Care Home: St Philips Close

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Philips Close 1 St Philips Close Middleton Leeds West Yorkshire LS10 3TR two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Valerie Francis Date: 0 2 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: St Philips Close 1 St Philips Close Middleton Leeds West Yorkshire LS10 3TR 01132778069 F/P01132778069 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Milbury Care Services Ltd Name of registered manager (if applicable) Mrs Yvonne Brown Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: Date of last inspection 0 2 1 0 2 0 0 7 A bit about the care home 1 St Philips Close is a purpose built bungalow located in a residential area of Middleton close to local amenities and public transport routes. There is roadside parking to the front of the home. There are well maintained gardens to the rear of the property that are accessible to the people who live there. The home is registered to provide personal care for four people with learning disabilities. The accommodation includes four single bedrooms, a communal lounge, dining room, a communal bathroom and toilet, a domestic style kitchen and separate laundry room. 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: Two star good 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 How we did our inspection: This is what the inspector did when they were at the care home. The last time we inspected was the 2nd October 2007. The inspection was done in one day, and people did not know that we were coming. When making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The operational manager who was visiting the home facilitated in the process. We looked at records and looked at the home. What the care home does well What has got better from the last inspection Support plans now shows how staff are going to care for you. Any risks identified have a plan of action to show how risks are minimized and managed. Each hot water outlet now have a thermostat in place and a system to monitor hot water temperature, to make sure that people are safe from scalding. Any bed safety rail used now has a risk assessment in place to make sure they are appropriate for the person it is been used for. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Valerie Francis St Paul’s House 23 Park Square (South) Leeds LS1 2ND Tel: 0113 2204600 Fax: 0113 2204628 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 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 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 . The home provides people and their carers with good information for them to be able to make a choice if the home can meet their needs. A thorough admission process is carried out to make sure the home can meet the needs of people who move in. Evidence: We were told that the statement of purpose and service user guide is given to people who wish to use the service their families or others involved in their care. The statement of purpose and service user guide needs updating to make sure that people have correct information that tells them about the service. In the AQAA we are told that the home carries out an in-depth assessment for all new people wanting to come to live at 1 St Philips close. This involves the person and others involved in their care. We looked at a care file of the last person who came to live at the home and we saw that the assessment process had been carried out to a high standard. There was lots of detail about the person and their care and support needs, such as their health and social care needs. We saw that families and health and social care professionals are involved in the assessment process. We saw copies of multi agency assessment information and information from health care specialists. Visits and over night stays are encouraged. we were told that the moving in process is timed in accordance with the needs of the person. We were also told that the new manager was in the process of reassessing other Evidence: people who live in the home. One persons needs have changed and arrangement have been made for a reassessment and review of that persons care needs. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples individual needs are met by the implementation of clear and detailed support plans and risk assessments, which have involved peoples relatives. People are supported and encouraged to have their say and to make choices about the running of the home. Evidence: In the AQAA we were told that peoples individual plan is based on their assessment of needs, with clear information about how they want their care and support delivered. Since the key last inspecting the organisation has introduced a new format to record care and support plans. We looked at three peoples care files and found that each person care and support plan had good information about their care and support needs. There was information showing the involvement of health and social care professionals. We saw that the standard of peoples written information and risk assessments have improved. Peoples plans had information on moving and handling. We saw that staff have clear insrution how to mash or puree food for people who needs a soft diet. One person had information how their food should be served to them, such as liquidised or mash, staff said each food is liquid or mash separately so that each food can be identified. Any risk identified had a plan in place how it would be managed. We found that much of the information was person centered, describing how people care and support are delivered. So that people get the care they need in the way they wished. There was more written information on likes and dislikes and preferences with care Evidence: and support. One person had information that their care to be delivered by female staff. Peoples personal care had information about the amount of staff needed to assist them with moving and handling, for example one person care plan said he needed two staff to support him with moving and personal care. We saw evidence that peoples families and professionals are involved in review meetings. Any risk identified for people was properly assessed with an action plan put in place to manage the risk. These are evaluated and reviewed regularly to reflect peoples changing needs. Staff were knowledgeable about people and their needs. The visiting district nurse was very positive about the home and the staff. We were told that staff always sought their advise and carried out any instruction given. Staff told us and we saw that people are supported to make decisions about their daily life, by people being offered choices. We were told that due to the complex needs of people, it is not possible to get group decisions, people are always ask if they were happy with food. Staff looked at people body language and facial expressions for a response. People who can communicate verbally is given time to communicate their answers. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home are enabled to take part in activities they enjoy and go out in the wider community if they wish. Their daily choices and individual rights are respected and contact with families is supported. Evidence: Peoples support plan included an activity programme and daily record showing what they had done and where they had been. Activities included people attending day centre and other activities outside of the home, for example meals out, shopping and evening clubs. There has been more emphasis on in house and one to one activities, so that people can be assisted to do things that they individually like to do, such as art and craft and food preparation. One person told us they enjoyed going to the day center. We saw staff spending time with people giving them choice on how they wanted to spend their time and what they wanted to do. We were told that two people have a weekly massage, and an entertainer visits the home monthly to engage people in singing and other musical activities. Key worker also have a role in activity planning and enabling people to go out on outings, walking and visits to shops and pubs. In the AQAA we were told that the home welcomes visitors, and key workers support contacts with family and friends. Evidence: People can see any visitors they wanted. People are shown pictures of food, which help them to chose what food they wanted and with menu planning. People who have no verbal communication, body language and facial expression are observed for their response, others are given the time to speak. We were told that a dietitian is working with and supporting staff, giving advice for one person needing a soft diet. We did not see any evidence that nutritional risk assessments are carried out for people as part of the initial assessment process, to make sure people are not nutritionally at risk. We saw staff assisting people with their lunch, they talked to people throughout the time asking them if they were enjoying the food and if they wanted more. We noticed that people were given time to chew their food before another mouthful was given. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the home have their personal care and health needs met in a way that takes account of their wishes, rights, privacy and dignity. Evidence: We looked in detail at two peoples support plans and saw that they identify the individual health and personal needs. Discussion with staff and observation of staff interaction with people confirm that people are involved and consulted about their care needs. We saw good information and we were told that peoples care needs are constantly looked at to make sure they are getting the care they need. The homes AQAA told us that they provide people with the personal support they require in their preferred way, to meet their physical and health needs. We were also told that base on people’s individual capabilities they are given the opportunity to administer and control their own medication which is based on the organisations policies and procedures. None of the people living at the home at the time can administer their own medication. We were told that all staff have had a half day training on handling of medicine. We were told that people are supported with access to health care services. We saw in people’s information that effort is made to make sure people’s health care is met, such as how peoples epilepsy is managed. Staff have had training on caring for people with epilepsy. One person told us that staff support them to vist their GP. We saw that staff were mindful of people’s privacy and dignity by always knocking on bedroom doors before they entered. We observed staff speaking to people in a respectful manner. Staff were seen to be friendly without being overall friendly. 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 . The home encourages people to express their views and concerns and they know that their concerns will be taken seriously and acted upon. Staff knowledge and training of safeguarding protects people. Evidence: The AQAA told us that the home provide people and their visitors with a clear and effective complaints procedure and ensure people are aware of it and how to use it. They also said they have a robust adult protection procedure for responding to any allegation or suspicion of any type of abuse. We saw that people had access to a complaint procedure that was done in words and pictures which would enable them to make a complaint. However, we would suggest that this could be made even easier for people to understand. People told us in surveys that they did not know how to make a complaint. One person said they knew who to speak to. One person who we spoke to, said they would tell staff if they were not happy. Since the last key inspection there have been two issues of Safeguarding. The home had followed their procedure by referring both issues to adult protection, the police and us. During discussion with staff they told us that they had Adult Protection training and they knew the procedures to take if an issue relating to adult protection was brought to their attention. We looked at the arrangement for safe management of peoples money. We found that there was a good system in place. Each person had a transaction record sheet with records of expenditure and receipts. Peoples money is looked after by the organisation, and their day to day personal money is managed by the home. There is good financial procedures in place to make sure staff know how to handle peoples money. 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 provide people with a well maintain environment, that is kept clean. Evidence: The home is located in the area of Middleton in Leeds which is within walking distance of local shops and pubs. The home is adjacent to another home that is registered and managed by the organistion. There are four bedrooms, each personalised to reflect the individuals taste and interest. There is on going program of re-decoration and refurbishment of the building. The AQAA said that the home provides an accessible, homely, clean, hygienic, safe, well maintained and comfortable environment to meet peoples individual needs. Peoples personal space is a self contained single room, with suitable furniture. We found that people have a domestic style accommodation that is generally well maintained with modern furnitures and decoration. The lounge has several type of chairs which are suitable for peoples individual needs. The home was clean and tidy throughout. People indicated in their surveys that the home is clean and fresh. People are supported by staff to take part in domestic chores, which is done in accordance with peoples support plan. We saw that staff were observing infection control by wearing apron and gloves to assist people with their personal care, laundry and handling of food. Some staff have had training on infection control. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People care and support could further improve with specific training for staff on issues relating to people specific care needs, such as dementia. Evidence: We looked at the rota and saw that there was a minimum of two staff during the day and one at nights. Staff told us that there has been an improvement in staffing levels since the last inspection. There is now always a minimum of two staff on duty which mean we can sometimes take people out. At the last key inspection we saw that at times during the day there was one staff available to four people, which meant that there were not enough staff on shift to support people with care and activities. The operational manager said that a new staff had been appointed and they are now always a minimum of two staff during the day. We were also told that additional staff can be given in an emergency if peoples dependency level changes. We saw in one persons care and support plan that they needed two staff to support them with their personal care and moving whilst in bed. The rota showed that there was one staff on duty at night to care for this person. We were told that if people needed two staff, the staff in the house adjacent would come and assist them. We said that this practice put both people and staff at risk. The operational manager told us a reassessment of this persons care was due to be carried out. Some days after the visit we were told that at the reassessment it was decided that this person only needed one staff to assist them and additional moving and handling equipment to be put in place. We recommended that this persons care should be continually be monitored, to make sure they have enough staff to meet their needs. Evidence: During the visit we saw staff getting on well with each other and were seen to relate well to people. Staff meetings had been held but not regularly, we were told that the new manager had put plans in place to have them monthly. We did not see any staff recruitment files, as they were not accessible. We were told that the manager had the keys to the filing cabinet and she was on holiday. The organisation has a good recruitment and selection policy procedure in place, to make sure that staff are suitable to work at the home. At the last visit three files were inspected and we found that the home had followed the organisations procedure. All applicant had completed an application form, two references were taken up and an enhance CRB Criminal Record Bureau Checks was carried out before staff were employed. In the AQAA we were told that since the last visit the organisation have put systems in place for staff training and development. The manager and the operational manager monitor training fortnightly. Staff told us that they have training such as moving and handling which is updated annually. Staff said that although they know a lot about people, and what to do to meet their care needs. However, they feel they would benefit from additional training that related to peoples individual illness. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Although People and staff feel supported, they will benefit from a management team that is more accessible. Evidence: A new manager has been appointed from August 2008. She has experience of managing a home working with people with learning disability. She has a management qualification and NVQ 4. The deputy manager has worked at the home for some time and have NVQ 3 Since the new manager appointment further work has been done to ensure the continuity of care and the improvement of peoples written information. At present the manager and deputy are based at 3 St Philips Close, but although staff felt they are supported by the homes management team they look for guidance from management in the home. We recommend that one of the management team is based in the home to monitor that delegated task are being carried out. There is a quality assurance systems in place that include seeking the views of people and others involved in their care. We saw records of health and safety checks carried out. Since the last visit each hot water each outlet has had a temperature guards fitted and weekly monitoring of hot water temperature carried out. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description Timescale for action 1 34 17 Staff employment records must be available for inspection. 14/12/2008 So that we can make sure that staff are suitable and safe to work with people who live at the home. 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 1 1 The Statement of Purpose and Service User Guide should be regularly review. To make sure that the home still is providing the service that is in their written information. Peoples nutritional needs should be assessed and regularly reviewed, to make sure their are not at at risk. Some consideration should be given, for staff to have training on individual peoples specialist care need. Some consideration should be given to have one of the management team is based in the home. To monitor that 2 3 17 32 4 38 delegated task are being carried out. Helpline: 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 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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