CARE HOME ADULTS 18-65
Keevan Lodge 98 Clive Road Enfield Middlesex EN1 1RF Lead Inspector
Rebecca Bauers Unannounced Inspection 10th January 2006 11:20 Keevan Lodge DS0000034275.V269827.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 Keevan Lodge DS0000034275.V269827.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. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Keevan Lodge Address 98 Clive Road Enfield Middlesex EN1 1RF 020 8367 0441 020 8367 0441 SANJAYENATH@AOL.COM 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) Saivan Care Services Ltd Danwantee Bundhun-Ramsaha Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One specified service user who is over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as the specified service user vacates the home. Date of last inspection 9th September 2005 Brief Description of the Service: Keevan Lodge is a care home registered to provide residential services for three adults with a learning disability. The home is situated in a quiet residential street close to a supermarket, restaurants and a cinema. The Enfield Town Centre is approximately fifteen minutes walk away from the home. Each bedroom in the home has a shower, a wash hand basin and a toilet. The home has a separate bathroom and a toilet on the first floor. The kitchen/diner, a lounge and one bedroom are on the ground floor. The home is not accessible for people with physical disabilities. There is a large garden at the back of the home, which service users can use for sitting and relaxing when weather permits. The home was registered on 2nd August 2003 and has admitted three service users in the time it has been open. The registered manager is Ms Danwantee Bundhun-Ramsaha. The home has no vacancies. The philosophy of the home is to to promote a positive image of people with learning disabilities and create and maintain a homely environment conducive to the delivery of care and providing comfort. The home has an aim of creating a warm and supportive environment within which quality care can be delivered according to individuals holistic needs. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 10th of January 2006 as part of the annual inspection programme to identify progress with previous requirements and to check standards of care against the core standards. The inspection took three hours to complete. A partial tour of the home took place; two service users were spoken to independently. Care records, staff records and health and safety records were examined. Two staff were spoken to and the inspector was accompanied by the registered manager throughout. Further information was obtained through observation of staff interaction with service users. What the service does well:
Service users continue to benefit from the experience of multidisciplinary working to ensure that their personal care, social and emotional health needs are met. Each service user benefits from a person centred individual plan that they have quite clearly been at the centre of developing to ensure that they have control over their own lives with appropriate support from staff. The environmental conditions are homely and welcoming and the service users benefit from knowing that their assessed needs and aspirations are understood by staff who are supporting them in the way they prefer to promote independence. Service users continue to benefit from fulfilling activities to enhance their lives and meet their aspirations. Service users benefit from knowing their rights and responsibilities and feeling safe in the knowledge that staff respect these. The home ensures that service users, relatives and other professional’s views are listened to and addressed to improve service provision. Service users benefit from a well-established well trained staff team who understand their needs and are provided with the support and information to work with service users in a consistent way. Robust policies and procedures are followed in the recruitment of staff to ensure service users are protected. Service users say that the staff are helpful and friendly. All service users said that they felt comfortable in the home and enjoyed the food and activities.
Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
Eight requirements and three recommendations were made at this inspection. A requirement was made under the heading individual needs and choices for a risk assessment to be developed concerning road safety to safeguard service users and to promote independence in the wider community. A requirement was made under the heading lifestyle for service users individual plans to be developed to incorporate issues of sexuality and personal relationships. Two requirements were made under the heading personal and healthcare support. These concerned the need for staff to follow the homes medication policy and procedures and for all epileptic seizures to be recorded appropriately and accurately to safeguard service users and to ensure that accurate information is available during medication reviews. A recommendation was made under concerns complaints and protection for an up-to-date revised copy of Enfield’s adult protection procedures to be in place. A requirement was made under the heading environment for the newly fitted emergency lights to be checked and for these checks to be documented to safeguard service users. Three requirements were made under the heading staffing. These concerned supervision records, training and the need to record staff meetings. Recommendations were made to review staffing levels as this may be of benefit to service users when out in the community, for the rota to have clearly identified job roles, responsible person on duty and the hours contracted to work. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 7 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. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 8 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 Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 9 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): EVIDENCE: None of these standards were assessed at this inspection. There had been no new admissions since the last inspection. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 10 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 can continue to feel confident that their assessed needs are reflected in their individual plans. Service users have risk assessments in place to promote independent lifestyles; further risk assessments are needed as a result of recent reviews. Good evidence is available to indicate that service users make decisions about their lives with staff support. All service users are receiving regular reviews. EVIDENCE: A requirement made at the last inspection for an individual plan to be developed with the service user who had moved into the home in August 2005 had been fully progressed. All elements of the initial assessment had been included within the individual plan with clear support needs for staff to ensure continuity. Clear boundaries and guidance were in place for meeting individual’s challenging needs. ABC charts continue to be utilised to identify patterns and triggers to behaviour, there was evidence that the outcome from these behaviour charts are reviewed and discussed with psychologists. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 11 All service users have detailed risk assessments in place however there was no risk assessment in place with regard to road safety, which had been highlighted in a recent review as a concern. These must be developed to safeguard individual service users and to ensure that all staff are consistent in their approach and are aware of the risks whilst out in the community with individual service users. A requirement concerning one service user needing a multidisciplinary review had been progressed and had been planned for the 12/1/06. Daily detailed notes continue to reflect the decisions service users make with regard to the care they receive, what they do on a daily basis and future planning for example, holidays. The daily notes were excellent and reflected many aspects of service users personalities and lifestyles. Monthly evaluation sheets continue to provide a holistic view of the individual. Service users expressed positive comments with regard to living in the home. One service user stated ‘ I have settled in well, I like living here, I enjoy the comfort of Keevan lodge.’ Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 12 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): 13,15,16,17 Service users lead their lives in the way that they choose. Appropriate leisure activities and access to the community continues to be a regular occurrence. Service users have clarity with regard to their rights and responsibilities, which have been recognised in a multidisciplinary context. Service users enjoy a good balanced diet. EVIDENCE: Service users continue to access the community on a daily basis; this was reflected in the activities plan and daily records. For example, cafes, pubs, shops, walks and day trips. One service user likes to attend college three times a week. The other service users prefer to undertake activities in the home or within the wider community. Service users continue to decide and plan their day with staff on a daily basis these decisions are documented in the daily notes. Service users spoken to said that they enjoy going out and spending time talking to staff. Two service users indicated that there is regular family contact and a good relationship exists between the home and family. Other service users do not
Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 13 have contact with family members through choice or through their being no evidence of family existing. Service users needs with regard to personal relationships and sexuality had not been addressed in their individual plans this is an important aspect of an individual, which needs to be addressed, especially for those service users who may also exhibit some sexualised behaviour. Individual plans indicated that service users rights and responsibilities continue to be respected. Agreements are in place where service users take responsibility for replacing furniture that they have personally destroyed, or boundaries are in place for inappropriate behaviour. These had all been agreed within a multidisciplinary context. Service users had a good awareness of these agreements and as such had signed the documents to confirm their understanding. Service users are consulted with regard to food preferences this was observed during the inspection. Service users specific dietary and cultural needs continue to be met by the home. Records indicated that varied and balanced meals were being provided. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 14 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 Service users state that they receive personal support in line with their own preferences. Good records of multidisciplinary intervention are in place including clear outcomes from appointments to ensure that follow up occurs and that service users physical and emotional health needs are monitored fully. Service users are not being protected by the homes medication policies and procedures. The documentation of epileptic seizures are not always complete to enable a full analysis of possible patterns to the seizures. EVIDENCE: Service users said that they receive personal support in the way they prefer and that staff are caring and respectful. Personal support needs had been fully documented in the individual plans. Service users physical and emotional health needs are being well met. All service users receive support from a multidisciplinary team such as psychologists, GP’s, community nurses and occupational therapists. Case tracking service users case notes indicated that regular health checks continue to occur and that the full outcomes and recommendations are documented in the daily notes to ensure appropriate follow up. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 15 However the epileptic seizure charts had not always been completed fully, in some cases the date and the duration of the seizure had not been completed. It was also noted in the daily notes that a service user had had a seizure in January but this had not been recorded on the seizure monitoring chart, the last recorded seizure was in December. These charts must be completed fully to allow proper analysis of the pattern of seizures and to aid medication reviews with the correct up-to-date information. The medication administration record for the last four months were looked at and were found to be incomplete for one service user. Medication had not been signed for on ten occasions during October and November 2005. This must be investigated and the all staff must follow the homes medication policy and procedure to safeguard service users from potential medication errors. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 16 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 Service users continue to feel that they are listened to by staff and that they can discuss any issues and know that they will be dealt with. Service users are protected by the homes adult protection procedures and by confident staff who have been trained and deemed competent in the identification and reporting of allegations of abuse. EVIDENCE: Service users spoken to say that they felt that staff were easy to talk to and that at any time they felt able to say if they were unhappy about something. None of the service users wished to make a complaint during the inspection. Records confirmed that there had been no complaints since the last inspection. All staff had received adult protection training and those interviewed were knowledgeable with regard to the correct reporting procedures if an allegation was made by a service user. Service users are protected from abuse, neglect and self-harm by the homes adult protection policy and procedure although it is recommended that the revised adult protection procedure is obtained from the ‘host authority’. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 17 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): 24,26,29,30 Service users benefit from living in a comfortable, safe homely, clean environment. Handrails around the house help to promote independence with mobility. EVIDENCE: The home was well decorated and comfortable. Each bedroom had been personalised by the individual service users with ornaments and pictures for example. One of the en-suite bathrooms has been recently refurbished after it was flooded by a service user. The room will be painted soon according to the registered manager. The service users are protected by ensuring that all the fire doors are closed, the registered manager stated that she would however be getting a magnetic self closing device fitted to the kitchen door in the forthcoming months. Handrails have been placed strategically around the home following an occupational therapist assessment. These adjustments promote the safety and independence of service users around the home. The home is clean and hygienic.
Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 18 Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,36 Service users are supported and protected by the homes recruitment procedures. Service users benefit from a stable staff team who understand their needs. Staff are well supported although this is not always reflected in the documentation held on file. Staff have not received all refresher statutory training to safeguard service users. Service users would benefit from a review of the current staffing levels. EVIDENCE: Staff files examined demonstrated that service users are protected by the homes recruitment procedures. All relevant checks had been taken for example, references and enhanced CRB checks. Unfortunately the records of supervision were not always complete and did not indicate if staff were receiving 1to1 support every two months. Staff spoken to did however state that they had regular supervision. Staff spoken to stated that they had regular staff meeting although the last and only one recorded was for October 2005. All staff meetings must be minuted and happen on a regular basis to aid continuity in the staff support given to service users. It was evident from service users files and reviews that there are occasions where additional staff support would be of benefit, particularly if service users are exhibiting challenging behaviour whilst out in the community of if a service user has an epileptic seizure; and the nature of these are sudden as the
Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 20 individual drops straight to the ground and has on occasion caused considerable injury to themselves. It may be of benefit to think about reviewing the staffing levels in the home to protect both service users and staff. Staff morale remains high in the home and it was evident that good relationships had developed between service users and staff. Training records seen indicated that staff had not all received refresher training in fire safety, first aid and in some cases food hygiene, this must be rectified to ensure the safety of service users and staff. The rota was seen and reflected the staff on duty at the time of the inspection. The rota covered a four week period to ensure that staff know what they are working in advance. It would be helpful for clarity, if the designated responsible person on duty was highlighted and for the staff current role and contracted hours to be indicated on the rota. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,42 Service users benefit from a well organised manager, which is reflected in the ethos and leadership of the home. Staff morale is high. The health, safety and welfare of service users are protected in the sense of ensuring all relevant safety checks are carried out. EVIDENCE: Service users benefit from a well run home. The registered manager has a good understanding of the service users needs and staff benefit from and open management style where ideas and values can be shared equally. The registered manger has now achieved her RMA and is currently undertaking an NVQ assessor’s course. All records for the protection of service users with regard to health and safety were complete except the emergency lighting checks. The emergency lights have been installed since the last inspection however they have not yet been checked. The recommendation made by the external agency that checks the fire equipment is weekly. These checks must be recorded.
Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 22 The fire doors were all closed on the day of the inspection to safeguard service users in the event of a fire. The registered person will however be fitting magnetic closing devices to the kitchen door so that the door can be open but close automatically as soon as the fire alarm sounds. Staff were clear with regard to the fire evacuation procedure. Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 23 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 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X 3 X X 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 2 16 3 17 Standard No 31 32 33 34 35 36 Score 3 X 2 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Keevan Lodge Score 3 2 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 X X X 3 x DS0000034275.V269827.R01.S.doc Version 5.0 Page 24 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 YA9 Regulation 13(4) Requirement The registered person must ensure that all service users have a risk assessment in place for the management of road safety. The registered person must ensure that each service user has an individual plan in place that includes sexuality. The registered person must ensure that the record of epileptic seizures is completed each time a seizure occurs; this must include the date and duration of the seizure. The registered person must ensure that staff follow the homes medication policy and procedure and that the MAR sheets are completed fully. The registered person must ensure that the emergency lights are checked weekly and that this is recorded. The registered person must ensure that staff meetings are documented and that there is evidence that they occur periodically. The registered person must
DS0000034275.V269827.R01.S.doc Timescale for action 31/03/06 2 YA15 15(1) 12(4b) 12(1a) 31/03/06 3 YA19 31/01/06 4 YA20 13(2) 31/01/06 5 YA24 23(4e) 31/01/06 6 YA33 21(1) 31/01/06 7 YA35 18(1i) 01/04/06
Page 25 Keevan Lodge Version 5.0 23(4d) 13(4c) 8 YA36 18(2) ensure that all staff receive all statutory training annually. Staff must have fire safety, food hygiene and first aid training. The registered person must 28/02/06 ensure that supervision records are up-to-date and demonstrate that staff receive supervision at least every two months. 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 Refer to Standard YA23 YA32 Good Practice Recommendations The registered person should have an updated copy of Enfield’s revised adult protection procedures developed in 2005. The registered person should consider reviewing the staffing levels in the home to accommodate a service user who may require 1 to 1 due to challenging needs and sudden seizures. The registered person should indicate on the staff rota their role, who is the designated person on duty and the number of hours staff are contracted to work. 3 YA33 Keevan Lodge DS0000034275.V269827.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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