Inspection on 07/07/05 for 17 John Street

This inspection was carried out on 7th July 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

17 John Street 26/04/07

17 John Street 17/01/06

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 Maidstone Kent ME14 2SQ Lead Inspector Sophie Wood Announced 7 July 2005 10:00 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 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 Stationary 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 H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) United Response Ms Karen Suzanne Herwin CRH Care Home 5 Category(ies) of Physical Disability (5) registration, with number of places 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17 March 2005 Brief Description of the Service: 17 John Street was purpose built in the early 1990’s 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. The home currently has one vacancy, for which referrals have been received. 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection visit was the first to be conducted in the year running from 1st April 2005 to 31st March 2006. The inspector arrived at 9.30 am and spent seven hours on the premises. Care files were case tracked, the manager and staff were interviewed and a number of documents, policies and procedures were inspected. The inspector was especially grateful to the relatives, who took the time to come in to speak about their views of the service provided and the comment cards received from staff, placing authorities, relatives and visiting professionals were equally of value. Time was spent touring the premises and additional inspection information was obtained through receiving the pre inspection questionnaire, prior to this visit. What the service does well: What has improved since the last inspection? 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 6 Written records regarding the storage and administration of medication have improved. The rear garden wall has been repaired and the hall carpet has been replaced 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 H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 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 standard(s) 1, 2, 3, 4, 5. Prospective service users and their families are given the information they need to make an informed choice as to whether to use the service. Written term and agreements are supplied. EVIDENCE: All of the care files inspected held clear written evidence of assessments being conducted. These were detailed, clear and included consultation with prospective service users and their families. Specific and individual needs were identified and used to review staff training needs, in order for the home to be satisfied that such needs could be met. All service users living at the home have visited before choosing to move in and the manager is currently reviewing the existing contracts between the home and individuals, to ensure all of the required elements are clearly covered. 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 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 standard(s) 6, 7, 8, 9, 10. Service users are aware of the contents of their care plans and are encouraged, wherever possible to set their own goals. Clear, detailed risk assessments keep residents safe, whilst allowing opportunities. Service users are consulted in ways that are meaningful and appropriate, given the complex communication difficulties of individuals. Staff respect and protect confidential information. EVIDENCE: Care plans are detailed and clear. They include information from the service user, involved professionals, family members and care staff. The ‘How To’ guide tells staff exactly how and under which circumstances specific support is to be given, in the way the service user prefers. Examples seen included how to clean someone’s teeth, how to provide physical assistance at mealtimes and how to provide personal care. The attention to detail was commended. It demonstrated the commitment of the home to fully consult with individuals, to provide a service tailored to reflect their needs, choices and preferences. Written documentation evidenced that meetings with service users are regularly held and risk assessments ensure that safety is protected, whilst new 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 10 experiences are enjoyed. Clear written policy guidance on the handling and sharing of confidential information is known and implemented by the team. One individual has recently undergone a joint assessment of need, conducted by representatives from both ‘health’ and ‘social services’. The findings of this have highlighted the specific areas requiring intensive 1:1 support and through the inspection of care plans, shift plans and other daily records, it is evident that there are occasions where either this individual’s needs, or the needs of others, are being compromised, given the current allocation of staffing levels. This is an issue for the home to pursue with placing / funding authorities, in order to ensure that the identified needs of all those living in the home continue to be met. 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 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 standard(s) 11, 12, 13, 14, 15, 16, 17. Service users are enabled to develop through regular contact with the outside world. Individuals are valued by the staff, who actively encourage self – determination. Meals are nutritious, varied and wholesome. EVIDENCE: The staff team work hard to research and keep up to date with their local community, in order to access local resources and activities. Whilst service users benefit from attending ‘specialist’ services, such as physiotherapy sessions, the home is keen to ensure that leisure pursuits, in line with those enjoyed by individuals without disabilities, are also accessed by those living in the home. Family members are welcome to visit at any time and they do. One family member stated that staff always make them feel welcome and listen to their views and opinions. They added that they would find it particularly helpful if review meetings could be held at weekends. This was passed onto the manager. The kitchen was clean, tidy and well equipped. Fridges and freezers were well stocked and menus are planned and agreed with service users. Records pertaining to meals served showed that a wide range of ‘healthy options’ 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 12 continue to be offered and one individual was assisting with meal preparation at the time of this inspection. All staff have received food hygiene training. 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20, 21. Personal care is delivered sensitively in accordance with service users’ wishes and care plans clearly detail how physical and emotional health needs are to be supported. Service users do not self – administer medication. The subject of ageing, illness and death has been discussed with individuals and their relatives. EVIDENCE: Care plans provide explicitly clear details in describing the exact preferred methods of care delivery. A separate section, pertaining to health needs is also detailed and clear. All health care appointments are recorded and close working relationships with health care professionals exist and benefit service users. Medication is appropriately stored, administered and recorded. The requirements made from the previous inspection, with regards medication, have been fully implemented. Written evidence within care files demonstrates that staff have discussed topics including ageing, illness and death with service users and their families. 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 14 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 standard(s) 22, 23. Service users and their families have ample opportunities to express their views. These are listened to, valued and acted upon. Clear procedures are in place to ensure residents are protected from abuse, neglect and self – harm. EVIDENCE: A clear, comprehensive complaints procedure is in existence and made available to service users, families, visitors and external agents. Comment cards received from all parties confirmed that, although the complaints procedure is known, it has not been necessary to instigate its use. Symbols, pictures and explicit language is used within the service user’s complaints procedure, in order that it is understood by its intended recipients and the family members spoken with, gave assurance that matters raised have been successfully resolved through ‘informal resolution’. 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 15 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 standard(s) 24, 25, 26, 27, 28, 29, 30. Service users live in a clean, homely environment. Bedrooms are clearly ‘owned’ by occupants and are furnished in a way that best meets their needs and promotes independence. The lack of communal space and storage facilities does pose risks to restricting freedom of movement around the home and potential health and safety hazards. EVIDENCE: The premises were toured and the previous requirements from the inspection of 17/3/05 were discussed with the manager. Staff are commended for their continued efforts to provide a clean and well maintained environment and the works required to the outside wall have been completed. The hallway carpet has been replaced and bedrooms are decorated and furnished in a way that reflects the lifestyle and personal tastes of the occupant. One bedroom has excellent en – suite facilities. Given the presenting needs of the remaining individuals; this type of facility would greatly enhance the care provision for everyone, given the complex care needs presented. However, the remaining group are served by the two communal bathrooms and although these are equipped with suitable baths, sinks and showers; the previous requirement to 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 16 address the condition of the flooring in these rooms, remains outstanding. It is noted that the manager has written to the home’s ‘Landlord’ regarding this issue. One individual is currently experiencing difficulties to obtain the style and type of wheelchair, which would best suit his presenting needs and the home needs to ensure that the provision or non – provision of such specialist equipment is clearly featured within its Statement of Purpose and individual service user contract. Given the individual needs of those accommodated, a number of ‘specialist’ items are required to be held on the premises, for example; wheelchairs, walking frames, toilet seats, etc. Such equipment is bulky, cumbersome and sometimes difficult to store; requiring staff to manoeuvre such items before being able to see to the needs of individuals and then needing to move it all back again, to avoid potential accidents from occurring. The premises do not currently provide adequate storage space for such items and steps to remedy this situation were recommended at the previous inspection. Given the potential for accidents to occur, the need to provide adequate, safe storage space is now a requirement. Additional shortfalls remain in terms of the size of the premises, which necessitates the second sleeping in member of staff to use a chair – bed in the office. Whilst the team has made every effort to ‘make best’ this provision, it is not conducive to a good night’s sleep, which is then to be followed by completing an early shift. 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36. Clear lines of accountability and responsibility are followed. Staff receive more than the required amount of training per year and the courses attended are relevant to the needs of service users. New staff receive a thorough induction and all have regular, documented supervision meetings. EVIDENCE: The home was adequately staffed at the time of the inspection. Although the equivalent of a full time vacancy exists, evidence was seen to demonstrate that this is being advertised and any gaps in the rota are being filled with existing relief staff or regular ‘agency’ members, who know the home and service users well. Personnel records were inspected and individual staff members were interviewed. A robust recruitment process was confirmed by those spoken with, including a long serving support worker, relief worker and agency member. Written records evidenced a sound induction period, which leads into regular, recorded supervision meetings, with managers who are trained to provide this. Training records were scrutinised and in addition to mandatory courses, such as food hygiene, fire safety, manual handling, etc, specific training, including, autism and sign language is provided, to enhance the services offered by the home. Personnel records are held securely, however; the original documentation pertaining to interviews is stored at the 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 18 Organisation’s Head Office. The manager was advised that copies of interview notes and CRB clearance is required to be held at the home, for the purposes of inspections. Copies of individual staff’s contracts are also required to be held on file at the home and in line with data protection requirements, such personnel information should be held separately, as opposed to the current practice of all being held in one encompassing folder. All staff have detailed and clear job descriptions, which are regularly reviewed. New staff receive induction training in line with LDAF guidance and regular staff meetings and handover periods are built into the working rota, without compromising the care needs of service users. Clear lines of accountability and responsibility are understood by those working at the home and arrangements for deputising in the manager’s absence are clear and explicit. 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, 42, 43. The home is well – run and an effective leadership style promotes and encourages service user and staff participation. Sound working practices safeguard the health, safety and general well – being of staff and service users. EVIDENCE: The manager is suitably qualified and experienced. She is respected by the staff team, who describe her as being an inclusive manager, who allows staff and service users to shape and determine the ways in which the service is run. The deputy manager is currently undertaking the NVQ Registered Manager’s Award and she was spoken about in a similar positive fashion. Staff feel supported and encouraged and receive good quality training. This aspect reflects positively in terms of the quality of care delivered to service users. All records regarding health and safety checks, routine servicing of appliances and equipment were seen by the inspector. All were up to date and the home 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 20 possesses adequate insurance cover. Staff and service users are conversant with emergency evacuation procedures and the manager is currently in consultation with the local fire office, with regards the fire evacuation plan, based upon the presenting needs of a recently admitted individual. A clear ‘on call’ arrangement means the home has 24 hour access to a senior member of staff. Records pertaining to gas and electrical servicing and maintenance were up to date and the home has adequate insurance cover. Financial documentation with regards service users’ monies was inspected and found to be in order. Staff work within the Organisation’s written guidelines, ensuring that the health, safety and general well being of service users is protected. 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 2 3 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 4 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 2 2 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 17 John Street Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 4 3 3 3 3 3 H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 22 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 27 Regulation 23(2)(b) Requirement 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 and is carried over from the previous inspection visit of 17/3/05. The registered person shall ensure that the care home is conducted so as to make proper provision for the care, treatment, education and supervision of service users. This requirement is made within the context of ensuring that adequate staffing levels are maintained to meet the needs of service users, individually and collectively. The registered person shall 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. The registered person shall Timescale for action Action plan to be received by CSCI by 14/8/05. 2. 3 12(1)(b) Action plan to be received by CSCI by 14/8/05. 3. 5 5(1) ( c) Action plan to be received by CSCI by 14/8/05. 4. 24 23(3)(b) Action plan Page 23 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 5. 28 23(2)(l) 6. 34 19(5) Schedule 2. provide for staff sleeping accommodation where the provision of such accommodation is needed by staff in connection with their work at the care 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. The registered person shall 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 which compromises the health and safety of staff and service users. This was a recommendation made from the previous inspection of 17/3/05. The registered person shall not 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. to be received by CSCI by 14/8/05. Action plan to be received by CSCI by 14/8/05. Action plan to be received by CSCI by 14/8/05. 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. Refer to Standard 6 Good Practice Recommendations It is recommended that consideration be given to holding some review meetings at weekends, in accordance with requests from family members. H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 24 17 John Street 2. 17 John Street H56-H06 S24078 17 John Street V223399 070705 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent 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. 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