Inspection on 17/10/05 for Kean Street, 17

This inspection was carried out on 17th October 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 found no outstanding requirements from the previous inspection report, but made 5 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 12/09/06

Kean Street, 17 16/01/06

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 with Caroline Marshman Announced Inspection 17th October 2005 10:00 Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 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.V258507.R01.S.doc Version 5.0 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.V258507.R01.S.doc Version 5.0 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.V258507.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th March 2005 Brief Description of the Service: Kean 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.V258507.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection with two inspectors carried out on Monday 17th October from 10 am through to 5pm.The Manager and assistant manager were available throughout the day. The inspection included a tour of the project, speaking with service users, a shared lunch with service users, a group meeting with three staff, discussions with the manager and reviewing records. The service users and staff were welcoming to the inspectors. 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.V258507.R01.S.doc Version 5.0 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.V258507.R01.S.doc Version 5.0 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): 2,5 All service users are admitted to Kean Street following a full assessment. Each service user has a licence agreement renewable every six months. EVIDENCE: All service users are admitted to the project following a full assessment by the Westminster Care Management Team. The staff at Kean Street then complete their own assessment. The format of their assessment is in the midst of changing to a joint assessment form which shows both the service users and the key workers assessment of different aspects of service users life. The manager and staff spoken with felt that there were many good aspects to this new system as long as key information is not lost within its streamlined format. The license agreement was looked at in the light of a discussion regarding possible future referrals. It was noted that these contracts are for a six month period and include an opt out clause if the association requires the premises. People can also be asked to move rooms at a weeks notice as part of the contract. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Service users are fully involved in creating their care plans and in making sure that they reflect their changing needs. Risk assessments are carried out for all service users however Kean Street must make sure that the new format used maintains the amount of key details contained in the previous system EVIDENCE: Four care plans were reviewed and three of the respective key workers spoken with. A new format for both the recording and planning of care plans is just being implemented. The service users and staff are still getting used to completing them. It allows them to make their individual assessment of aspects of their emotional, physical, social and cultural needs. Kean Street has generally a good standard of record keeping and care plans which reflect the service users needs and aspirations. Each service user has a profile where you can see at a glance their key issues and needs. This is particularly important for agency staff. The care plans seen gave a good flavour of the life styles of the service users and the work undertaken with their key workers. One care plan outlined how agreement was reached in making sure a service user was dressed in sufficient clothing so as not to offend other service users. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 Page 9 One of the new additions of the new care plan recording is a detailed contact sheet that highlights the present issues, the progress and planned action. Both the service user and the key worker sign these. Another is the monthly summary contact sheet which is very good as it gives a clear picture of the contact each service user has received from their key worker. Staff spoken with felt that initially the new care plans demanded a lot of work but that they felt they would work well for the service users and key workers once the teething problems had been sorted out. Staff echoed similar concerns to that of the inspectors about the new risk assessments formats. There is a lack of space for recording both the specific risks and the action taken to address them. It is recommended that the detail afforded in these areas by the previous system be maintained. Risk assessments are an important area within Kean Street. Since the last inspection the staff have made sure that all risk assessments are updated after any incidents. The majority of service users smoke and all bins are metal to help minimise risks. Staff and service users commented on the effects of the new pension swipe card system and how people need more support to access their monies. One of the care plans seen was not of the same standard as the others. It had scanty information and did not demonstrate that the key worker had the skills to assess and work with the particular service user and little regular contact with the service user was recorded. The manager must make sure that all key workers have the capacity to carry out their job and that all recording of service users needs is carried out to the same standard. All summaries of specific needs and other key information needs to be signed and dated. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 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 the following standard(s): 12,13,15,16,17 The Manager and staff at Kean Street work hard to ensure that the service users have opportunities for leisure activities both within and outside of the project. The new chef has developed, together with the service users, an excellent health conscious menu with attractive and tasty meals. EVIDENCE: Kean Street has a developed sense of increasing peoples social and leisure pursuits both within and outside of the project. There are regular weekly groups of an art group, a pub group, DJ mixing, bingo and board games. The gym is used by some service users, along with their key workers. Throughout the year various themed activities held. A bike ride in Hyde Park in the summer took place with service users from another project and some service users were also involved in work with the London Theatre Museum performing Othello and some of their own work. The service users are fully involved in preparing for Kean Streets forthcoming tenth anniversary including art, performing Shakespeare and a play written by the service users. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 Page 11 Kean street have contact with the local community and staff have been trying to promote links with City and Lit college but so far none of the service users have opted for any courses. The service users are, on the whole, adhering to the non smoking policy in the reception area which was implemented following a service users meeting. Since the last inspection the Manager and staff have created a daily breakfast club which provides porridge and toast for about fifteen to twenty service users. All service users have facilities to prepare food in their flats and this initiative was taken up to help people have a nutritious start to the day and ensure that they ate before receiving medication. There is also a new chef at Kean Street who spoke enthusiastically about the needs of the service users and she is working to increase the salad, fruit and vegetable part of their diet. The chef was very service user centred and continues to work with service users to prepare meals they would both enjoy and enhance their nutrition. The food served was attractive and fresh. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 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 the following standard(s): 18,20 Service users at Kean Street receive support in the way they wish with respect shown for people’s privacy. There is an excellent system for administering and auditing medication. EVIDENCE: One service user who has mobility problems remains a very private person and their determination to manage their own personal needs is respected by the staff. An appropriate assessment of their healthcare needs was seen and the support worker was able to highlight how the service user chose to manage and the risks attached to this. Whilst care plans were clear it is important that they reflect actual practise for example a person with mobility needs was always worst in the morning so not always able to come to the office for their medication. The support worker spoke of how the service users would alert the staff when they did not feel well enough and the medication would be taken to the person’s room. However this was not included in the care plan. Other care plans showed similar situations where the practise was good but not written. All medication is kept in a room alongside the office and reception. Medication is administered to the majority of service users. All medicine not in blister packs was clearly marked. The PRN medication is kept in a separate cupboard. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 Page 13 There was a clear system for returned drugs and for ordering prescriptions. Boots carry out a three monthly audit of medication. Kean Street also does an ongoing audit of medication where a project worker is responsible to check medication at each shift resulting in medication checks four times a day. It is a clear and good system which enables staff to see at a glance if someone has not appeared for their medication and they can act accordingly. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 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): 22,23 Kean Street have an accessible and well used complaints procedure. All staff spoken with showed a clear understanding of the polices and procedures regarding the protection of service users speaking enthusiastically of the excellent training they had received. EVIDENCE: The information received prior to the inspection showed that there had been five complaints since the last inspection all of which had been dealt with. The manager and staff encouraged the service users to use the complaints format to deal with any form of behaviour from other service users and to express their feelings on any aspect of project life. The complaints form is very good and clear with a written agreement on outcome. It details the complaint the action taken, what action the service user wants what solution offered and the service user signs if they agree with all. The staff spoke enthusiastically of the training they received on the protection of vulnerable adults, how much it helped them reflect on their role and gain a real working insight into the whole are of protecting service users. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 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): 24,27,29, 30 Kean street creates a homely atmosphere for the service users within the constraints of the building. The general standard of cleanliness has improved. Care must be taken to ensure service users personal areas are cleaned. The bathrooms need attention and the hydraulic bath needs to be fixed. EVIDENCE: Kean Street is located in the heart of London in Covent Gardens close to shops, transport and leisure facilities. All service users live in self-contained flats with a kitchen and en suite shower (apart from two rooms) on the first to third floor. Each floor has a bathroom, a kitchen and a communal lounge. All parts of Kean Street are accessible via two lifts. There are three ground floor flats which are adapted for wheelchair users. The ground floor houses the administration and reception area whilst the lower ground has the dinning area, kitchen, communal lounge and the gym. There is also a patio and garden area. The project was generally cleaner and the manager and staff say that the weekly checks in communal areas are working well. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 Page 16 One of the service users gave the inspectors a tour of their flat. It was noted that their toilet had significant black lime scale marks around the rim. The service user had been supported to clean their flat. The cleanliness of the toilet needs to be improved to maintain the standards of both hygiene and aesthetics. The bathroom floors and tiling have been repaired to a poor standard and already water marks are covering the flooring. There does not appear to be adequate drainage and a build up of lime scale was also noted. The bathrooms floorings and tiling must be repaired to a good standard followed by appropriate decoration. The ground floor bathroom has a hydraulic bath in need of repair this is a requirement Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 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, 35 Kean Street has a dedicated and service user focused staff team. The content and amount of training is good. EVIDENCE: Discussions about staffing were held with the manager, assistant manager and three staff members. Talking with staff confirmed that they were all clear about their roles and responsibilities. They were able to talk about the keyworker role, how they discuss and create support plans with service users. It was clear that the good care plans reflected their practise. There is still a high level of agency staff and they try to have the same workers as much as possible. There are very good induction guidelines and checklist for agency staff. A profile of each of the service users is available with their key support needs to ensure that these are met. The staff spoke of the extra support required by service users following the introduction of the new benefit system. This is partly being addressed by a proposed change is the shift hours. The manager discussed the format of the current rota and would like to change the shift plan from 8am to 9am in the morning to make better us of staff later in the day when service users needs require more support. He will do this on a three-month trial and then review. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 Page 18 There are regular staff meetings and the staff spoke of a supportive and good team working.’ There is good team communication’,’ I love working here it’s a good project’. There is a programme to achieve NVQ level 2 and seven of 14 staff are currently NVQ 2 or above. One staff member has just completed their TOPPS. The staff spoken with have received all the mandatory training as well as courses in challenging behaviour, dual diagnosis and working with aggression. The staff confirmed that their training and development needs were looked at in supervision as well as service user focused work. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 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): 37,42 Kean Street is well led by an experienced and enthusiastic manager who encourages new initiatives and new ways of supporting service users. There are well recorded health and safety checks carried out regularly. The initial discussions regarding a change in service must include consultation with service users views and the commission. EVIDENCE: There was good thorough information about the project supplied prior to the inspection by the manager which helped cover all the key areas. The Manager has been in post for some years and continues to display an enthusiasm and dedication to the project. The staff and service users who spoke of him being ‘helpful, supportive’ ‘someone who makes things happen’ confirm this. There are clear roles and responsibilities for the manager and the deputies. Staff spoke highly of the supportive management how they work as a team and have good rapport with the service users and staff. Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 Page 20 There are regular forums for service users and staff and a sense of ownership of the project was noted in all. Up until just before the inspection there were two deputy managers but one has been dismissed. This was a difficult time for all within the project and the manager met with service users and staff to tell them the outcome of a disciplinary hearing. There have been initial discussions held with Social Services about changing the client group and admission criteria to Kean Street. These must proceed with complete service users consultations about proposed changes and the impact on the project. The commission must be kept informed of all proposals and consultations. A monthly health and safety assessment is carried out for each of the service users flats and the communal areas. The pre inspection information received showed that the fire officer visited in august 2005, the annual fire equipment was carried out in July 2005 Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X 2 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Kean Street, 17 Score 3 X 3 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 3 X DS0000010865.V258507.R01.S.doc Version 5.0 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 2 Standard YA6 YA6 Regulation 15 15 Requirement All records must be signed and dated. The manager must ensure that key workers have the capacity to assess and meet service users needs. The bathroom flooring and tiling must be repaired to a good standard and then be decorated. The toilet in the service users flat must be made clean. The hydraulic bath must be repaired Timescale for action 30/11/05 30/11/05 3 4 5 YA27 YA27 YA29 23 23 23 31/12/05 30/11/05 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA9 Good Practice Recommendations That the new risk assessment format maintains the detail and action of the previous system Kean Street, 17 DS0000010865.V258507.R01.S.doc Version 5.0 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.V258507.R01.S.doc Version 5.0 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. 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