Inspection on 18/10/05 for Boons Park

This inspection was carried out on 18th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Boons Park 23/01/09

Boons Park 20/02/07

Boons Park 30/05/06

Boons Park 05/05/05

Boons Park 17/12/04

Boons Park 13/05/04

Boons Park 02/10/03

Similar services:

Prinsted

Elizabeth House

Kenward House

Winthrop Hall

Life Works Community Ltd

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

CARE HOME ADULTS 18-65 Boons Park Toys Hill Road Toys Hill Edenbridge Kent TN8 6NP Lead Inspector Ruth Burnham Announced 18 October 2005 09:30 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. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Boons Park Address Toys Hill Road Toys Hill Edenbridge Kent TN8 6NP 01732 700202 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) Kenward Trust Mr Allen Belton CRH Care Home 20 Category(ies) of Alcohol dependence past/present (20) registration, with number Drug dependence past/present (20) of places Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents with drug and/or alcohol dependency problems may also have a mental health difficulty. 2. Total number of bedspaces must not exceed 20 Date of last inspection 05 May 2005 Brief Description of the Service: Boons Park is a large detached premises with accommodation arranged on 3 floors in the main building and accommodation is also provided in a barn conversion adjacent to the property, it is owned by Kenward Trust who provide a number of care homes for people with past alcohol and drug dependency in the South East. This home is located in a rural area near to a small hamlet. Accommodation is currently provided for 19 service users with past or present drug or alcohol dependency. The home has 15 single and 2 double bedrooms. There are communal rooms including a dining room, lounges, meeting and counselling rooms. The home is set in extensive grounds with off road parking for several cars. Staff accommodation is also provided on site.The home employs counselling and support staff who work a rota which includes a member of staff working at night on sleep in duty. In addition to these staff, there is a housekeeper and central administrative and management support at the local area office. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by one inspector who was in the home from 9.30 a.m. to 15.30 p.m. during which time 2 service users, 1 member of staff, the Manager and the Director of Residential Services were spoken with. The Barn annexe and a number of records were inspected. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 6 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 Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 7 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) 1-5 People who are considering undertaking the programme provided in the home are provided with detailed information about what they can expect. EVIDENCE: People who are considering moving to the home are provided with detailed information about how the service is run and what they can expect and all information is available in formats which are accessible to the service users. The Director confirmed that the updated version of the statement of purpose would be forwarded to the Commission for approval. People who are thinking about moving to the project are visited in their current situation when an assessment is made of their suitability for the programme. This is recorded and placed in the individual file along with a care management assessment that are obtained wherever possible from the referring agency as a basis for the care plan. Wherever possible, prospective residents are encouraged to visit the home prior to admission. People who move into the home benefit from specialist help delivered through a therapeutic programmed with support from qualified counsellors, they enter into a contract which includes the room to be occupied, personal support, specialist services and therapeutic interventions and any rules which may limit personal freedom. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 8 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 - 10 People who live in the home benefit from excellent support within the therapeutic programme, however their care and support outside this context is still compromised by poor care planning and risk management. EVIDENCE: Service users spoken with praised staff, particularly staff involved in counselling and group work. There were 13 service users accommodated in the home at the time of the inspection. Some work has been done to ensure that there is a care plan in every file, which is drawn up by the Keyworker and counselling staff in consultation with the service user. It was clear that there is a lack of understanding about the purpose of the care plan in that it did not provide clear guidance to staff about how to meet the day to day care needs of people living in the home. This lack of understanding and guidance was having a negative impact on some aspects of care in that insufficient support was being given to service users who needed help with daily living skills, for example to protect themselves from risk of infection through good hygiene practices. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 9 Staff other than counselling staff, were still not using the care plan as a basis for their practice, they continue to complete activity sheets on a weekly basis which do not relate to the care plan. This fails to promote good care for service users outside of the therapeutic programme. It was also clear that there is a lack of understanding among staff who are recording risk assessments, these are still not being used by staff as part of their day to day guidance and do not generate clear guidance to staff on how to minimise risk to people living in the home. People who live in the home are consulted about life in the home through regular meetings, there is a resident’s meeting every six weeks but it was clear through discussion with people who live here that this is too infrequent, particularly as the programme only lasts for six months. The manager agreed to increase the frequency of these meetings to every month. Discussion again took place with staff and management about the reason for care plans, risk assessments and day-to-day recording processes. There is a need to ensure that the systems used generate and maintain a cohesive working document for each service user, which reflects their changing needs and provides staff with up to date guidance to enable them to provide ongoing and consistent support, not only within, but also outside of counselling and group sessions where the greatest amount of service users’ time is spent. The Director agreed that additional training was needed to ensure that these standards are met. People who live in the home can be confident that their confidentiality is maintained through systems and practice, which ensures that personal information is stored securely and is available solely to authorised and appropriate people. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 10 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) 12 - 17 Life in the home provides a variety of opportunities, rights are respected and choices are available. Boredom for service users may be a problem when staffing levels are too low. EVIDENCE: Service users spoken with again said that there was a problem with boredom, however transport is available at set times to enable service users to pursue activities during leisure periods. Trips are arranged to cinemas, bowling, walks and some group trips are arranged from time to time for those who share the same interests. Service users are encouraged to become involved in local churches; a local drop in centre and other local groups, libraries and the leisure centre. There is a notice board providing information about local events. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 11 Some entertainment is available in the home including a snooker room, darts and table tennis. An excellent leisure facility has been opened since the last inspection in converted garages with a range of gym equipment. Whilst the inspector takes note of the fact that some of the complaints reflect the particular needs and difficulties experienced by service users in this category rather than any failure on the part of the service provider, inadequate staffing levels outside of the therapeutic programme indicate that their concerns may be valid. Family and friends are welcomed within the agreed restrictions of the therapeutic regime. In the same context visitors are welcomed and may be seen in private. Staff interaction with service users observed during the inspection was warm and respectful. People who live in the home may choose when to be alone or in company and, within the agreed therapeutic arrangements, they may choose when not to join in an activity. Service users have unrestricted access to the home and grounds and visitors have access subject to individual and collective consent. Service Users spoken with said that the food is excellent and they are offered some choice within the menu plan, meals are offered three times daily with snacks and drinks available at all times. Mealtimes are relaxed and take account of individual nutritional needs. The inspector has eaten with service users at previous inspections and was impressed by the quality of the food provided. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 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 standard(s) 18 - 21 People who live in the home are provided with access to healthcare support however, those who need higher levels personal care are not being adequately supported. EVIDENCE: The home operates a designated Keyworker system. Service users are provided with work clothes and often assistance is given to purchase other necessary items of clothing. Poor care planning and inadequate numbers of support staff means that people who need higher levels of personal support in their daily lives, are not being helped to the level which they require. All service users are registered with the local GP and given an initial health check on moving into the home. Access is also provided to opticians and dentists as required. Specialist referrals are made where necessary. Service users’ safety has been improved in that medication is now stored, administered and recorded in line with relevant guidance. However, not all staff who administer medication have received accredited training in this area. Service users in this home only stay for short periods as a stage in their recovery, staff have received training in bereavement and loss. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 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 standard(s) 23 Inadequate checks on volunteers could place people who live in the home at risk of harm EVIDENCE: Service users are protected through a clear adult protection policy and all staff are checked prior to appointment however, people who live in the home could be placed risk of harm through the failure to check all volunteers through the Criminal Records Bureau. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 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 standard(s) 24 - 30 The quality of life for people who live in the Barn annexe is being adversely affected by neglect of the premises and they are being placed at risk of harm through poor hygiene practices. EVIDENCE: Only the barn annexe was inspected on this occasion, there are 3 people living in this area which has 4 bedrooms (that have wash hand basins), a small living area, a ground floor bathroom and a first floor toilet with washing facilities. These residents also have access to all other communal areas. People who live in the annexe are expected to keep the area clean as part of their therapeutic programme however, it was clear that not all the occupants are able to take on this responsibility without significant levels of support from staff. The carpets were very stained, bathroom/toilets were dirty and used flannels were left around, a sink was cracked and water was very hot with no warning signs. Some furnishings were very worn and dirty. One bedroom in particular gave cause for serious concern, in that sheets were torn and dirty, the mattress was worn and misshapen and the pillow had disintegrated. In comparison with the main building this area had been neglected, adversely affecting the quality of life for these residents and placing them at risk of harm through infection. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 15 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 - 36 People who live in the home are supported by an enthusiastic and dedicated staff team, however their safety and quality of life is compromised by low staffing levels and inadequate training. EVIDENCE: People who live in the home can be confident that staff will understand them, through the home’s policy to employ staff who have first hand experience of the challenges facing them. Staff are divided into therapeutic and support staff, with a part time housekeeper and chef. Service Users benefit from the support of therapeutic staff who are highly qualified with professional supervision provided on a regular basis. People who live in the home can be confident that staff are only appointed following rigorous recruitment procedures, which include the gathering of detailed information about applicants through the application form, informal and formal interviews and the taking up of references and criminal record checks. Appointments are only confirmed following a 3 month probationary period. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 16 The management agreed that there were insufficient support staff, including adequate housekeeping hours, to ensure that people who live in the home are adequately supported outside of the therapeutic programme. Inadequacies in care planning, risk assessment and general daily living support indicate that there are significant gaps in training for support staff, including statutory training. Training in moving and handling has still not been provided, the Director was again reminded that statutory training must be provided, this issue is outstanding from the previous 3 inspections. However, some evidence was seen that service users’ safety is being protected, in relation to fire safety awareness, first aid and food hygiene, through competence-based training by a qualified instructor. National Vocational Qualifications have still not been accessed for support staff and there is a vacancy that the home is seeking to fill. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 17 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, 39, 41 & 42 The quality of life and the safety of service users is being compromised by ineffective management systems. EVIDENCE: The manager is currently undertaking the Registered Managers Award to broaden his skills in the management of the home and improve the service for the benefit of the people who live here. The Director of Residential Services provides additional management support and visits the home regularly. It was agreed that regular reports in line with Regulation 26 would be submitted monthly to the Commission and that an effective internal quality assurance system would be put in place to ensure that standards are met and the quality of life for people who live in the home is improved. The management also agreed that shortfalls identified throughout this report in relation to statutory training, risk management, health and safety and infection control will be addressed to ensure that people who live in the home are protected from harm. Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 18 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 3 Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 2 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 3 3 3 2 Standard No 11 12 13 14 15 16 17 3 3 2 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 2 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Boons Park Score 2 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 2 x H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 19 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. 2. Standard 6 9 Regulation 15& Schedule 3 13(4)( c ) Requirement Timescale for action By 31/11/05 By 31/11/05 3. 13 4. 18 5. 6. 20 24 & 26 7. 30 Individual care plans must be drawn up for each service user which are kept under review unecessary risks to the health and safety of service users must be identified and eliminated within the context of an effective risk management system to include up to date individua and environmental risk assessments. 16(2)(n)& Sufficient numbers of staff 18(1) should be available to ensure that adequate support is available at evenings and weekends. 18(1) Adequte numbers of staff should be available to ensure that adequate personal support is available 18(1)( c ) Staff who administer medication should be provided with accredited training 16 (2)( c ) There must be adequate furniture, bedding and floor coverings which are clean and fit for purpose 16(2)(j) & Training should be provided for 13(4) staff and service users in infection control to ensure safe practices in the home. All areas of the home must be kept clean H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc By 31/11/05 By 31/11/05 By 31/11/05 By 31/11/05 By 31/11/05 Boons Park Version 1.40 Page 20 and in good repair 8. 32 19(5)(b) Staff must be qualified and competent to carry out the task they perform through access to the relevant NVQs Volunteers should be checked through the crimninal records bureau Adequte numbers of staff should be available to ensure that the care needs of service users are met and all areas of the home are comfortable, clean and safe. Staff must be qualified and competent to carry out the task they perform including personal care support and care planning and risk assessment. The home shall provide a report to the commission of the outcome of it’s quality assurance review and a monthly report in line with regulation 26. Training for support staff must be provided in moving and handling, health and safety, infection control and handling medication. By 31/11/05 By 31/11/05 By 31/11/05 9. 10. 23 33 13(6) 18(1) 11. 35 19(5)(b) By 31/11/05 12. 39 24 & 26 By 31/11/05 13. 42 13(4)(5) & 19(5)(b) By 31/11/05 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 8 Good Practice Recommendations Service users house meetings should be more frequent Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 21 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. Extracts may not be used or reproduced without the express permission of CSCI Boons Park H56-H06 S23865 Boons Park V242765 181005 Stage 4.doc Version 1.40 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!