Inspection on 12/05/05 for Keller House

This inspection was carried out on 12th May 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

Keller House 04/10/07

Keller House 29/08/06

Keller House 06/12/05

Keller House 11/01/05

Keller House 15/06/04

Keller House 03/06/03

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

CARE HOMES FOR OLDER PEOPLE Keller House 52 Carew Road Eastbourne East Sussex BN21 2JN Lead Inspector Debbie Calveley Unannounced 12 May 2005 0700 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. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Keller House Address 52 Carew Road Eastbourne East Sussex BN21 2JN 01323 722052 01323 722052 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 Twalebuddeen Durgahee Mrs Erlinda Durgahee Mr Twalebuddeen Durgahee Mrs Erlinda Durgahee. Care home only 15 Category(ies) of Dementia - over sixty-five (65) years of age registration, with number (DE(E)) of places Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum number of service users to be accommodated is fifteen (15). 2. That only service users with a dementia type illness can be accommodated. 3. That service users must be aged sixty-five (65) years and over on admission. Date of last inspection 11 January 2005 Brief Description of the Service: Keller House is registered to provide care and accommodation for fifteen service users that meet the registration category of older people with dementia. It is a large detached house situated approximately ¾ of a mile from Eastbourne town centre and the train station. On the day of the inspection there were fourteen service users in residence with one vacancy. The home comprises of eleven single bedrooms and two double bedrooms. There is a large lounge area, a separate dining room, which is situated next to a compact kitchen.On the lower floor there is a conservatory, which leads out to a natural well-tended garden. To the front of the house there is a patio area. There is a passenger lift that allows level access to all areas of the home. There is little equipment found specific for people with dementia. The home aims to provide a comfortable and homely environment for older people with dementia on a long-term basis and to care for them with dignity and to respect their rights as individuals. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 12 May 2005, from 0700 hrs until 1300 hrs. Two inspectors inspected the home and conducted informal interviews with five residents, two relatives and two members of day staff and two members of night staff. The inspection process consisted of a tour of the building, inspection of documentation and records, observation of the lunchtime meal and looked at the delivery of care for twelve residents. Mrs Durgahee has the main responsibility for managing Keller House What the service does well: What has improved since the last inspection? What they could do better: Some of the requirements made at this inspection have been previously identified as areas for improvement for Keller House. As discussed, the care plans and risk assessments need to accurately reflect the needs of the individual service user. This is so that staff can provide safe and consistent care and that changes in needs can be tracked and additional advice be sought when necessary. A programme of activities needs to be provided that meets service user needs. The menu needs to be followed and the quality and presentation of the meal improved. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 6 Some maintenance issues were identified throughout the inspection process and need to be addressed as they affect the health and safety of the service users. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 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 Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 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) 3 and 5. All service users have an assessment performed before admission to the home, although, not all complex needs are identified. All prospective service users are invited to visit the home prior to admission which is found beneficial. EVIDENCE: A new pre-admission assessment has been introduced since the last inspection. Two recent pre-admission assessments were viewed and the content was adequate. The tick box answers though do not always give the opportunity to convey some more complex needs as all residents present differently. From talking with two residents and a relative they said they had been able to visit the home and meet other residents prior to admission. All residents move into the home on a trial basis before their stay becomes permanent. This is clearly stated in the terms and conditions. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 9 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 and 10. The care planning system in place at present does not provide staff with all the information they need to satisfactorily meet the needs of the service users. The administration of medication of a good standard. The practice of covert administration of medication needs to be transparent and policies and procedures in place. EVIDENCE: The care plans of twelve service users were viewed and there has been little change or improvement in the risk assessments and associated plan of care since the last inspection. The care plans of two new service users were not available for inspection, all documentation pertaining to individual service users must be available I the home for staff to be able to follow a plan of care. The reason given by the manager is that they are still developing a new care plan. A follow up visit was arranged to view these care plans. There was no evidence in the care plans of service user/ relative involvement. Information regarding appetite and weight loss were not consistent in the diary entries and the care plans. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 10 The wound care information of one specific service user was missing from their care plan, the only reference available was “visit from the district nurse”. It did not include instructions of how to deal with the dressings for bathing, walking or rest, for staff to follow. There are no care plans for the social preferences of service users. A high amount of incontinence is found at the home, there is a policy in place re gaining continence, this is to be developed and individual care plans devised for promotion of continence. Covert administration of medicine was found described in the care plans of certain individuals and discussed. A policy and procedure needs to be in place and discussed with the G.P, Pharmacist and Next of Kin. Risk assessments are required to be in place. The medicine administration charts were seen and were correctly completed. The home has policies and procedures on respecting service users privacy and dignity. There are two double bedrooms and screens have now been provided to ensure privacy whilst personal care is being given. During the mealtime service users were seen being fed in a way that was not dignified and respectful. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 11 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 and 15. There is a lack of planned activities, and consequently, not all service users’ experience a lifestyle in the home that matches their expectations and preferences. There is an open door policy in the home and family and friends are welcomed in to home. The home does not provide a varied menu of well presented food, therefore service users are not able to exercise choice and control over their diet and what they eat. EVIDENCE: There was little evidence of social life within the home. From 0700 am, thirteen of the fourteen service users were sitting in the lounge, with the television on. Nothing happened until 1130 am when a carer was seen throwing a ball to some service users and then they went through to the dining room for lunch. One service user said that they watched television everyday. A visitor said that not very much went on. It was evident from the comments received that service users would benefit from a more robust plan of activities, which should take place both inside and outside of the home. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 12 Keller House promotes an open door policy during the day. Service users spoke of visitors they had received and the home maintains a register of the visitors received in the home. All service users except one, were up, dressed and in the lounge having had breakfast by 0730 am. One staff member said that some service users woke up early. This needs to be demonstrated in the care plan that this is their preferred choice along with what time they retire to bed. Five service users expressed their boredom with the morning routine. The inspector acknowledges that this is a difficult problem when there are varying degrees of dementia present, but systems need to be in place to enable all service users to exercise their choice of activity. From speaking to four service users they conveyed that they were not given the opportunity to exercise choice and control over their everyday lives. Whilst chatting to three service users in the lounge before lunch, they expressed their dislike of the food. Two said it was horrible and they could not eat it, another said that it was not food she would choose. The midday meal was observed. The meal served was not the one advertised on the menu and was not the alternative meal that the inspector was informed of. The meal was poorly presented and was not appetising. As service users’ sat down, the “cook “ served the meal to each individual and when they did not start eating, tried to inappropriately feed them between serving other service users. Five service users expressed their dismay at the meal presented to them and refused to eat it. No alternative was offered until asked by the inspector. The manager was approached and she offered to cook omelettes. The service users by this time were saying “ I do not want to be a nuisance”. The manager explained that they have employed a new cook but are waiting for Criminal Record Check clearance. Monitoring visits will be maintained to continually monitor the standard and quality of the meals served. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 13 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 and 18. The complaints process is not effective as there is no evidence that service users’ views are listened to or acted upon. All though staff have received training in Adult Protection the care provided does not ensure protection. EVIDENCE: The complaint procedure is clear and accessible to service users, their representatives and staff. The manager is aware that a record is to be kept of all complaints and it is to include all details of investigation and the outcome. The complaint book was seen to be empty. There is no evidence of regular resident meetings and service users spoken to do not get the opportunity to voice their views. Of the four staff spoken with two were knowledgeable about the vulnerability of residents and the systems in place to protect them, whilst two were a little hesitant in responding to the questions. There is evidence of staff attendance to a lecture on Prevention of Abuse in December 2004. It is required that all staff within the home, including domestic and ancillary staff attend training on Adult Protection and the prevention of Abuse. Three staff recruitment files were viewed and were found to be robust and contained the necessary information required. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 14 Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 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 and 26. The home is pleasantly decorated and the furniture of good quality, however, a number of maintenance issues causes concern of the service users’ safety and well-being. EVIDENCE: The home was found to be well-maintained in respect of décor and furniture. There is a paved area to the front and a large garden to the rear of the property, which is used in the summer months. The home has a large lounge, but it is arranged with chairs around the outside of the room with a large television as the focal point. It would benefit from being arranged so as to encourage service users to talk amongst themselves or to have access to small tables for individual activities such as puzzles as one service user volunteered that they enjoyed jigsaws. The homes has a lift which provides access to all floors of the home, but it was found to be faulty. It was asked immediately that a sign be placed on the lift to ensure it is not used until repaired. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 16 A new call bell system was in place, however the staff need to ensure that all service users have access to a call bell and an appropriate risk assessment in place for those who do not have the capacity to call for assistance and a system put in to place for checking on the service user who is confined to her room. The home have converted a bathroom into a wet shower room since the last inspection and have also purchased an electrical bath hoist, both which are proving popular with the service users. Random hot water temperatures were tested and there were identified rooms that had water in excess of 60°c. This was a requirement in the previous inspection. The radiators in some areas were found cold and this again had been identified at the last inspection. An Immediate Requirement was made that the water temperatures and heating were attended to. The cleanliness of the home was of an adequate standard, some areas need to be included in the housekeepers’ weekly rota and include areas such as lampshades, shelves and the service users photographs and pictures, which were found grimy and dusty. There is no sluice facility available and commode pots were found standing in the bath to be used by service users, this is not considered good practice and an alternative method sought for cleaning commode pots is needed. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 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 and 30 There were sufficient staff to care for the basic needs of the service users. The recruitment process is robust. Induction and mandatory training for staff is now provided, but staff need training in areas specific to dementia. EVIDENCE: The staff rota evidenced that there are two carers on duty continuously throughout the 24 hours. The night shift has one carer awake and one sleeping. Mrs Durgahee is supernumery to these numbers and is on call at all times. The recruitment process was found to be robust, staff files of new employees were examined and were found to contain all the necessary documentation and Criminal Record Checks. Staff training is on-going and the recording of staff training has improved. All new staff complete an induction programme in line with the National Training Organisation. Staff have or are to attend a study days on dementia and Prevention of Abuse in order to have a full understanding of caring for older people with Dementia. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 18 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 and 38. Service users’ views are not sought on a regular basis and consequently do not have the opportunity to effect how the home is run. The fire, health and safety measures in the home do not safe guard service users and staff from harm. EVIDENCE: There is no evidence of regular resident meetings and residents spoken with said that they do not get the opportunity to voice their views or complaints about how they feel. Three mentioned the poor quality of food and continuous noise from the television. Staff training has commenced, this was evidenced by the training file; training will be on-going to ensure that all staff receive the mandatory training on a regular basis. Some areas regarding health and safety were identified during the inspection and were Immediate Requirements on the day of the inspection. Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 19 These include • That the call bell system is checked for accessibility in all rooms, and a risk assessment in place for those who cannot ring the call bell when required. A system needs to be developed for evidencing checks on residents remaining in their room for long periods of time who do not have the capacity of ringing for assistance. A large amount of fire doors are not to be propped open with a variety of objects. The temperature of certain rooms were found cold. Radiators in identified rooms were found uncovered. The hot water temperatures were checked randomly and some were found to be in excess of 52 ° C. One resident room basin was found without a valve and was 62 ° C • • • • • Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION 2 3 2 2 3 3 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 x x x x 2 Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 21 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. Standard 7 Regulation 15(2)(b)(c) 12-(1) Requirement That a comprehensive plan of care is generated from a comprehensive assessment is drawn up for/with each service user, and it is reviewed at least once a month. (Previous timescale of 17/01/05 not met.) That service users (where practical) or the representatives are consulted on the formation of care plans and the implementation of specific care, including baths.(Previous timescale of 17/01/05 not met) That policies and procedures are developed and in place reguarding covert medication. That service are treated at all times with dignity and respect. That an activity programme is developed taking in to account the wishes and preferences of individual service users. That service users are offered a varied, appealing, wholesome and nutritious diet. That an alternative menu is always available and that a record of all meals refused is kept( Previous timescale of 11/03/05 not met) That service users concerns and Timescale for action 14 July 2005 2. 8 15 (1) (2) 14 July 2005 3. 4. 5. 8 10 12 13 (2) 12 (4) (a) 16 (2) (m) 16 (2) (i) 14 June 005 14 May 2005 14 June 2005 14 May 2005 6. 15 7. 16 22 (1) (2) 14 June Page 22 Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 8. 9. 22 22 (3) (4) (5) (6) 23 (2) (m) 23 (2) (c ) 10. 25 23 (2) (p) 13 (4) (a) (c) 11. 25 13 (3) (4) (a) (c) 12. 13. 14. 26 26 33 12(1) (a) 13(3) 24 (1) (3) 15. 38 23(4) (a) 16. 14 12 (2) (3) 17. 30 18 (1)(a) ( c) (i) (1) views are recorded and responded to. That the passenger lift is repaired That call bells are in reach and that appropriate risk assessments and alternative systems are in place for those service users who cannot use a call bell. ( Previous timescale of 11/01/05 not met) That the temperature of rooms are checked on a regular basis and the boiler is checked for efficiency. That all radiators are guarded.( Previous timescale of 11/01/05 not met) That the hot water temperatures are checked on a regular basis and do not exceed 43 degrees celsius. ( Previous timescale of 11/01/05 not met) That all areas of the home are kept clean and free from dust. that the home have a sluicing facility separate from service users communal bathrooms. That effective quality assurance and quality monitoring sysyems are in place enabling service users to raise concerns. That the wedges used in service users doors and throughout the building are removed and advice regarding this practice sought from the fire service. (Previous timescale of 11/01/05 not met) That the home as far as practicable ascertain and take into account their wishes and their feelings in regard to getting up and going to bed. That training is provided in caring for older persons with dementia. and nutrition. 2005 14 May 2005 14 May 2005 14 May 2005 14 May 2005 14 May 2005 14 May 2005 14 May 2005 14 May 2005 14 May 2005 31 July2005 Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 23 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 Good Practice Recommendations Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Keller House H59-H10 S21145 Keller House V221618 140605 Stage 4.doc Version 1.20 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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