Inspection on 16/02/06 for Kanner Project (Wixenford)

This inspection was carried out on 16th February 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kanner Project (Wixenford) 27/11/07

Kanner Project (Wixenford) 27/08/06

Kanner Project (Wixenford) 29/06/05

Kanner Project (Wixenford) 02/11/04

Kanner Project (Wixenford) 29/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Kanner Project (Wixenford) Wixenford House Colesdown Hill Plymouth Devon PL9 8AA Lead Inspector Tina Maddison Unannounced Inspection 16th February 2006 10:00 Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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 Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kanner Project (Wixenford) Address Wixenford House Colesdown Hill Plymouth Devon PL9 8AA 01752 895094 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) Small House Homes Ltd Mrs Clare Denise Lowther Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th June 2005 Brief Description of the Service: Kanner is operated by Small House Homes Ltd who own a number of care homes around the Plymouth area. The property is a large detatched house that is set in its own grounds near the town of Plymstock. Kanner project is registered to provide care and accommodation to five young people under the category of Learning Disability. Service users may also present behaviours that challenge services. Service users have their own lockable area of the house that includes a bedroom, lounge and bathroom facilities. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced at 1000. The current service users living at the home are unable due to their learning disabilities to articulate any opinions regarding their care at the home, but appeared happy and relaxed on the day of this inspection. A variety of records were examined, and discussions were held with the Manager and staff. A tour of the building was undertaken. What the service does well: What has improved since the last inspection? What they could do better: Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 Page 6 Copies of contracts stating what the home is financially responsible for and what the service users are responsible for are not kept at the home and are not available for inspection. A quality assurance system has not yet been fully developed, although questionnaires have now been sent out. The worn out bed base in one bedroom has not yet been replaced as recommended at the last inspection. Due to the care needs of the service users at the home, radiators must be low surface temperature, covered or individually risk assessed. Hot water from outlets must not exceed 43oc. 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. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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 Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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): 1,5. The homes statement of purpose and service users guide provide prospective service users and their families with detailed information which enables them to make an informed decision about admission to the home. EVIDENCE: There have been no new admissions since the last inspection. The homes admission processes and documents remain unchanged. The home has a comprehensive statement of purpose and service users guide. These documents have been produced in widget form and symbols to aid the service users understanding of these documents. Documents stating terms and conditions of a placement in the home, and individual contracts were not available for inspection, and the Manager was unclear regarding exactly what service users could expect to be provided in the home as part of the contact price, and what the individual service user is expected to fund themselves. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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. The service users individual needs and preferences are understood by staff, and independence and risks are appropriately balanced. EVIDENCE: Three placement plans/care plans were assessed, and evidenced that each service user has a plan that is comprehensive and identifies care needs and how these will be met at the home. This is achieved using a person centred planning approach. The plans include the short, medium and long term goals that the service user, with the support of staff at the home is aiming to reach. The information on the plans is derived from the homes assessment processes and ongoing social needs and healthcare needs assessment. Staff at the home are trained to undertake risk assessments, and are encouraged to carry out risk assessments for any activity undertaken outside of the home. Some service users have high ratio staffing needs, and one service user at the home requires three staff to accompany him at all times outside of the home. This has been agreed by the service users family and care manager. Each service user has individualised procedures in their plan for dealing with aggression or self harm. Although the service users verbal communication is limited, it was observed that staff are very “tuned in” to the service users individual methods of communication, and are able to detect subtle changes in behaviour that my Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 Page 10 lead to an aggressive outburst. Some of the service users use makaton and symbols and pictures are also used in the home as a means of communication. It was documented that plans are regularly reviewed. Service users are encouraged to make their own decisions and be as independent as possible. The home has tried to obtain independent advocates for the service users and the home uses the Mencap advocacy service. All the service users have their own self contained part of the house, and are encouraged to help to undertake the household chores and their own laundry. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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): 11,14,16,17. Service users rights are respected, and appropriate activities are available for personal development. A varied selection of food is available that meets dietry needs, tastes and choices. EVIDENCE: All the service users have daily activity plans. These are displayed for each service user in their part of the house, and are in pictures and symbols to aid understanding. None of the service users at the home, due to their complex care needs are able to work or attend college courses. However, staff have created meaningful activity plans for the service users, and these include cookery, arts and crafts, walking, trampolining and a well equipped sensory room. One service user goes on holidays, however the other service users find being away from the home too stressful, so enjoy day activities instead. Each service user has their own vehicle and enjoy trips to the local pub and supermarket and shops. The home has its own swimming pool that is currently being refurbished for the summer. Dietry needs are noted on care plans and there is a four weekly rotated menu. The home employs a full time cook. Staff and residents eat together and the home now has pleasant dining room. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 Page 12 Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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 the following standard(s): 18,19,20. Service users are encouraged to be as independent as possible with personal care tasks. The medication is well managed at this home and service users personal care needs and medical needs are met. EVIDENCE: A service user who needs specialist input because of thyroid problems could be seen to be receiving the specialist input from health services that they need, in the file was documented evidence that they had a consultation with a specialist, had received appropriate tests, and were being carefully monitored under the direction of the hospital and GP. None of the service users at the home self medicates. The home keeps lists of side effects of the drugs used in the home, and had received permission from the GP for the user of homely remedies. Medication procedures were found to be satisfactory, and medication records were accurately kept. Medication was appropriately stored. The home works closely with the Plymouth learning disability service. All of the current service users require prompting with personal care tasks, and some staff support, but are encouraged whenever possible to undertake their own personal care. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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 the following standard(s): 21,22 The Manager and staff have a good working knowledge and understanding of adult protection issues. Service users and their families can be assured that their concerns will be listened to and acted upon. EVIDENCE: Kanner has a complaints policy and procedure that is available in a format that is accessible to the service users. However, the current service users would need a lot of support from their families or advocates to use the procedure. The current residents have a high level of challenging behaviour, and there is potential for aggression towards staff. All staff have received training in physical interventions, de escalation techniques and breakaway techniques. All physical interventions were recorded. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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 the following standard(s): 24,25,27,28,30. Generally, Kanner is a homely and comfortable place to live. Further development of the maintenance and refurbishment programme would further enhance the home. EVIDENCE: Kanner House generally has a comfortable homely appearance. The property is a large detached house that has been divided so that each service user has their own space and communal areas. Some areas of the home are locked and alarmed in and this has been agreed with families and care managers to ensure that the service users needs can be met safely. A staff intercom is also in place. Since the last inspection some refurbishment has taken place in the house, and the outdoor swimming pool is being refurbished and covered. There is still work to be done, namely that one bedroom that would benefit from redecoration. One bed base in the downstairs bedroom should be replaced as it is very worn. A window in a service users bedroom should be covered with material that will enable them to see out but people outside would not be able to see in, as their bedroom overlooks the road outside. Generally the service users bedrooms are individually decorated, and they are able to use a sensory room. Two of the bedrooms are very plain and have basic furnishings due to the destructive behaviour of the service users. This has been agreed with care managers. Staff undertake cleaning duties and it was noted that the home was Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 Page 16 very clean on the day of this unannounced inspection. Since the last inspection, the dining room and activity room have been made separate. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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 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): 32,34,35 The staff at Kanner have a good understanding of the residents complex support needs and there are sufficient staff on duty at all times to meet the residents care needs. Robust recruitment procedures are in place to ensure the protection of residents. EVIDENCE: There has recently been a high turnover of staff mainly due to the complex and demanding care needs of the service users at Kanner, and an incident that resulted in disciplinary action taken by the company and the consequent dismissal of some staff. However, a recent recruitment drive has resulted in the home now being fully staffed. Not all of these new staff had a current CRB check, but were not working unsupervised. All the new staff have a probationary period of three months and a thorough induction process is undertaken with them. Training that is a priority for new staff is breakaway training. Two references had been obtained for new staff, and checks on identity had been undertaken. Small House Homes organises a training programme from their head office. Staff rotas evidenced that there is sufficient staff on duty at all times. Staff undertake 14 hour shifts on the rota, and staff spoken to said that they preferred to do long shifts and then take days off. There is always twelve staff on duty during the day at Kanner, due to the high care needs of the residents. At night time there is two sleeping staff and three waking staff on duty. A Manager is always on call. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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): 37,39,42 The recent appointment of a new Manager appears to give the staff positive leadership. Some areas of health and safety in the home need to be addressed. EVIDENCE: Since the last inspection, the Registered Manager has left the home, and a new Manager, Clare Slade, has been appointed. She is to undertake the Registered Managers process in due course. Ms Slade has completed her Registered Managers award and holds an NVQ3/4 in care. Ms Slade has worked at Kanner for some time and is familiar with the needs of the residents. Records have been reorganised and are easily located. Risk assessments are in place for staff, service users and the building. Any activities outside of the home are also risk assessed. The accident book evidenced accurate recording of any accidents. Fire prevention logs evidenced that fire safety is a priority in the home. The home has not got automatic water temperature regulators fitted to each hot water outlet, but has water temperatures set centrally on the main boiler. On the day of the inspection the water coming out of one of the taps in Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 Page 19 a service users bedroom exceeded 43oc. Radiators are not guarded. On the day of the inspection risk assessments for these could not be found. Risk assessments for radiators must be in place if these are not guarded. All windows above ground floor level had restrictors fitted. Portable appliance testing took place in October 2005. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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 Standard No Score 1 3 2 x 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 x ENVIRONMENT Standard No Score 24 2 25 2 26 x 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x x x LIFESTYLES Standard No Score 11 3 12 x 13 x 14 3 15 x 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 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 YA1 Regulation 17 Requirement Copies of contracts and terms and conditions between the home and residents must be kept at the home. The registered person must establish and maintain a system for reviewing and improving the quality of care in the home. Radiators must be low surface temperature radiators, be covered or have a current risk assessment in place. Individual temperature control valves must be fitted to individual hot water outlets. Timescale for action 30/04/06 2. YA39 24 31/05/06 3. YA42 13 31/05/06 4. YA42 13 31/05/06 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 YA24 YA25 Good Practice Recommendations A plan and timescale for maintenance and refurbishment of the house should be established. The bedroom window facing the road should be covered with a material to enable the service user to look out but DS0000047799.V285236.R01.S.doc Version 5.1 Page 22 Kanner Project (Wixenford) 3. 4. YA24 YA26 that ensures privacy for the service user. Consideration should be given to improving the garden and ensuring it is interesting and accessible to the residents. The bed base in the downstairs bedroom should be replaced. Kanner Project (Wixenford) DS0000047799.V285236.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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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