Inspection on 26/07/06 for Kazdin

This inspection was carried out on 26th July 2006.

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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kazdin 24/07/07

Kazdin 18/01/06

Kazdin 12/07/05

Kazdin 01/12/04

Kazdin 06/07/04

Similar services:

Credence House

Radfords

Honeybourne House

32 Beaumont Way

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

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

CARE HOME ADULTS 18-65 Kazdin Selway Lodge Tamerton Foliot Road Plymouth Devon PL6 5ES Lead Inspector Tina Maddison Unannounced Inspection 26th July 2006 10:00 Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 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 Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 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. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kazdin Address Selway Lodge Tamerton Foliot Road Plymouth Devon PL6 5ES 01752 702105 01752 702105 kazdinhouse@smallhousehomes.co.uk 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 Vacancy Care Home 3 Category(ies) of Learning disability (3), Physical disability (3) registration, with number of places Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Age range 16-35yrs Learning disabled adults some of whom may have a physical disability One service user, named elsewhere, over the age of 35 years may reside at the home. 18th January 2006 Date of last inspection Brief Description of the Service: Kazdin is a detached bungalow with an additional attached annexe that is set in its own large grounds that has a swimming pool and backs on to woodland. The home is registered to provide personal care and accommodation to three people under the categories of learning disability and children who have a learning disability. The age range the home is registered for is 16-35 years, however, one current service user is over the age of 35 years. The home has the use of two vehicles and is close to shops and local amenities. Kazdin is one of a number of registered homes belonging to Small House Homes Limited. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26th July 2006. Two service users were present at the home and one was spoken with. The tour of the home was conducted by the acting Manager. Two staff members were interviewed during the inspection. Records and documents covering a wide range of topics were examined. The homes policies and procedures were examined. A pre inspection questionnaire was returned prior to the inspection, and feedback cards returned from two service users, one relative and the General Practitioner for the service. What the service does well: What has improved since the last inspection? What they could do better: Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 6 Since the last inspection the Registered Manager has moved to another home in the group and one service user had to be given notice because of escalating behaviour that was challenging the service. Four staff had left and not yet been replaced and it was found that staffing levels were not adequate during July, and must be reviewed. An immediate requirement was made during the inspection as a sofa was found to be in an unsafe condition. This sofa has now been removed. One service users bathroom was found to be very damp and smelly and should be refurbished. This work is now planned according to the Provider. None of the care staff at Kazdin hold a current life saving qualification and therefore the swimming pool is not able to be used safely. Not all staff files contained proof of identification. There have been concerns raised by neighbours regarding the noise and disturbance level of verbal aggression from one of the service users, who has now left the service. Service users contracts were not available for inspection at the home on the day of the inspection. It is recommended that the homes quality assurance system is further developed. 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. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 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 Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 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): 1,2,3,4,5. Quality in this outcome area is adequate because sufficient assessment of prospective service users is made prior to admission and service users receive adequate information about the home before deciding to move to Kazdin. This judgment has been made using available evidence including a visit to this service. EVIDENCE: Kazdin has a statement of purpose and service users guide that it offers to prospective residents. Copies of the service users contracts were not available for inspection. There is an admissions policy and procedure, and at the time of the inspection, the Acting Manager had been involved in assessing the needs of a prospective resident. Documentation evidenced that there had been liaison with health and social care professionals. Staff are preparing to spend a period of time with the prospective resident at their current care setting to further assess care and emotional need and build up a relationship with the whole staff team. A list of rules and boundaries at the home is given to prospective residents, so that they are aware of what behaviour is expected, and clear boundaries are explained. The prospective resident is also invited to list their expectations, and staff will respond to these. Prospective residents are invited to visit for lunch and tea visits and see their proposed bedroom. Relatives and representatives are also invited to visit the home, and a trial period is offered. Kazdin does not accept emergency admissions, due to the complex care needs of the residents. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10. Quality in this outcome area is good because The balance of risk and choice is appropriate and Independence in all areas is encouraged. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users at Kazdin have complex care needs, and behaviour that may challenge the service. Placement plans for the two service users living at Kazdin on the day of the inspection were examined. Plans are updated on a monthly basis. Staff are invited to read the monthly updates. The acting manager said that she then asks staff questions to test their knowledge of the placement plans, as it is vital that staff are consistent with their care. Placement plans are also discussed at supervision sessions. It was evident that staff liaise with health and social care professionals, including the challenging behaviour service, Speech and language therapists, who have devised a pictorial board to aid the service users with their communication. Service users are encouraged to be as independent as possible. The two service users currently at the home are not able to go out of the home without staff members accompanying them. This is documented as agreed by care managers. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 10 Risk assessments are in place for all activities in and outside of the home. Behavioural management strategies are also documented and de-escalation techniques are in place for staff to follow, and physical intervention is used by staff as a last resort. Physical interventions are recorded. One service user has increasingly required physical intervention and as a result has been referred to the challenging behaviour service. One exit door at Kazdin is alarmed, and this is documented as agreed by care management. Service users are encouraged to participate in the day to day running of the home, and their views are encouraged by holding residents meetings and key worker meetings. Key worker sessions are recorded. A service user confirmed that they helped to plan the menus, and help to keep their rooms clean, and are able to choose a holiday if they wish. It was evident that service user files are stored securely at Kazdin. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17, Quality in this outcome area is adequate because service users are able to be as independent as possible at Kazdin. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Weekly planners evidenced that service users are offered a variety of activities in and outside of the home. These currently include music therapy, recycling, College courses and swimming. Person centred planning meetings are held regularly to discuss any activities that a service user may like to undertake. Due to recent staff shortages, less activities than usual outside of the home have been offered to the service users. Before any activity takes place, a full risk assessment is undertaken. The home has an outdoor swimming pool, however at present there are no qualified lifesavers amongst the staff, and therefore the pool must not be used until a member of staff has gained this qualification. The home has a large garden, and one service user was observed in this area during the inspection enjoying a game of cricket with staff. Concerns have been raised with the Commission for Social Care Inspection from neighbours of Kazdin who were concerned about the levels of noise and verbal and physical aggression that they were hearing and seeing at the home. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 12 The resident who was mainly responsible for this disturbance has now left the home, however the neighbours are concerned that this disturbance may continue if another verbally or physically aggressive resident moves to the home. These concerns were addressed by the previous Manager by sending a letter of apology to the neighbours. Consideration for and liaison with the neighbours needs to be kept under review. Family links are encouraged, and there was feedback from one service users family stating how pleased they were with their relatives progress at the home. Staff assist with family visits, and encourage phone calls and remembering birthdays and anniversaries. A service user said that they liked the meals at Kazdin and confirmed that they helped to choose them and assisted with the shopping and preparation. Healthy eating is encouraged. Menus were examined and evidenced a range of healthy and nutritious meals. Service users also enjoy an occasional take away meal. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 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. Quality in this outcome area is good because service users health and personal care needs are met at Kazdin. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The two service users currently living at Kazdin have minimal personal care needs, and mostly need prompting and encouragement to care for themselves independently. Staff interactions with the service users during the inspection were observed to be respectful and positive. Routines in the home are flexible, depending on activities planned for the day. There is a key worker system in operation at the home. Both service users are registered with the local General Practitioner, and staff access specialist help from the Learning Disability services as required. Medication records were found to be up to date and accurate. Kazdin has a medication policy and procedure. Staff that administer medication have received appropriate training. A Pharmacist visited to examine the medication system and records in May 2006, and no recommendations were made. Documents and records showed that one service user has their blood pressure taken on a regular basis, and the service users weight is monitored. The service users are able to access a community dentist and optician as required. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 14 Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good because service users can be confident that their concerns and complaints will be taken seriously and acted upon. Adult protection procedures are robust at Kazdin. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission for Social Care Inspection has not received any formal complaints regarding Kazdin in the last twelve months. There has however, been two concerns raised, one regarding the disturbance to neighbours from service users living at Kazdin, and one regarding shortages of staff at the home. The acting Manager at Kazdin has taken these concerns seriously, and has agreed to resolve these concerns. The home has a ‘moans and groans’ log where service users can state any issues that they have. Actions taken by staff to resolve these have been recorded. Staff have received adult protection training from Plymouth Social Services, and staff are aware of adult protection procedures. The home has a whistleblowing policy. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30. Quality in this outcome area is adequate because while the home provides a homely environment, improvements in some areas are needed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Kazdin is a large detached bungalow situated in large well maintained grounds that includes a swimming pool and backs on to woodlands. Generally the bungalow is well decorated and maintained and is decorated in a homely style. The hall carpet is worn and requires securing in some areas to ensure that it is safe. The acting Manager stated that it is due to be replaced shortly. The hall carpet in the annexe area also requires attention. The bathroom in the annexe area is flooding and has sustained water damage. The Registered Provider has confirmed that this also is due to be repaired. Kazdin has two bathrooms, and the other bathroom has recently been refurbished. One service user eats in the annexe and one currently eats in the dining area. The dining table chairs are rather dated and worn, and staff report that the service users find them uncomfortable and therefore they should be considered for replacement. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 17 New fire doors have been fitted following advice from the fire officer. All areas of the home were found to be clean and hygienic on the day of the inspection. Bedroom and bathroom doors are lockable, and bedroom door keys are available following a risk assessment. A service user stated that he liked his bedroom. Bedrooms are personalised and reflect individual likes and interests. The home has good sized communal areas ensuring that there is plenty of space for the service users should they want quiet time by themselves. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36. Quality in this outcome area is poor because staffing levels are sometimes not sufficient to meet the care needs of the service users. This judgement has been made using available evidence including a visit to the home. EVIDENCE: Since the last inspection, four staff had left the home. This has resulted in staff shortages. This has impacted upon staff and service users in a negative manner. Staff interviewed confirmed this during the inspection, and an anonymous letter expressing concerns regarding shortages of staff at Kazdin was received. Staff reported that staffing levels have at times been dangerously low, and this was very apparent during periods of behaviour that challenged the service by one service user who has now left the home, when because of a shortage of staff, those on duty found it difficult to manage the service users behaviour. On one occasion this behaviour resulted in injury to a staff member. Low staffing levels, as evidenced by the rota and staff feedback meant that the service users did not benefit from the staffing levels that Kazdin is contracted to provide. It also meant that the service users could not enjoy outings out of the home as there was not enough staff on duty to ensure their safety. The acting Manager confirmed that the company have agreed to employ two new members of staff and this should ease the staffing situation. Staff are also volunteering to do overtime to cover the vacancies. Four staff files were examined, and all contained evidence of the recruitment policy and procedure of the home, with all the files containing CRB checks, 2 Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 19 written references, and a medical report. Two files did not contain any proof of identification. Staff confirmed that they receive supervision and this is recorded. Staff meetings are held and these are also recorded. From speaking with staff and records examined, it was evident that the company provide a variety of training and staff confirmed that the training was of a good quality and useful. Amongst areas covered were adult protection, first aid, fire safety, protection of vulnerable adults and training about therapeutic holds. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42,43. Quality in this outcome area is adequate because a change in the management of the home has unsettled the staff, and while systems are in place, more work needs to be done in this area. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been a management change at Kazdin since the last inspection. The Registered Manager has moved to another home in the company, and an acting Manager has been in post since the 17th July. She is being supported and advised by the previous Manager. A relatively high staff turnover, staff shortages and change of manager have meant that the last three months has been a time of change at Kazdin. This has resulted in an unsettled period for staff and the service user. The Provider and Manager should communicate a clear sense of direction, support and leadership at this time. The acting Manager aims to develop the quality assurance system. Currently questionnaires are sent out to service users and their families, but there is no formal quality assurance system in place. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 21 Health and safety records in the home evidenced that a record of accidents and actions taken are kept. Fire logs evidenced that fire safety precautions are in place in the home. Portable electrical appliances were tested in January 2006, and gas and electrical system tests are up to date. Monthly monitoring reports had been completed by the Provider. Kazdin has appropriate insurance cover in place. Lines of accountability within the home are clearly understood by staff. There is a swimming pool at Kazdin. Currently no staff member holds an up to date life saving qualification. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 22 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 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 1 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 2 2 x x 2 3 Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 23 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 YA42 Regulation 23 Requirement Timescale for action 30/08/06 2 3 YA24 YA33 23 18 The swimming pool must be made safe and not used by service users until a member of staff is on duty that holds the appropriate life saving qualification. The sofa in the lounge must be 30/08/06 made safe, by means of repair or removal. The Registered Person must 30/08/06 ensure that at all times staff are employed in the home in sufficient numbers as are appropriate for the health and welfare of the service users and the safety of the staff. 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 YA5 Good Practice Recommendations All service users should have a copy of their contract/statement of terms and conditions kept on their file. DS0000003459.V302140.R01.S.doc Version 5.2 Page 24 Kazdin 2. 3. 4. YA34 YA36 YA39 All members of staff should provide proof of identification as part of the homes recruitment process. The registered Provider and Manager should provide support to staff through the period of change in the home. Effective quality assurance and quality monitoring systems, based on seeking the views of service users should be in place. Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 25 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. Extracts may not be used or reproduced without the express permission of CSCI Kazdin DS0000003459.V302140.R01.S.doc Version 5.2 Page 26 - 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!