Inspection on 04/10/05 for Keele House

This inspection was carried out on 4th October 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Keele House 23/01/09

Keele House 06/02/07

Keele House 13/02/06

Keele House 02/02/05

Keele House 24/08/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Keele House 176 High Street Ramsgate Kent CT11 9TS Lead Inspector Sandra Crosby Announced 04/10/2005 at 09:30hrs 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. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Keele House Address 176 High Street, Ramsgate, Kent. CT11 9TS 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) 01843 591735 Soory & Co Limited Ms Joan Elizabeth Smith Registered Care Home 31 Category(ies) of Older Persons registration, with number of places Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 02/02/05 Brief Description of the Service: Keele House is a detached building comprising of two properties joined together, one side three-storey and the other side two-storey. There are two shaft lifts, one on either side, which provide access to all floors. There are 27 single bedrooms and 2 doubles and 22 bedrooms have ensuite toilet facilities. Bedrooms are provided with call bells and most have television points. There are 3 lounges; a separate dining room and 2 separate ‘quiet’ lounges, one on the first floor and one in the basement – all easily accessible. There is also a separate small room for ‘smokers’ use. There is an enclosed garden with patio and seating area for residents’ use, weather permitting. The home is located within easy reach of local shops and all public amenities. There is on-street parking in the adjacent road. Keele House ownership changed on 7th June 2004. There has been continuity in management in that the Registered Manager stayed on and has worked at the home for a total of 25 years. The new owner visits the home weekly. There is a staff team of full and part-time workers, including carers who work a rota that includes 2 staff on ‘waking’ duty at night. There are designated staff members responsible for the cooking and cleaning. The home aims to ensure that the care provided to residents suits their individual needs. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was announced and carried out over two days on Tuesday 04 October 2005 and on Wednesday 05 October 2005. During the inspection the Inspector spoke individually with eight Service Users, the Registered Manager, Deputy Manager, one carer, a person undertaking domestic duties, and the cook. Records were seen and an accompanied tour of the premises was made. The majority of the key standards were inspected at this inspection visit. The atmosphere of the home was welcoming, calm and relaxed, and the home was clean and orderly at the time of the inspection visit. Ten Relatives/Visitors Comment Cards were received overall indicating that they were satisfied with the services provided at the home. The Pre-inspection Questionnaire completed by the home prior to inspection and the information in the comment cards and provided by Service Users and staff at the time of the inspection, has been used in this report. The requirements and recommendations made in this report were discussed with the Registered Person on the 10 October 2005, and he confirmed that the issues raised were currently in the process of being addressed. What the service does well: Observation and discussion with Service Users confirmed that the standard of personal care provided was delivered to a high standard. It was observed that staff respect Service Users dignity and privacy, and have a good rapport with Service Users. A thorough recruitment system is in use. Staff training is ongoing at the home. The standard of the environment within the home is good providing Service Users with an attractive and homely place to live. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 6 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. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 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 Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 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) 1,3,6 The homes Statement of Purpose and Service User Guide provide Service Users and prospective Service Users with the information they need to make a decision about moving into the home. Service Users move into the home knowing that their needs can be met and that their independence will be maximised and promoted. It is not the general policy of the home to admit Service Users for intermediate care, and this standard was judged as not applicable at this inspection visit. EVIDENCE: The Statement of Purpose and Service User Guide were seen. Following discussion with the Registered Managed and Deputy Manager, it was agreed that small amendments would be made to both documents Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 9 The Registered Manager carries out pre-admission assessments of prospective residents, either in their own homes or at hospital. The Inspector saw evidence that this process is documented. A copy of a Care Management Assessment was seen on one of the files examined. The evidence confirms that the homes current assessment process meets this standard. Although the home does not provide intermediate care, the home has a contract and currently provides four beds for Service Users to be admitted initially on a short-term basis. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 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) 7,8,9,10 The care planning system meets the requirements of the minimum standards and regulations, however recording relevant information, cross-referencing and reviewing of information needs to be maintained. The health needs of Service Users in the main are met, but not always appropriately recorded. The systems for medication administration are good with clear and comprehensive arrangements being in place to ensure Service Users medication needs are met, however recording of medications indicate that Service Users may be at risk. Personal care is offered in a way to protect Service Users privacy and dignity. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 11 EVIDENCE: The Inspector viewed six Service User plans, and it was seen that the quality of the care plan records was variable. All components of the Service User Plan as required by legislation were seen and generally the Service User Plans contained sufficient information covering a range of care needs and action plans for staff to follow. It was however seen in some cases that Service User Plans had not been updated even though it was clear that needs had changed. Members of staff had not signed appropriately against some of the entries seen. Risk assessments were seen as part of the Service User Plan documentation, however the Registered Manager and Deputy Manager agreed to implement risk assessments for example for epilepsy and for persons on Warfarin medication. On the whole it is indicated that the health needs of Service Users are met, although it was seen that for example on two occasions for two individual Service Users a blood test had not been carried out. These issues were discussed with the Registered Manager and Deputy Manager. A small medication room is now operational, and it was found that when checking the medication charts and the medications stored that there were several inaccuracies, and these were discussed with the Registered Manager and Deputy Manager. The Inspector was told that twelve staff have undertaken medication training and a further three staff were to complete the same course. Relatives comments cards included positive comments about the way their particular relative/friend are being cared for. Comments included “the staff show great kindness and consideration for everyone” and “the care she gets is beyond the basic caring for her needs”. Service User comments to the Inspector were also positive, for example: “staff were 101 ”, and “staff are very caring”. A staff member said that the Manager constantly reminds staff to respect Service Users dignity and this was also evident in care plans checked. The Inspector observed staff interacting with Service Users and noted that their manner was courteous and friendly. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 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) 12,13,14,15 Service Users spoken with confirmed they were happy with the lifestyle they had living at the home. Service Users are encouraged to maintain contact with family and friends. It was indicated from discussions that Service Users are able to exercise choice and control over their lives within their capacity to do so. The meals in the home are good offering both choice and variety and catering for special diets. EVIDENCE: During conversations with several Service Users they spoke about various activities that they participate in within the Home, including: bingo, a floor snakes and ladders game, exercises to music and a musical entertainer comes every week to play the piano and sing the “old songs”. They also spoke of individual pastimes and interests, including reading, watching television, purchasing regular favourite magazines. The Inspector saw that Service Users interests are recorded in their care plans. Service Users also confirmed that daily routines are flexible and they can choose how they wish to spend their Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 13 time. Some Service Users choose to stay in their bedrooms except for meal times, while others prefer to sit in the lounges, either for some of the time, or for the whole day. The Registered Manager gave examples of how Service Users have been encouraged to exercise choice and maintain control over their lives. This is usually achieved by input from relatives. Service Users are encouraged to bring their personal possessions into the Home and the Inspector observed that many rooms are personalised. The day’s menu is displayed on a wipe clean board in the dining room. The Inspector talked to the Cook about menu planning and was informed that she uses a 6-week menu plan that is usually rotated on a 4-week basis. The Inspector viewed the menus, which include meals such as: braised steak, fresh homemade chicken pie and minced beef cobbler. The Cook stated that there is always one fresh vegetable and one frozen vegetable dish each day. The record of food was seen and indicated a varied nutritious diet. The Cook confirmed that special diets are catered for, such as diabetic diets. Comments from Service Users all confirmed that they enjoyed the meals provided, and confirmed that alternatives were available. The Inspector was pleased to confirm that evidence obtained at this inspection indicates a commendable standard with regard to the food served at this Home and mealtime arrangements. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 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 The home has a satisfactory complaints system with some evidence that Service Users feel that their views are listened to and acted on. Policies and Procedures are in place to safeguard Service Users from abuse. EVIDENCE: Service Users spoken to said they had no complaints and felt comfortable in speaking with the Registered Manager or staff if they had any worries. Service Users praised the home, saying that the staff are good and listen to them. A complaints notice is prominently displayed in the entrance hall and the Registered Manager confirmed that each Service User is given a copy. There is a system in place to record any complaints together with information about the action taken by the home to resolve any issues. The Home has a detailed policy and clear written procedures on abuse and adult protection. The ‘whistle blowing’ policy was seen at a previous inspection visit and there is also a policy on restraint and a management of aggression document. The Registered Manager said that these policies are covered in the staff induction programme and are regularly discussed. It was also stated that any suspicions of abuse would be reported to care management and to the Commission. A staff member confirmed awareness of the ‘whistle blowing’ procedure and said she would speak to the Manager if she were concerned about anything that might indicate abuse. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 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) 19,20,21,22,23,24,25,26 The standard of the environment within the home is good providing Service Users with an attractive and homely place to live. The home was clean and pleasant at the time of the inspection visit. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 16 EVIDENCE: During the accompanied tour of the home, the Inspector could see that a homely, comfortable environment has been created for Service Users. The home is well decorated and well maintained. The Registered Manager confirmed that a regular programme for the renewal of fabrics, furniture and fittings is in place and some redecoration work was being carried out to hallways. A major kitchen refitting is to be completed this month. The Home provides a variety of communal areas, and these were seen, to be attractively decorated and comfortably furnished to meet Service Users needs. Information previously provided indicates that the communal space available in the Home meets this standard. There are 3 bathrooms, 1 shower facility and 5 toilets, plus 22 bedrooms have en-suite toilet facilities. On the accompanied tour of the building the Inspector noted various mobility aids, such as grab rails, raised toilet seats and frames, individual aids such as walking frames and wheelchairs. There are two shaft lifts, a stair lift on two stairs in a corridor and mobile hoists. Information previously supplied to the Commission indicates that the home meets the space requirements specified in this standard. Several Service Users commented to the Inspector that they liked their bedrooms and from the tour of the building it was clear that bedrooms have been arranged to suit Service Users individual needs. The Registered Manager confirmed that action is to be taken to replace the existing indicator style door locks with a suitable lock with keys approved by the Fire Safety Officer. The Inspector was pleased to note that high standards of hygiene are being maintained in this home. All areas seen pleasant smelling with no unpleasant odours noted. There is laundry in the basement and there is a small sluicing facility staff toilet. cleanliness and were clean and a well-equipped adjacent to the Discussion took place in relation to the correct clinical waste category bags being used, and for the home to have an up to date Clinical Waste Certificate. The Registered Manager said that she would address these issues. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 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) 27,29,30 From discussion with management and staff, it was found that Service Users needs may not have been met at all times by the numbers and skill of staff. Service Users are protected by the homes thorough recruitment procedures, and staff training is ongoing. EVIDENCE: The current weeks staff rota was seen and now showed the full names of the members of staff, however the designations of staff and total number of hours worked each week had not been completed. The Inspector was told that currently the home has two vacancies one full time and one part time, and that these hours, are being covered by current staff working extra hours. The Registered Person has calculated the staffing hours using the Department of Health Guidance, however it was indicated from the staff rota seen and staff rotas provided by the Registered Person that there were insufficient numbers of staff on duty on a Saturday and Sunday between 8.00am and 10.00am and on seven days a week between 6.00pm and 10.00pm. At these times it is indicated that there are only two care staff on duty. It was also discussed that the care staff at the home undertake laundry duties. The Registered Manager agreed to discuss the above issue with the Registered Person. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 18 Four staff files were audited and seen to contain all relevant paperwork in relation to the requirements of legislation for example application forms, proof of identity, references, job descriptions and statements of the terms and conditions of employment. Evidence of CRB checks was seen. The Inspector saw evidence in staff files sampled and in the training matrix, of a thorough induction process and that staff are encouraged to attend at least three training days per year. The Inspector was pleased to see that the commitment to staff training evident at this home, and a staff training matrix has been provided as part of the preinspection questionnaire. Moving and handling, infection control, first aid, fire training are examples of training undertaken this year. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 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) 33,38 Service Users benefit from a well run home, and on the whole the health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: The Inspector was told that the Deputy Manager is to undertake the NVQ4 Registered Managers Award. Currently the home does not have a maintenance person, however there is a list of contact names and addresses of tradesmen to be used to carry out a variety of jobs. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 20 It was noted during the accompanied tour of the building that the call bell alarm system could not be heard in the Laundry area. As care staff undertake laundry duties, and would not be able to respond to a request for assistance the Registered Manager agreed to address this issue. The Fire Safety Log Book contained records of weekly fire bell tests, regular staff fire instruction and fires drills. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 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 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 x 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 x x x 3 Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard 7 8 9 Regulation 15(1) 12(1) 13(2) Requirement Timescale for action 05/10/05 4. 27 18(1) Keep Service User plan under review and ensure all relevant information is recorded To promote and make proper 05/10/05 provision for the health and safety of Service Users The Registered Person shall 05/10/05 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home Ensure that at all times suitably 05/10/05 qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of Service Users 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 26 Good Practice Recommendations To have available up to date Clinical Waste Certificate and to ensure that waste is disposed of into the correct H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 23 Keele House category of clinical waste bags. Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent. TN23 1HU 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 Keele House H56-H05 S60970 Keele House V235646 041005 stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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