Inspection on 12/09/06 for Kean Street, 17

This inspection was carried out on 12th September 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kean Street, 17 21/11/08

Kean Street, 17 16/01/06

Kean Street, 17 17/10/05

Kean Street, 17 15/03/05

Kean Street, 17 04/08/04

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

CARE HOME ADULTS 18-65 Kean Street, 17 17 Kean Street Convent Garden London WC2B 4AZ Lead Inspector Ann Gavin Unannounced Inspection 12th September 2006 10:00 Kean Street, 17 DS0000010865.V306709.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 Kean Street, 17 DS0000010865.V306709.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. Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kean Street, 17 Address 17 Kean Street Convent Garden London WC2B 4AZ 020 7240 8338 020 7240 8558 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) Look Ahead Housing & Care William Campbell Care Home 31 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (93) of places Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2006 Brief Description of the Service: Keane Street is a care home for 31 people with severe and enduring mental health needs encouraging people to live as independently as possible. Peabody Trust owns the property with the care provided by Look Ahead Housing and Care. There are 31 self-contained flats on four floors with lift access to all floors. Each flat has a lounge/bedroom, kitchen and an en suite bathroom and toilet. On each floor there is a communal lounge, kitchen and bathroom. Service users have the facilities to prepare meals in their flats and a choice of meals is also provided in the lower ground floor dining area. In the basement there is a large dinning area which holds a pool table and table football. There are two communal lounges and also a small well equipped gym. Externally, there is an attractive patio and garden area to the rear of the home and a balcony with potted plants on the same level as the reception area. Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 12th September from 10 am till 5.30 pm. It was unannounced. This report is made up of information gained from speaking with service users, staff, managers as well as looking at records, tracking the care of four service users and a tour of the communal areas of the project. There were 11 services users, 1 relatives/visitors and 2 professional questionnaires returned. Keane Street is well run and encourages services users to be fully involved in the project. The service users and staff were welcoming to the inspector. 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. Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 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 the following standard(s): 1,2 The outcome for this area is excellent. Keane Street has good clear information for prospective service users. All service users needs and aspirations are assessed before entering the project and throughout their stay. EVIDENCE: ‘I wanted to live at Keane Street’ ‘I got all the information I wanted when I got here’ ‘This is a good place for me. I feel good here’ These are some of the comments gathered either through talking with the people who live at Keane Street or from the questionnaires they completed. Four people’s care was looked at and each person had a comprehensive assessment of their needs and aspirations. Each service user is involved in their assessment and both their and the staff members comments are noted. Keane Street has a video of the life in the project available to those people who may wish to move in. This was completed three years ago and work is beginning to make a new video to reflect the life of the project now. There are plans to have an open day in Keane Street for the service users to invite who they wish to know more about the project. It will also be open to those who may be referring people and any organisation or individual Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 8 interested. There will be presentations on different aspect of the life at the project and an Art exhibition of the service users art. Kean Street, 17 DS0000010865.V306709.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 The outcome for this area is good. Service users complete joint plans with their key workers. These are updated regularly. The ethos of the project is based on the service users being involved in all aspects of their home. There are clear guidelines and procedures for safeguarding service users in all areas of their lives. EVIDENCE: ‘I talk to my key worker or my doctor if I am unhappy.’ ‘I am not generally unhappy but can talk to my key worker if I am.’ The service users spoken with were clear about who their key worker was and that they met regularly and did things together such as going out for coffee or going to a place of interest as well as looking at how best they can be supported. Keane Street uses a joint assessment form that is completed with the service users. This covers every aspect of people’s lives. Long and short term goals are set from the plan. The four files seen had good accessible plans with clear action plans and realistic and achievable goals. Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 10 There are daily contact sheets with an overview of contact completed monthly. Since the lasts inspection the deputy managers have begun an audit of each persons care file every month. They write their findings and suggestions so that the plan is accessible, clear with action plans. Those looked at showed that they had looked closely at the files and made helpful comments and suggestions. There is a good standard of planning and goal setting which has further developed since the last inspection. There was also evidence of the involvement of service users throughout the process confirmed when talking with them. Staff spoken with were happy with the care planning and reviews saying that they are a good aid to working with service users making sure that the right people are informed of the supported wanted and offered to the service users. Each of the four care plans looked at had risk assessments. One was excellent clearly covering all areas of the person’s life identifying the risks and completing a clear action plan for each. Any staff member would know how to support the service user. Two others were good and one although good needed to have clearer action plans for the identified risks. There are regular service users meetings where service users are consulted and involved in all aspects of the project and kept up to date in the proposed changes. Minutes showed that ideas for events, socials are created and planned Kean Street, 17 DS0000010865.V306709.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): 11,12,13,14,15,17 The outcome for this area is excellent. Keane Street creates enjoyable ongoing and diverse opportunities and activities with service users. The service users are encouraged and supported to develop their own skills and leisure pursuits. Service users enjoy an excellent range of healthy meals and a programme of ‘food for mood’ EVIDENCE: ‘I have been very impressed with the enthusiasm and interest in healthy eating that your service users have shown over the last past year or so… it has made a very positive contribution to their well being and health in general. There have been some remarkable examples of appropriate weight loss and a general re-awakening in the approach to eating sensibly and healthily… This extract from a letter from a local GP to the project highlights the effects of a new way of designing menus preparing and providing food at the project. The chef has continued to encourage the service users to increase their vegetable and fruit intake creating balanced and tempting foods. Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 12 On discussion she spoke of recognising the need to also meet the service users sweet tooth with puddings. The kitchen was organised with good menus displayed. One of the service users spoke of going to the breakfast club, which is still running successfully. The managers and staff work enthusiastically with service users to create a wide range of opportunities for all who live in the project. The walls display the work of the service users art. The art group will be holding an auction of their work at the planned open day. This aims to be the beginning art group regularly displaying and selling their work. One service user works at a supported art scheme another with the workshop company. There have been numerous events, a tennis tournament in June in which eight people from the project took part. In July an evening with a quartet of saxophones from an initiative called ‘live music now’. A video of the evening was made. The summer also saw the workshops with the New London Orchestra. Another event was an Australian evening with a BBQ and different aspects of Australian life. This event came about during a cook and eat group where a staff member form head office picked up on interest being shown of Australia. All of the events engage and encourage the service users. There are plans for a reunion party for all former service users and staff in October to mark their anniversary of opening. The men’s group continues to meet monthly and the women’s group meets on a weekly basis. Two of the service users have joined the local leisure centre and attend regularly. Keane Street own gym is also available. The project is applying for grants to help continue with the different workshops. One staff member spoke of applying for a grant to support a series that they are planning of international music and dance evenings where they will also draw from the talents of the staff and service users. Kean Street, 17 DS0000010865.V306709.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 The outcome for this area is good. The service users are supported in the way they wish. Systems are in place to monitor healthcare. There are initiatives for healthy lifestyles. The medication system is generally good though all loose medication needs to be tracked and all bottles and ointments dated when opened. EVIDENCE: ‘I have always been so impressed by the commitment and dedication of the staff at Keane Street. I don’t know how I would manage without them they are superb’ ( local GP) The joint care plans seen for the four service users gave evidence of their healthcare needs being assessed and action plans were in place to address them. The key workers spoken with showed a good understanding of the service users needs and clear plans to support the service users to either maintain or achieve their healthcare goals. There were good guidelines in place to support service users and good record keeping. Staff were observed relating with service users respecting their rights. A number of service users were seen smoking in the main lobby which is Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 14 designated a non-smoking area and staff gently but firmly reminded service users. The local Primary Care Trust (PCT) is starting a smoking cessation programme in the project next week. All bar one or two service users smoke in the project which has both health and safety implications for service users and staff. Smoking in the project and the rules pertaining to it are a frequent item of discussion. The risk assessments all relate to the risk of fire from service users being distracted or careless when smoking and staff are constantly alert and working with service users to promote safe practises. The medication records of four service users were looked at along with the medication cabinets. There are good systems in place to alert staff to service users who have not arrived to take their medication. Most prescribed medication is delivered in blister packs. All medication is booked in and all medication is tracked. However there is a problem with prescribed medication which outside of the blister packs due to a hospital admission or other reason. At present no system is in place to keep track of the amount kept. The staff member showing the medication agreed they would use the same system that is in place for the medication which is prescribed on an as necessary basis. It was noted that no bottles or creams used had the date on which they were opened this will be addressed. Kean Street, 17 DS0000010865.V306709.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 The outcome for this area is good. The service users spoken with felt that their views were listened to. There are good systems in place to help safeguard service users. The staff were familiar with the policies and procedures in place to protect service users. EVIDENCE: Keane Street has a good complaint system that the service users are encouraged to use. There have been seven complaints since the last inspection and records showed that all have been dealt with and all parties sign their agreement with the outcomes. The staff maintain good record keeping. There are clear systems in place for supporting service users with any financial dealings. Service users sign a consent form regarding help with money and a record and receipts are kept of all transactions. A record is also kept of money which is withdrawn. One of the deputy managers has recently updated the risk assessments to include storage of debit cards as a form of possible financial exploitation. The system regarding Criminal Record Bureau (CRB) checks has changed since the last inspection. A discussion was held with the manager about making a referral to the register for the Protection of Vulnerable Adults (POVA) regarding a former employee. All of the five staff members spoken with were aware of the procedures around protecting vulnerable adults. There is a rolling programme for all staff to attend a two-day POVA training. A referral to POVA must be made for a former employee Kean Street, 17 DS0000010865.V306709.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): 24,27,30 The outcome for this area is good. A tour of the communal areas was made. Staff encourage service users to make the project as homely as the building will allow. There is new furniture in the lounge areas and generally the project is kept clean EVIDENCE: A tour of the communal areas with one of the deputy managers showed that the project is kept clean. There is still some need to continue to monitor the communal kitchens one of which needed a deep clean. The bathrooms remain with stained unattractive flooring and the 4th floor bathroom needs the damp attended to. The timescale for the redecoration and tiling is starting in November 06 as part of a full building redecoration. Once this is completed the flooring in the bathrooms will be replaced. One service user was happy to show their flat. They were pleased with it and said that they had all they required. However it does need to be redecorated. The deputy said that they will see if the service user would like to do this with a member of staff. Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 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): 32,34,35,36 The outcome for this area is excellent. Staff at Keane Street are clear about their roles and how to support service users. The managers have developed project specific interviews for prospective staff. There are new ways developed for the supervision of staff. New better shift patterns for the waking night staff with clear shift roles and responsibilities. EVIDENCE: ‘Working here is about supporting the people who live here ’ ‘ … My role is encouraging others and making a change…’ ‘It’s a good team, we work well together and have good managers’ Keane Street have a good confident staff team with a good mix of skills. Five support workers; both deputy managers and the chef and assistant chef were spoken with during the inspection. All were very focused on the needs of the service users and the ways in which they worked to support them. They spoke of good teamwork, supportive and encouraging managers and regular supervision. The managers have developed a new format for interviewing prospective staff. Interviews are based on scenarios and interviewees then write a care plan. This together with group discussions helps to judge the level of understanding of the scope of the job and the service users needs. Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 18 The waking night staff now work 10pm till 8pm with a clearer structure and specific areas of responsibility outside of being available to respond to service users. They include areas of health and safety checks, maintenance, and setting up records for medication. These are designed so as to free up staff during the day to spend more time with service users. The staff have an admin/ key working day built into the shift rota which works well. There was the correct number of staff as noted in the rota on at the time of the inspection. Five of the staff are currently completing NVQ level2. There is a good programme of in-house training. The project have set up links with Thames Valley college for specific training on substance use, dual diagnosis and personality disorder. All the discussions held with managers, staff and the paperwork looked at showed a commitment to promoting equal opportunities. The staff mix reflected both the gender and ethnic background of the service users. The deputy managers supervise the staff between them. They have revised schedules and introduced ‘case management ‘meetings every three months. Each deputy manager reviews two care plans a week giving written feedback. This forms part of the ‘case management’ that looks more in depth at the individual service users needs and how they are being met by the key worker. Two staff file were looked at. They held confirmation of CRB, supervision records, training and development profiles and evidence of induction training. Original application forms and references are held centrally in head office. Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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 outcome for this area is excellent. Keane Street is led by an enthusiastic and competent management team. There are excellent health and safety monitoring procedures being developed and put in place. EVIDENCE: A discussion was held with the Manager who gave an overview of, the service users and the ongoing and developing aspects the project. The Manager of Keane Street has assumed other senior tasks within the organisation taking him away from the project. The information provided in the pre inspection questionnaire gave a clear picture of how the lines of responsibility for the project are divided among the managers. Both the deputy managers were spoken with together and singly. They agreed that this system is working well for the project. Staff meetings are held weekly. Service users meetings are also held regularly. One of the deputies has done work on updating the health and safety guidelines, procedures and practice. There is a new clearer fire procedure for service users. Fire blankets have been ordered for all service users flats. Other Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 20 changes include the following: a formalised daily security checklist, guidance notes attached to the Health and Safety checklists, health and safety checklist involving service users. The added Guidelines formalised practise and helps both new and agency staff to put them into practise. Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 4 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 4 32 X 33 X 34 4 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 X 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 4 X 3 X X 3 X Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 22 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 YA20 Regulation 13 Requirement Timescale for action 30/09/06 2. 3. 4 YA23 YA24 YA24 13 23 23 Arrangements must be made to ensure that all loose medication is tracked and all bottles and ointments marked with the date of opening. A referral to POVA must be made 30/09/06 for a former employee The service users flat must be 30/11/06 redecorated The communal kitchens must be 31/10/06 monitored and cleaned. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Kean Street, 17 DS0000010865.V306709.R01.S.doc Version 5.2 Page 24 - 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. 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