Inspection on 17/01/06 for 17 John Street

This inspection was carried out on 17th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

17 John Street 26/04/07

17 John Street 07/07/05

17 John Street 17/03/05

17 John Street 21/07/04

17 John Street 25/03/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

Ernest Kleinwort Court

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 17 John Street 17 John Street Maidstone Kent ME14 2SQ Lead Inspector Marion Weller Unannounced Inspection 17th January 2006 01:00 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 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 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 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. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 17 John Street Address 17 John Street Maidstone Kent ME14 2SQ 01622 664021 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) john.street@unitedresponse.org.uk None United Response Ms Karen Suzanne Herwin Care Home 5 Category(ies) of Physical disability (5) registration, with number of places 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: 17 John Street was purpose built in the early 1990s to provide ground floor accommodation for up to 5 people with multiple disabilities and was the product of a group of parents in association with Social Services and Sense. The home is owned and maintained by a housing association and offers single rooms to all Service Users. Maidstone town centre is within walking distance and access to public transport is close by. There is sufficient car parking space to the front of the building and a fair sized garden area to the rear of the property. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Regulatory Inspector Marion Weller carried out an unannounced inspection of 17 John Street from 1pm until 5pm. During that time the Inspector spoke with the area manager for United Response, the registered manager and some staff. A tour of the premises was undertaken. Some documents, records, policy and procedures were inspected. Care files were case tracked. Due to the nature of the service provided it is not possible to accurately incorporate reflections of service users in the report. The manager and staff gave their full co-operation throughout the inspection. What the service does well: What has improved since the last inspection? Service users individually and collectively benefited from the recent agreement for increased staffing levels in the home. The manager said that in direct response to a comment received by a service users relative, person centred planning meetings can now take place at weekends and would be facilitated by the deputy manager. To further support the involvement of service users relatives or representatives in review and planning meetings, minutes are distributed and relatives can be offered conference call facilities. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 6 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. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 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 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12345 Prospective service users and their families receive the information they need to make an informed choice as to whether to use the service. They are further protected by written terms and agreements. EVIDENCE: Case files held clear evidence of comprehensive assessments being undertaken in consultation with service users relatives or representatives. The procedure identifies whether the homes resources could meet the needs of the person being referred and thus offers valuable safeguards to both parties. Trial visits had been undertaken prior to the service user moving in. Written evidence seen shows that care managers, service users where possible and family members all contribute to the provision of necessary and up to date information held by the home. The manager continues work to review the contract offered between the home and individuals taking up residence. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 9 10 Service users benefit from involvement in comprehensive care plans that are regularly reviewed. Risk assessments keep them safe, whilst allowing valuable opportunities and a service where they are consulted in ways that are meaningful and appropriate given the complex communication difficulties that exist. Staff respect and protect confidential information shared with them. EVIDENCE: Care plans are comprehensive and detailed. They included information from service users involved specialist and local health care professionals, family members and staff. The home has a “How To” guide that tells staff exactly how to care for individuals in specific circumstances, the service users preferences and the level of support to be given. The attention to detail is commendable. The home has a firm emphasis and commitment to fully consult with service users and therefore provides an individual service tailored to reflect their needs, choices and preferences. Written documentation evidenced that review meetings are regularly held and risk assessments ensure that safety is protected, whilst new experiences are enjoyed. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 10 Service user files are overly large and cumbersome due to the amount of work undertaken with and documented about individuals. Service users would benefit from the regular archiving of documents reviewed and superseded to ensure staff have ease of access to current information. The home has a policy on the handling and sharing of confidential information, which the team is conversant with. Staffing has recently been increased due to a service users joint assessment, which identified additional 1:1 support needs. The agreement is due to be reviewed in February 2006. The home must continue to pursue the additional funding from commissioners to ensure that the individuals needs continue to be more appropriately met and the needs of those living in the home are not compromised should the additional resource be removed. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 12 13 14 15 Service users are enabled to develop through regular contact with the local community. Individuals are valued by staff, who actively encourage self-determination. EVIDENCE: The home understands the key role they play in providing opportunities for service user development. The manager spoke of the importance of this and of service users accessing a range of appropriate leisure facilities in the local community. Service users also benefit from attending ‘specialist’ services, such as physiotherapy sessions. The home has its own transport. Staff were seen to encourage independence and gave service users opportunities to make choices and take decisions. The manager said that service users opinions as to daily routines and activities within the home are listened to and acted upon. Family members are welcome to visit at any time and are made welcome. Important relationships are noted on care plans, respected and encouraged. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 Personal care is delivered sensitively in accordance with service users expressed wishes. Care plans clearly detail how physical and emotional health needs are to be supported. EVIDENCE: Care plans seen were comprehensive and detailed the type and nature of support that individuals need to maintain optimum physical and emotional health. A section of each individual care plan defines service users specific health care needs. Written records showed the home continues to liaise with specialist and local healthcare professionals in supporting service users in their health care needs. Medication was not inspected in detail on this occasion. However, the manager discussed recent medication administration training accessed by staff. The manager spoke of the intention of incorporating regular ongoing competency testing of designated medication administrators into regular staff supervision sessions. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23. The home has a clear and effective complaints system in place. Clear procedures exist to ensure residents are protected from abuse, neglect and self-harm. EVIDENCE: A complaints procedure is in place and made available to service users, families, visitors and external agencies. Symbols, pictures and explicit language are used within the service users complaints procedure. No new complaints had been received by the home since the last inspection. If necessary the manager seeks to resolve any concerns at an early stage through informal discussions with all parties. The regulation 26 visitor regularly reviews any complaints received and actions taken by the home during routine visits. The home had up to date policies and procedures regarding the protection of vulnerable adults and appropriate training for staff. The manager evidenced a thorough understanding of the reporting process and whistle blowing procedures. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 26 27 28 29 30 Service users live in a clean, homely environment with bedrooms that meet their individual needs and promotes their independence. The lack of communal space and storage presents restrictions as to freedom of movement to individuals moving around the home and raises potential health and safety hazards. EVIDENCE: The premises were toured. The requirement from the previous two inspections regarding the condition of the two communal bathroom floors was discussed with the manager. The manager has continued to liaise with the homes ‘landlord’ regarding this issue and to seek a satisfactory resolution, but it remains outstanding. Staff continue to provide a clean and well-maintained environment. The bedrooms are decorated in a way that reflects the lifestyle, communication needs and the personal taste of the occupant. One bedroom has excellent ensuite facilities. Given the presenting needs of the remaining service users, this type of facility would greatly enhance the care provision for everyone. The communal bathrooms used by the remaining four service users are equipped with baths, hoists, sinks and showers. The manager spoke of the benefit of installing a height adjustable bath for one particular service user but was realistic about the limitations of obtaining and installing this type of specialist equipment. Provision or non provision of such specialist equipment 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 15 which would clearly enhance and benefit a service users lifestyle should be clearly featured within the homes Statement of Purpose and within service user contracts, so that individuals are made aware of the homes environmental limitations. A number of specialist items of equipment are required to be held on the premises, for example walking frames, standing frames, wheelchairs, and hoists. This type of equipment is bulky, cumbersome and difficult to store. It requires staff to manoeuvre such items before they are able to see to the needs of individuals and then to move it all back again to ensure accidents are avoided. It cannot be said clearly enough that the current accommodation does not provide adequate storage space for such items and steps must be taken to remedy the situation. The need to provide adequate safe storage space remains an outstanding requirement and the provider must address this now as a matter of priority. Additional shortfalls remain in terms of the size of the premises. There is one cramped bedroom for one member of staff sleeping in, the second sleeps on a chair bed in the main administration office. This situation is not conducive to a good nights sleep and is followed by the same individual having to work an early shift. It is to the staffs credit and to the careful management of the situation that it is dealt with in an objective and understanding manner and is tolerated because of their commitment to the service. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 35 36 Service users benefit from being cared for by a cohesive and effective staff team who have a good understanding of their needs and who receive regular supervision and training opportunities. EVIDENCE: Clear lines of accountability and responsibility are understood by staff and arrangements for deputising in the manager’s absence are clear and explicit. There was adequate staff at the time of the inspection. Staffing levels have recently been increased. The additional provision is to be reviewed again shortly as mentioned elsewhere in the report. The home uses agency staff to cover for rota absences or leave. Because of the complex nature of service users presenting needs, regular agency members are used who know and understand service users Staff files evidence a robust recruitment process. One minor amendment is required to the staff application form to reduce any potential of harm to service users. Personnel records are held securely. Some original documents pertaining to staff interviews, required by regulation and for inspection purposes are stored centrally at the employers head office. This was discussed with the manager, who still seeks suitable resolution of the issue. Written records evidenced a sound induction period, which leads in to regular and recorded supervision and appraisal meetings with managers who are trained to provide this. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 17 Staff training needs were clearly identified, with numerous opportunities for development which covered mandatory courses such as food hygiene and fire safety and also service specific training which encompasses sign language, autism awareness and epilepsy amongst others. It was clear from discussion with staff that development opportunities have benefited and guided their work with service users. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 38 40 41 42 43 The home benefited from a manger that is accessible and has high expectations of the service. Sound working practices safeguard the health, safety and well being of staff and service users. EVIDENCE: The manager is experienced and suitably qualified. One staff member said of the manager “ It is so good to be led by someone who really does care, not someone who just says it!” The deputy manager is undertaking the NVQ Registered Managers Award and was respected in the same positive way. Staff feel supported, motivated and encouraged and receive good quality training. The health and safety policy and other associated guidance documents are clear and available. Staff are conversant with emergency procedures. An ‘on call’ arrangement means the home has 24-hour access to a senior member of staff. Staff work within the organisations written guidelines ensuring the health safety and general well being of service users 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 19 All records regarding health and safety checks, routine maintenance and equipment checks were maintained and up to date. Records of gas, water and electrical service were equally in order. Certificates and up to date reports demonstrate the home has adequate insurance cover. Regulation 26 inspections are made regularly by the owner organisation. Written and comprehensive outcomes of the visits are given to the manager and sent to the Commission. 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 2 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 4 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 1 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 17 John Street Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 4 x 3 3 3 x DS0000024078.V272268.R01.S.doc Version 5.0 Page 21 YES 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 YA27 Regulation 23(2)(b) Requirement Timescale for action 31/03/06 2. YA5 5(1)(c) 3. YA24 23(3)(b) The registered person shall ensure that the premises are kept in a good state of repair. This requirement is made within the context of the current condition of bathroom floors. (Previous timescale of 17/3/05 and 14/8/05 not met) Action plan to CSCI within timescale given. The registered person shall 31/03/06 produce a standard form of contract for the provision of services and facilities by the registered provider to service users. This requirement is made within the context of such contracts being reviewed by the manager, to ensure they detail the elements as listed under standard 5.2 (Previous timescale of 14/8/05 not met) Action plan to CSCI within timescale given The registered person shall 31/03/05 provide for staff sleeping accommodation where the provision of such accommodation is needed by staff in connection with their work at the care DS0000024078.V272268.R01.S.doc Version 5.0 17 John Street Page 22 4. YA28 23(2)(l) 5. YA34 19(5) Sch 2 home. This requirement is made within the context of the home reviewing the current arrangement for the second sleep - in member of staff having to use a chair - bed in the office. (Previous timescale of 14/8/05 not met) Action plan to be completed within timescale given. The registered person shall 31/03/05 having regard to the number and needs of the service users ensure that suitable provision is made for storage for the purposes of the care home. This requirement is made within the context of large, necessary items being stored in a way that compromises the health and safety of staff and service users. (Previous timescale of 17/3/05. and 14/8/05 not met) Action plan to CSCI within timescale given. The registered person shall not 31/03/06 employ a person to work at the care home unless he is fit to do so. This requirement is made within the context of the home retaining on the premises, the information as listed under Schedule 2 of the Care Homes Regulations (Previous timescale of 14/8/05 not met.) Action plan to CSCI by timescale given 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 23 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. Refer to Standard YA20 YA29 Good Practice Recommendations It is strongly recommended that the manager regularly checks designated medication administrator’s ongoing competency skills and maintains records of outcomes. It is recommended that the manager consider the purchase and installation of an adjustable rise and fall bath to benefit service users and reduce any potential risks to staff. It is recommended that the manager consider the purchase of a lightweight mobile hoist to reduce the potential risk to staff during service user transfers. The home must seek a statement as to a prospective staff member’s physical and mental fitness to work in the home. The current staff application form should be amended as discussed. It is recommended that the manager review service user files and archive documents superseded by review and updating of information to ensure staff can access service users current care plans, risk assessments and other relevant information required with ease. It is strongly recommended that the registered manager fulfil the stated aim of arranging and maintaining individual staff personnel files. 3 4 YA29 YA34 5. YA41 6 YA41 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 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 17 John Street DS0000024078.V272268.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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