Inspection on 21/06/05 for Esken House

This inspection was carried out on 21st June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Esken House 10/09/07

Esken House 25/07/06

Esken House 06/12/05

Esken House 18/02/05

Esken House 19/07/04

Esken House 23/03/04

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

CARE HOME ADULTS 18-65 Esken House 69 Charlesford Avenue Kingswood Maidstone, Kent ME17 3PH Lead Inspector Sophie Wood Announced 21 June 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. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Esken House Address 69 Charlesford Avenue Kingswood Maidstone Kent ME17 3PH 01622 843786 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) Mrs Esme Davis Mrs Esme Davis CRH Care Home 3 Category(ies) of LD Learning Disability (3) registration, with number of places Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18 February 2005 Brief Description of the Service: Esken House is a detached, ‘dormer style’ bungalow providing accommodation for three Service Users. The accommodation is on two floors, with Service Users having their accommodation throughout the ground floor. The Owner / Manager lives on the premises and the first floor is for her use only. The home is situated in a quiet residential area, approximately five miles from the town of Maidstone. The accommodation includes bedrooms with nurse call facilities, a lounge, separate dining room, conservatory, kitchen, utility room and facilities for visitors to stay overnight. The home has its own transport and provides car parking facilities to the front of the property. There is a large garden to the rear of the house. The home is staffed on a 24 hour basis and is described to be ‘a home for life’ for the three Service Users in placement. The Owner has provided care to the current individuals placed for 11, 15 and 17 years, respectively and does not plan to admit any future Service Users into the home. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection commenced on 21st June 2005 and lasted for five hours. One service user is currently in hospital and it is as yet unknown as to whether the home will be able to continue to meet her needs. In this event, the home still has no plans to admit any other service users, but will continue to accommodate the remaining two. Time was spent reviewing care plans and other associated documentation. Both service users were spoken with and two visiting relatives. The owner / manager was interviewed as were care staff and a tour of the premises was undertaken. Additional evidence was gained from the returned pre inspection questionnaire and comment cards received from service users, relatives and professional visitors to the home. Permission was obtained from the home’s G.P. to include his direct comments, “An outstandingly well run home combining a family atmosphere with an acute awareness for medical problems. The manager provides a warm and caring environment with excellent care”. Comments from others included, “Their (service users) well being is uppermost in everyone’s minds. A lovely warm house” and “Esme provides an excellent quality of care and service to her residents”. What the service does well: The home recognises and accommodates the individual needs and wishes of the service users. They are able to make own choices in respect of how to spend their time. Staff know the individuals well and communicate effectively with them. A safe, clean and well - maintained premises further ensures physical safety and well being, and attention is paid to ensuring optimum physical health through regular health checks and the supply of nutritious meals. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 Page 6 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. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 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 Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 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. Written information is available to enable individuals to make an informed choice about living at the home and individual contracts clearly describe the type and scope of service provided. EVIDENCE: Although all of the above standards were discussed and explored, many of the elements are no longer applicable to this home. There are no plans for any future admissions and the service users who are in residence each have a written contract, detailing the terms and conditions of occupancy and the services they can expect to receive. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 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. Greater detail within care plans would ensure that personal goals are accurately reflected. Service users are enabled to make own decisions and have an influence on how the home is run. Safety is maintained through the use of clear and detailed risk assessments and staff handle confidential information appropriately. EVIDENCE: Given the presenting needs of the two service users spoken with, it is difficult to ascertain that the purpose and contents of individual care plans are fully understood. However, when asked specific questions, responses were clear, “Staff look after me”, “I go out where I want” and “It’s good living here”. Direct observations saw individuals helping with household chores, moving independently around the home, with no restrictions and electing where to be and what to do. Staff were observed to offer appropriate support and to also respect individual wishes for privacy. Esken House H56-H06 S23929 Esken House V223453 210605 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) 11, 12, 13, 14, 15, 16, 17. Service users enjoy the activities of their own choosing. Community links are strong and personal relationships, outside of the home are encouraged and maintained. The food provided is of good quality and served in accordance with service users’ own personal preferences. EVIDENCE: Those persons living at the home are able to follow the hobbies and interests of their own choosing and such personal preferences are known by the staff. One individual particularly favours day trips to France and as such, this trip happens at least once every three months. Care notes reflect that a steady, though flexible routine occurs on a day - to day basis and those in placement feel safe with this. Outing happen frequently, the Aylesford Priory is a particular favourite, as is having ‘lunch out’. ‘In house’ activities continue to be offered and are clearly enjoyed. These include a visiting aromatherapist, hairdresser and the recent transformation of a spare bedroom into a music room. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 Page 11 The home can provide overnight accommodation for visiting relatives and always collects and returns family members from the train station. The two visitors today informed the inspector they are always made to feel welcome and are invited to join their relative for a meal whenever they visit. The kitchen was observed to be clean, well – equipped and stocked with fresh produce and meals were served with ample portions. They looked wholesome and appetising and the inspector was told that, “the food is always excellent”. Esken House H56-H06 S23929 Esken House V223453 210605 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, 19, 20, 21. Intimate and personal care needs are attended to in a dignified manner and the physical and emotional health of individuals is promoted. Safe medication practices are followed and individuals and their families have been consulted with regards illness and dying. EVIDENCE: Staff are fully aware as to the type and nature of the support required for individual’s personal and intimate care needs. Every effort is made to maintain privacy and dignity when people are being supported with bathing, washing and dressing. Written feedback from the home’s G.P. was extremely complimentary, (included within the summary section), and the system in place with regards the storage and administration of medicines is safe and secure. Only Mrs Davis, who lives on site, administers medication and she is a trained nurse. Records were inspected, with no errors noted. Those in residence are becoming older and this factor is fully appreciated by carers. This is reflected through staff training and the types and frequency of activities that are offered. Individual and family members’ views and wishes with regards ill health and dying are recorded within care plans and it is the aim of the home that individuals will remain there for as long as their needs can be met. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 Page 13 This remains a sensitive issue at present, given that a service user is currently in hospital and may need to move into nursing care. Staff fully understand the reasons for this, however, many have known the individual for a number of years and have been visiting the hospital every day. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 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 express their views readily and are confident that staff act in their best interests. Adult protection policies and procedures give clear guidance in order for service users to be protected. Notifications of serious incidents must be reported to the Commission to further ensure the protection of individuals. EVIDENCE: Whilst a clear and detailed complaint’s procedure is detailed within the home’s Statement of Purpose and Service User’s Guide, the home has not needed to use its formal process. Neither has the Commission received any complaints about the home. Service users said they talk to the staff if they are not happy. They then told the inspector that they are very rarely unhappy and that staff always listen to them. Policy and procedural guidance was clear and staff demonstrated a sound understanding in terms of putting this guidance into practice. There have been no adult protection alerts raised on this home. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 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, comfortable, well – furnished home. Ample communal space, including an accessible garden further enhances this provision and the aides and adaptations required to maximise independence are provided. EVIDENCE: The home was toured and no obvious health and safety hazards were noted. Toilets and bathrooms are accessible and afford privacy. All areas were clean. Bedrooms reflect the personal choices of the occupants, with two people continuing to elect to share a room, despite being offered single accommodation. There are no restricted areas within the home and no separate provision for staff. This was explored through conversations with staff and service users, who all advocated that the service is run as a family home, with no desire from anyone to run it any differently. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 36. All staff have written job descriptions and contracts of employment. Training courses are provided and accessed to reflect of the needs of service users. Staff are well – supported by the owner / manager. EVIDENCE: Staff files contain evidence of a safe recruitment procedure, with references and CRB checks seen. Job descriptions are clear and everyone has a written contract. Given the presenting needs of those in placement, the fact that the owner / manager lives on site and the support regularly received from her own adult children, only part time hours are used. Perusal of rosters against the presenting needs of service users supported that current staffing levels are sufficient. Training records indicated that statutory courses continue to be accessed, as do other courses, which reflect current needs, for example, epilepsy awareness and continence. All of the staff spoken with confirmed they receive continued, ongoing and effective support from Mrs Davis. Meetings are held every week to discuss issues / concerns / progress, however, formal supervision meetings are not occurring. Esken House H56-H06 S23929 Esken House V223453 210605 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, 38,39, 42. The home is well – run by an experienced and competent owner / manager, who adopts an inclusive style of leadership. The needs and wishes of those accommodated clearly influences how the home continues to operate and regular servicing checks, staff training and policy guidance ensures that everyone’s health, safety and welfare is protected. EVIDENCE: Staff and service users confirmed that they are regularly consulted by Mrs Davis with regards the ongoing running of the home. A real team spirit exists and staff are wholly concerned that the care they deliver meets the needs of those receiving it. The home is commended for the efforts recently made with regards reviewing and amending the home’s policies and procedures. These are clearly written, well – presented and cover a comprehensive range of topics. Clear health and safety guidance is understood and equipment is regularly serviced and maintained. Emergency evacuation procedures are practised and Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 Page 18 fire - fighting equipment is serviced, as are gas and electrical appliances. Sufficient insurance cover is in place. Staff have received fire fighting training and food hygiene and first aid. The inspector and Mrs Davis discussed the recent hospitalisation of a service user, who had fallen whilst in the home. The documentation seen was clear and it detailed all of the immediate and subsequent action taken. The G.P. was made aware, as was the care manager and there were no concerns as to how this accident occurred. However, the owner / manager was reminded of her duty to inform the Commission of any such event, within 24 hours as this piece of work had not been completed. Esken House H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 Page 19 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 N/A N/A N/A 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 4 4 3 3 Standard No 31 32 33 34 35 36 Score 3 x x x 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Esken House Score 3 4 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 1 x H56-H06 S23929 Esken House V223453 210605 Stage 4.doc Version 1.40 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 42 Regulation 37 Requirement The registered person shall give notice to the Commission without delay of the occurrence of any of the instances as listed under this regulation. This requirement is made within the context of an accident occurring to a service user which was not reported to the Commission. Timescale for action Action Plan to be received by CSCI by 26/7/05. 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. 2. Refer to Standard 6 36 Good Practice Recommendations It is recommended that care plans be reviewed to include greater detail with regards the preferred activities of service users and how these are to be supported by staff. It is recommended that staff meetings be formally recorded. This is to also include formal individual supervision meetings. Esken House H56-H06 S23929 Esken House V223453 210605 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. 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