Inspection on 21/06/05 for Keate House

This inspection was carried out on 21st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Keate House 24/10/06

Keate House 05/12/05

Keate House 01/02/05

Keate House 27/05/04

Keate House 02/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Keate House Brookfield Road Lymm Warrington WA13 0QL Lead Inspector Maureen Brown Unannounced 21st June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Keate House Address Brookfield Road Lymm Warrington WA13 0QL 01925 752091 01925 754022 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr M Clarkson/Mrs A Clarkson Mrs Avis Clarkson Care Home Only 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 48 service users to include: Up to 48 service users in the category of OP (old age, not falling within any other category) 2. Bedroom numbers 1 & 94 only may be used to accommodate two service users. 3. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection. 4. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 1st February 2005 Brief Description of the Service: Keate House is a care home providing personal care and accommodation for up to 48 older people. The home is located in Lymm, close to the village centre shops, pubs, restaurants and banks. The home was opened in 1989 and consists of a four-storey building with service user accommodation on the ground and first floors. In December 2004 a three storey extension was completed providing additional single bedroom en-suite accommodation The home has forty-four single and two double bedrooms, all of which are ensuite. There are two passenger lifts. Car parking is provided at the front of the building and there is a garden to the side. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out during 21st June. The total time in the home was six hours. The inspector spent an hour and half planning the inspection by reviewing previous inspection reports and the service history. The inspection included a full tour of the home, inspection of records and discussions with thirty residents, the co-owner, the deputy manager, care assistants, administrator, five relatives and a Social Worker. Twenty out of thirty-eight standards were assessed and all were met. Feedback from this inspection was given to the deputy care manager and the co-owner at the end of the inspection. What the service does well: What has improved since the last inspection? A new care plan system had been set up and was now operational. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 6 The new residents’ surveys had been completed and a summary sheet had been produced, and the information is to be shared with residents and other interested people. New storage area for medications had been created within the lower ground level. This new area is a larger room in which medication can be safely stored. The deputy stated that this was an improvement on previous arrangements. On-going decoration work has been maintained and a new bedroom has been created on the first floor. The conversion of a bathroom into a new office within the main hall area has been completed. Staff were wearing name badges as previously requested by residents. 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. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 & 3 Sufficient information is provided for residents to make a decision about moving into the home. Full assessments of needs are carried out to ensure that the home can meet the residents’ needs. EVIDENCE: The statement of purpose and service users guide are produced in a bound file and include information about the facilities, services provided, fees, terms and conditions of residence. A copy of the most recent inspection report was available separately. Residents and relatives confirmed that they were aware of the service users guide and the inspection reports. The home’s statement of purpose and service users guide be updated to include new staff information and details of the new extension. (See recommendation No 1). The residents’ contract covered the fees payable, terms and conditions of residence, rights and obligations of residents and proprietors, services provided and additional services. It also contained the room number to be Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 9 occupied. The administrator stated that fees were reviewed in April each year and that residents and relatives were notified of changes by letter. A sample of three care plans examined showed that assessments had been carried out with each person before moving into the home. Residents and relatives confirmed that they had visited the home prior to admission and staff said that admissions were planned. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 9 The residents’ health, personal and social care needs are met by the staff team. Administration and control of medications were appropriate for the needs of the residents. EVIDENCE: Samples of four residents’ care records were seen during this inspection. These were comprehensive and well presented in individual ring binders. Each contained basic information, all areas of personal care information, risk assessments for personal safety, social activities, a record of visiting professionals and a copy of the daily report sheets. The care plans seen were drawn up in consultation with the residents and family and were based on their assessed needs and risks. The care plans were reviewed on a monthly basis, in conjunction with the residents. The residents signed their care plans to show that they agreed with the contents. Including a residents’ life history, a photograph and the date of arrival would improve the care plans. (See recommendation No 2). Details of wishes at the time of death should be kept with regard to the residents. (See recommendation No 3). During discussions Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 11 with relatives and residents they stated that they were aware of the care plans. Daily record sheets seen showed day-to-day activities of each resident. They were written clearly, easy to follow and were signed by carers. Medication records examined showed that this was recorded and administered appropriately. Medication was kept secure and controlled drugs were stored appropriately. The deputy manager agreed that controlled drugs should be checked against the register on a weekly basis. (See recommendation No 4). Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Residents were able to take part in a range of activities of their choosing. Personal and family relationships were encouraged by the home and the staff team supported people with this. Residents’ dietary needs were well catered for with a balanced and varied selection of food that met peoples’ tastes and choices. EVIDENCE: The residents’ plans reflect the range of activities undertaken which included activities such as reading, bingo, dominoes, sing-a-longs, garden activities such as boules and watching television. During the afternoon many residents’ were observed playing bingo in one of the lounges. Residents said they particularly enjoyed reading the newspaper in the mornings and participating in activities during the afternoon. Bingo was a firm favourite. External activities included visiting Clwyd special needs riding centre, outings in the bus, going out with “contact the elderly”, a national charity that takes older people out and about. Visits from family and friends were recorded in the case notes. Residents shared with the inspector the contact they had with family members and said they could choose to see visitors within their own room or in the shared Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 13 lounge/dining area. Relatives said that they were always made very welcome by the staff and were offered refreshments. They said that they could visit with their family in the privacy of their own bedroom or one of the lounges. The menu reflected people’s personal choices. Special diets were catered for such as diabetic diets. The main meal of the day was observed being served. It was hot, appetising and well presented. An alternative was always available. During the meal it was observed that staff assisted residents as necessary in a friendly and unobtrusive manner. After the meal residents said that “the meal was lovely” and that “the food is very good”. Fridge, freezer and hot food temperatures were recorded. The kitchen was maintained in a clean and tidy condition. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Clear policies and procedure were in place to ensure that residents were protected from abuse, neglect and self-harm. Residents and relatives were satisfied with the support they received from the manager and staff. No complaints had been made since the last inspection. EVIDENCE: The home’s Protection of Vulnerable Adults Policy was consistent with the “No Secrets” guidance from the Department of Health. A copy of Cheshire Social Services’ policy on Adult Protection was available within the home and was accessible to staff. Policies on whistle-blowing and challenging behaviour were also available. Discussions were held with the deputy manager about Adult Protection procedures and she was clearly able to demonstrate the procedure to be followed in this situation. Most staff had undertaken training on Adult Protection Awareness. The policy on complaints was seen and no complaints had been received at the home since the previous inspection. All relevant paperwork was available in the event of a complaint being received. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The home provided a clean and comfortable environment for the people to live in. EVIDENCE: The home was furnished in a domestic style with additional equipment such as grab rails, raised toilet seats and hoists provided as necessary to meet the residents’ needs. There was a good standard of décor throughout. Heating and lighting was sufficient throughout the home. The garden area is enclosed and residents are encouraged to sit outside during the better weather. The home was clean, tidy and free from any unpleasant smells. Records of menus and daily checks on fridge, freezer and hot food temperatures were kept. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 16 The home had a separate laundry room, which was clean and tidy. Cleaning materials were stored appropriately and basic information on hazardous materials was available to the staff team. Staff stated they were aware of this file and that chemicals must not be mixed with other chemicals. Random samples of hot water temperatures were taken in residents’ bedrooms. These were between 38 to 43 degrees centigrade and within the acceptable guideline of up to 43 degrees centigrade. The new extension was now complete apart from a few minor jobs. This area has significantly improved the facilities for the residents. The home now has 44 single and 2 double bedrooms all of which are en-suite. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 The manager provided clear leadership. Records were well maintained. Staff received support to enable them to meet residents’ needs. Residents are protected by the procedures in place for recruitment of staff. EVIDENCE: At the time of this inspection the agreed staffing levels were met. The staff team included co-owners and managers, deputy manager, senior care assistants, care assistants, domestic staff, laundry staff, cook, kitchen assistants, maintenance staff and administration staff. The deputy manager said that six staff had completed NVQ level II in care (about 25 of the staff team) and that seven staff were currently undertaking NVQ level II in care, two of which had nearly completed this. (See recommendation No 5). The deputy manager is undertaking NVQ level IV Registered Managers Award. All staff had completed manual handling, first aid course, food hygiene and fire awareness training. Other courses included adult protection from abuse, health and safety, COSHH, falls in the elderly and diabetic training. Staff that administer medication had received appropriate training. Staff on duty confirmed they had completed NVQ training and mandatory courses. During discussions with the deputy manager and administrator the inspector saw copies of the staff files belonging to those staff employed from abroad. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 18 These contained two references were obtained, also confirmation of Criminal Records Bureau checks in the country of residence, work permit and National Insurance number. All appropriate checks were in place before the staff started work. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36 & 37 Residents’ views are used to inform future planning within the home. Decisions about changes to the service are influenced by the information obtained from satisfaction surveys and conversations with each resident. EVIDENCE: Residents and relatives said that they felt the home was well run and that the manager and staff were very welcoming and friendly. Residents also said that they “were well looked after”, “the care is very good” and “the home is lovely and clean and they were well satisfied”. This was confirmed during the inspection. Relatives said that the staff worked in a very professional manner. Visiting professionals said that the staff followed procedures as directed and that they had a good relationship with the home. Contact had always been conducted in a professional way. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 20 A residents’ survey was completed on 17th May 2005 and will be conducted on an annual basis. The information gathered is used to influence the future service provided. A copy of this was available and a summary sheet was produced. The administrator said that this information was shared with the residents and relatives. One of the issues raised during the last survey was that some residents would like the staff to wear name badges. This has now been adopted as current practice within the home. Relatives confirmed they were aware of the survey summary. The deputy manager said that one to one supervision was given on a regular basis. She had a group of care staff that she supervised. Areas covered in supervision were work practice, problems, review of policies and procedures and training issues. Staff supervision is carried out every eight weeks and annual appraisals were due to be undertaken. Observed day-to-day supervision of staff was good and the staff team confirmed they were supported by the manager and the senior staff in their delivery of care to residents. The staff said that formal supervision was conducted on a regular basis and records were kept. Supervision records were kept secure in the office. All records, policies and procedures seen were up to date and accurate. These were kept secure within the home. Residents have an individual sheet documenting their personal allowances. A monthly invoice is produced for items such as hairdressing, personal toiletries and papers and magazines. Residents’ finances are kept in a bank account, which is managed, by one of the co-owners. A float is kept within the home so that residents may have access to their money. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 3 3 x Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 22 None 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 Regulation None Requirement Timescale for action 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. 3. 4. 5. Refer to Standard 1 7 7 9 28 Good Practice Recommendations The registered person should ensure that the statement of purpose and service users guide are updated to include new staff information and details of the new extension. The registered person should include residents life history, a photograph and the date of arrival in the care plans. The registered person should keep details of wishes at the time of death with regard to the residents. The registered person should ensure that a check to the controlled drugs against the register is made on a weekly basis. The registered person should produce a plan to show how 50 staff will obtain NVQ level II in care. Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Keate House F51 F01 S27005 Keate House V229964 210605 Stage 4.doc Version 1.30 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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