussex TN40 1QL 01424 731150 01424 731150 Lucerne-House@tiscali.co.uk 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) Mr Steven Alexandrou Mr Steven Alexandrou Care Home 3 Category(ies) of Learning disability (3) registration, with number of places St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of residents to be accommodated is three (3) The people accommodated will be aged between eighteen (18) and sixty-five (65) years on admission 30th August 2006 Date of last inspection Brief Description of the Service: St. Moritz is a semi-detached property located in a quiet residential area of Bexhill-on-Sea within easy walking distance of the town centre shops. There is a well-tended private garden to the rear with a large, timber garden room, used for meetings, training and office work. The home is registered for three (3) adults with learning disabilities. Accommodation is provided on two floors, which includes the owners living accommodation. The home is furnished and decorated to a high standard. The well-equipped kitchen, dinning room and lounge are used communally. Residents have their own bathroom and toilet facilities. St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced “Key Inspection”. The Inspector arrived at the home at 12:20 pm and stayed until 3 pm. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager and any information that CSCI has received about the Service since the last inspection. Although the manager is Mr Steven Alexandrou, his wife is in charge of the day to day running of the home. She has had many years experience as a registered manager, and continues to act in this role. The home is currently for sale, the one resident is fully aware of the proposed change. We discussed life in the home with the resident, who told us that he likes living at St Moritz very much. He told us that he has an interesting life, getting out and about a lot and seeing old friends. He is pleased to do things in the kitchen and feels that he has enough to do each day. The fee range to live at this home has a starting point of £750.00 per week. Further information in the statement of purpose and service user guide can be obtained from the provider, as can previous inspection reports. There is one Required Developments at the end of this Report. What the service does well: People know that they will have their needs assessed, and their dreams and hopes for the future supported. The assessments seen had involved the person and the people who were important to them. The manager had made sure it was satisfactory for a person aged over 65 to live in the home before they were offered a place. The manager is developing a person centred planning system with the resident. They are going to use a digital camera to fill in information. The care plan has been written with the residents input and clearly says how they wish to be supported, and what extra support is needed to do activities safely. The resident said that he gets to do lots of activities that he has chosen. He enjoys a particular place to eat, so this is built into the weekly planner. Education and learning is still a big part of the residents’ lifestyle. A personal tutor has been employed to help the person learn about their laptop computer. St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 6 Health and welfare has been carefully assessed and documented. The individual feels that they are in good health and know they can ask to see the doctor if they feel unwell. The resident said that they have a say in what goes on in the home. They know that the house is for sale and know that changes are taking place. 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. St Moritz DS0000021382.V356056.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 Moritz DS0000021382.V356056.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. Future residents can be certain that their needs and aspirations will be assessed carefully, and they will know if the home can meet their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An assessment of needs and aspirations has taken place with the prospective resident. The manager / owner has spent time with the person discussing what they want out of the home, and what the home can offer them. Other important information has been collected, such as past history, likes and dislikes and specifically, how the person wishes to be treated. This has been reviewed in the first 6 weeks of residence, and has informed the care plan. St Moritz DS0000021382.V356056.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. Residents know that the care provided will have been agreed with them in advance and that they will be supported to develop. The care management team must be kept informed as to changes in a persons support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The person living at the home is having help to develop a person centred plan. This is a recent piece of work, and there are plans to use a digital camera to make it user friendly. The manager said that better communication plans might really benefit the person. The individual nodded and agreed more pictures would be helpful. The resident told us that they have the right support in their everyday life. Records and care management feedback showed that the individual had developed or re-captured life skills. The type of support they need was clearly documented in a care plan. This included decision-making likes and dislikes and risk assessments. St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 10 Most of the risk assessments had supporting information as how to help the person do a task whilst lessening the risk. We discussed using the kitchen. The individual enjoys using this, and is requested to ask for support in advance. There are no goals to develop kitchen skills further, which could increase independence. Other plans have been reviewed with the help of an advocate and development of skills was clearly evident. A risk and support assessment for a short stay with another person had not involved the care manager. The resident was fully involved and looking forward to this. The manager agreed to contact the care manager immediately. Future plans of this nature must involve the care management team well in advance, and this forms a requirement of the report. St Moritz DS0000021382.V356056.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. People have the lifestyle that they have chosen and enjoy the benefits of living in a small home where they can make ordinary lifestyle decisions every day. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The person living at the home described their life to us. Most days are full and busy. Three times a week they attend centres where computers, art and social events take place. On other days, they go out to places that interest them, with the manager(s) giving support. Some evenings are spent in the pub, having a pint. On weekends, outings to places of special interest are organised, such as looking at aircraft and meeting friends. A private tutor has come to the home to do teaching sessions on the residents’ personal laptop computer. They told us that they were able to play four games now, and took some printed information they had done themselves. Daily chores are shared out amongst the family and person living at the home. Washing up and laying tables is a routine job. Sometimes the resident will get involved in baking, but St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 12 mainly the staff cook main meals. Food preparation and cooking could be an area that could be developed and improve further on independent living skills. Everyone gets involved in shopping, and a good range of high quality food is always available. St Moritz DS0000021382.V356056.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 good quality outcomes in this area. People living at the home know that their health and personal care needs will be supported in a way that suits them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The person living at the home has worked with the manager to complete a health assessment, which will form a health action plan. There are clear records that all general health care support needs are being met, including medication reviewing. We suggested that an annual ‘well man’ heath check might be included as an action point, which the manager felt could easily be incorporated. Personal support needs are also well documented, and these have also been drawn up with the person’s involvement. At the moment, only the owners work in the home, which gives the person living at the home continuity of support. Medication records were in very good order, and storage was clean and safe. We suggested that assessments and development around supported selfSt Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 14 administration of medication would help the individual to increase independence. St Moritz DS0000021382.V356056.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. The person living at the home knows that they will have concerns and issues taken seriously, be listened to and protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The person living at the home discussed how they would make a complaint, and said that they felt ok to tell the owners. They were happy to discuss their problems, and the manager said that they look for any signs of anxieties. They offer the person living at the home a chance to talk and discuss what’s wrong. They have a chance to speak to an independent advocate and also the support at the day centres attended. Triggers for anxiety are known and recorded in the care plan. The manager clearly described how she would proceed with any allegation or protection issue, describing the process of informing Social Services. Although the current resident knows how to make a complaint and what to expect, there is no ‘easy read’ (simple pictures in a format that suits the person) complaints procedure available. Before further residents move in, one should be drawn up and be available to all. St Moritz DS0000021382.V356056.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 good quality outcomes in this area. The house is homely and suits the needs of the service user. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owners of the home have placed the house up for sale, and have started to remove their furniture. The home remains very homely and cosy. The resident told us that it was ‘…lovely, the room was nice, big window, like to look out’. The furniture was all in very good condition, and as some was removed, it was being replaced with good quality alternatives. There are two bathroom / toilets (upstairs and downstairs). There is free access to the kitchen, and a conservatory for dining. The owners have a dog that the resident likes. At the moment, there is no washing machine. An alternative arrangement of using the facilities at a local caravan park is in place. The owners are debating where to situate the machine. We recommend that they discuss their possibilities with the environmental health officer before taking any action. St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 17 St Moritz DS0000021382.V356056.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 good quality outcomes in this area. The service user knows that staff who support him will get to know him well and understand his support requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the visit, there were no staff employed by the home. Support is given to the resident from the owners, but a new staff member was due to start on 13/12/07. The resident had some input into the recruitment process, and told us that he liked the new person, who he already knew a bit and had come to work with support from the manager as part of the introductory process. The manager described that the POVA check had been sent for, and that references had been obtained. There is a clear development plan in place for the new starter, and both she and the manager are going to do a full health and safety and the Mental Capacity Act training courses throughout January 2008. A recent CRB certificate had also been seen. St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 19 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. People living at the home know that the manager will promote their welfare and focus development of the service around their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager takes a back seat in the actual management of the home. The day-to-day manager is his wife, who has had many years experience supporting people who have various difficulties. She takes a lead role in the running of the home, but having recently obtained her NVQ 5 award in management, is set to retire. The service user is fully aware of this, and has been kept in the picture about the changes to his home. The potential new owner has spent time getting to know him. All development in the home focuses around the individual’s support and development needs. Although there is no ‘formal’ quality assurance process, general day-to-day support and St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 20 person centred plans clearly demonstrate that the resident is at the heart of the home. As mentioned earlier, it is important that the manager keep the care manager informed of any planned changes to the support of individuals. The manager has booked herself in for full updates of health and safety training for January 2008. The fire risk assessment has been reviewed in line with the latest legislation and has been signed off by a ‘competent’ person. All environmental safety certificates are up to date. St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 21 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 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 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 3 3 X 3 X 2 X X 3 X St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 22 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13 (4,b, c) 14 Requirement To ensure service users have the right support at all times, risks such as planned holidays and breaks must be notified to the care manager with sufficient advanced notice. A documented assessment of support and risk must be in place in advance of the activity taking place. Timescale for action 01/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA17 YA20 YA22 Good Practice Recommendations Assessing and supporting residents to do more cooking would improve ordinary life skills and increase independence. More support around people taking a bigger part in controlling and administering their own medication could be developed. Make sure that prior to admitting further service users, a fully accessible complaints procedure is available. St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Maidstone Local 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. Extracts may not be used or reproduced without the express permission of CSCI St Moritz DS0000021382.V356056.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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