Inspection on 24/05/07 for Kemsing Road Respite Service

This inspection was carried out on 24th May 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kemsing Road Respite Service 22/11/06

Kemsing Road Respite Service 31/05/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Kemsing Road Respite Service 11 Kemsing Road Greenwich London SE10 0LL Lead Inspector Keith Izzard Unannounced Inspection 24th May 2007 10:00 Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 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 Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 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. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kemsing Road Respite Service Address 11 Kemsing Road Greenwich London SE10 0LL 01707 652053 0208 269 0805 Telephone number Fax number Email address fProvider 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) Caretech Community Services Tony Onabanjo Care Home 8 Category(ies) of Dementia (0), Learning disability (0), Mental registration, with number disorder, excluding learning disability or of places dementia (0), Physical disability (0), Sensory impairment (0) Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Learning Disability - Code LD Physical Disability - Code PD Sensory Impairment - Code SI 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 8 22nd November 2006 Date of last inspection Brief Description of the Service: 11, Kemsing Road, is a new purpose built semi-detached property, offering respite care and accommodation for up to 8 Service Users at any one time. This respite care is completely flexible, and can be for as little as one night, or for several weeks, depending on the current requirements. The property was built in association with Greenwich Social Services, to provide respite care in place of other Homes that were no longer suitable. The Registered Providers and management are Caretech Community Services, who are experienced providers for these categories of care. Accommodation is provided in 2 flats of 4 bedrooms each, with one flat on the ground floor, and one on the first floor. The second floor contains office and staff facilities, the laundry, and a clinical room. Each bedroom is provided with en-suite shower facilities, and suitable Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 5 equipment for Service Users with physical disabilities. The rooms on the ground floor are slightly larger, and are usually reserved for Service Users who are wheelchair bound. The 2 flats are provided with separate kitchen, lounge and dining rooms, a shared bathroom, and separate gardens at the rear of the property. These also have separate access from the Home. A passenger lift provides easy access to all floors. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two separate days on 24th and 25th May 2007 over a period of 11 hours. The Inspector received assistance from the manager, two deputy managers and three members of care staff. Following the investigation carried out by the local Community Learning Disability team following a series of Safeguarding Adults incidents in 2006 the home has also endured this year three anonymous allegations made about the manager, a member of the care staff and the recently appointed deputy manager. This resulted in temporary suspension of the individuals concerned and whilst the allegations were found to be unsubstantiated, this has inevitably caused further disruption within the running of the home. The incidence of these allegations is a cause for concern. The Inspector is aware that the manager has attempted to deal with this issue within both supervision and team meetings, and the matter was on the agenda for the team meeting on one of the days of inspection. However, the Inspector felt it necessary to state within this report that such occurrences, apart from the obvious stress caused to those wrongly accused, also causes disruption to harmonious team working, and thereby, to the quality of the service provided to the residents. It was also noted that there was another change in the line management to whom the manager reports over the same period, this was unfortunate, and it is to be hoped that there will be ongoing support for the management team and that there will not be any further changes in line management personnel. Nevertheless, staff members have implemented virtually all of the recommendations made subsequent to the CLDT investigation but there is still some way to go in jointly reviewing with relatives and the CLDT, all the residents who have access to respite care within the home and a couple of training matters that are about to be completed. The inspection included a review of information received about the service, a tour of the premises, an examination of records that are required to be maintained, including care plans, talking to and observing residents’ interaction with members of the staff team. There was a happy and positive atmosphere in the home on the day of inspection and residents appeared well cared for by staff members who were observed to be both caring and professional in their approach with residents. What the service does well: The manager, deputy manager and staff members have, once again continued to provide a good service during a very difficult and disruptive period for them. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 7 The home has responded well by complying with 18 of the previous 21 requirements. Two others are underway and one was retracted owing to incorrect information provided at the previous inspection. Most of the 10 recommendations made had also been implemented. 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. The summary of this inspection report can be made available in other formats on request. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 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 Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents and their carers have the relevant information they need to make an informed choice of where to live during respite care provision. Residents’ individual needs and aspirations are assessed prior to admission but the programme of joint reviewing with the local Community Learning Disability Team with relatives/ carers involvement must be finalised to ensure assessment information is comprehensive. EVIDENCE: Standard 1 A requirement to update the Statement of Purpose and Service User Guide, made at the previous inspection of the home was complied with and both documents met the Standard. Standard 2 The Home uses a set assessment format, and the Inspector looked at two completed assessments in detail. This included religious and ethnic needs, physical health and medication, and psychiatric needs. The assessment has forms to record the personal hygiene needs; skills for dressing/undressing; aids and equipment needed; toileting needs; nutrition, feeding and dietary Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 10 requirements; mobility, and lifting and handling needs; sensory awareness; communication; social skills; likes and dislikes; and any difficult behaviour patterns or safety issues. Pre admission daily routines are discussed to inform the care plan and to ensure that any ongoing attendance at college or day centres be maintained during the respite break. Individual assessments clarify if any specific equipment is needed. For example if a resident has a tendency to develop pressure sores an alternating pressurerelief mattress is obtained and fitted to the bed prior to admission. Some residents require one to one nursing support in addition to support by the permanent staff in the home admissions are conditional upon this one to one support being available for the duration of the residents stay. The Manager arranges for residents with high physical needs to be admitted to the ground floor, where the communal bathroom and all bedrooms have overhead tracking fitted for hoisting facilities. Assessments also consider the compatibility of residents for living with others, and this is taken into account with the allocation of rooms. The manager reported that increased communication with CLDT and families prior to any admission for updating information since the previous respite period has assisted staff to assess for compatibility more accurately and a signed information sheet is required to be submitted by relatives prior to admission. Whilst the previously reported difficulties of arranging comprehensive reviews of all residents who use the respite service on a regular basis, have still to be scheduled, the manager stated and noted by the Inspector that all cases where additional support one to one support is needed were prioritised and have been completed. The Inspector acknowledged that there is an ongoing difficulty for CLDT to resource the implementation of review meetings and that additionally, some parents/carers had cancelled pre arranged review meetings that had been set up. The Inspector recommended that whenever review appointment letters are sent out in conjunction with CLDT it should be stressed how important it is to have up to date comprehensive assessments on potential residents and that reviews are carried out as soon as possible on mutually agreed dates. The new timescale for completion of all the reviews must be done by September 2007. See Standard 6. See Restated Requirement 1 & Recommendation 1 Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Both assessed and changing needs are reflected in individual plans of care for residents admission but the programme of joint reviewing with the local Community Learning Disability Team with relatives/ carers involvement must be finalised to ensure assessment information is comprehensive. Residents are encouraged to make decisions about themselves with assistance as needed and take risks as part of an independent lifestyle. EVIDENCE: Standard 6 From the assessment information referred to in Standard 2 a document entitled Individual Support Requirements is drawn up that specifically requires that staff members, the service user and or their representative sign to indicate their agreement or otherwise with the plan. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 12 The Inspector examined two of the new care plans that have been drawn up in response to the requirement made at the previous two inspections. As already stated in Standard 2 the home has an ongoing programme in conjunction with CLDT to update all care plans by the end of September 2007. Nine cases had already been completed, from those designated as priority cases, as they require the additional input of 1:1 workers who have care and support needs that can not be safely and therapeutically be met within the normal staffing levels of the home. These records were found to be up to date and comprehensive and much better structured, a good response had been made to the recommendations made by CLDT in that records that had been updated as far as possible. Staff members benefit from the greater clarity and relative ease of reference in the new records pertaining to each service user. The care records are retained individually in ring binders now named Active Files and these are now retained on the appropriate unit within the medicine cupboard. This is a good initiative to ensure records are readily available to staff members on each unit to house all the current information required on the residents accommodated at any one time. However, there is an outstanding requirement to update the remaining care files by September 2007 in conjunction with relatives and CLDT. The Inspector felt that the management of the home had done all they could to progress this matter but inevitably are dependent on CLDT and relatives to participate. See Standard 2. See Restated Requirement 1 & Recommendation 1 There are also ring binders entitled, “inactive files”. These contain historical information not relevant to the current care plans. They are stored separately on the admin floor. Standard 7 Interaction between staff and residents, observed by the Inspector, demonstrated choice being encouraged by staff members in relation to activities taking place and choice of food provided. The level of communication difficulty of most residents is such that staff members could not meaningfully engage residents in participating in the running of the home and contributing to the formulation policies and procedures, nor is this appropriate for a respite care service. On a daily basis, however, staff members do make attempts to involve residents in household chores and a specific page has been included within the Individual Support Requirements document that clarifies what involvement is acceptable to the resident and how this should be implemented by staff members. Enabling residents to express their choice in relation to outings, meals and activities are promoted by showing pictures and direct reference to specific items and the historical knowledge built up by staff members about individuals recorded in their care files. Some staff members have received training in communicating, for example, using “Makaton”. A communication profile is also provided for each service Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 13 user and located under section 3 in the new care file that guides staff members as to how to interpret and respond to the individual’s communication needs. A previous recommendation that all staff receive appropriate training in dealing with those with communication difficulties was implemented and it was noted that further training in this area is being planned for the future. Standard 9 Risks are being assessed, prior to admission to the home and action is taken to minimise any risks and hazards. Whilst risk assessments are available in all service user’s care files these are gradually being updated, following the programme of updating community care assessments. However, it is vital that the home continues to seek clarification from carers prior to current admissions of any service user with any changed needs, or functioning, since the previous admission of the service user. The facility for doing this exists and staff members are contacting carers and receive written confirmation from them, prior to admission in respect of any changed needs. Current risk assessments are now located under Section 4 of the care file as one of the specific “Individual Support Requirements.” Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Attention is given to meeting the leisure and social needs of the residents. Meals provided are varied and planned to meet residents’ choice and preferences. EVIDENCE: Standards 12-16 Any decisions required about promoting and developing practical life skills are taken by a multi-disciplinary team, in conjunction with residents’ carers. The decisions are taken within the ongoing reviews that take place within the community. Any updates for changes in the support plan for respite care admissions are obtained prior to each admission of a resident, and if recommendations for change are made these, should, have been communicated by either the family, Care Manager, Community Learning Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 15 Disability Team, Day Centre or college. It was noted that the manager has been in negotiation with the local CLDT team to improve communication and that regular meetings have now been set up to facilitate this. The staff team work alongside this process, ensuring that any new skills are identified and encouraged. This may also refer to skills of communication or emotional behaviour as well. A crucial part of this process is the newly introduced admission sheet that requires that carers provide accurate and updated information to assist and inform the care staff. Some residents have set days for attending Day Centres or colleges, and are enrolled for classes such as literacy and numeracy, where applicable. Classes might also include art and craft activities, computer skills and pottery. Most are at college or day centres from Monday to Friday, and the staff members of the home arrange activities, where possible, for evenings and weekends. The opportunity for evening activities may be restricted by the time taken for the admission process, the preparation of meals (which may include different diets), medication to administer, and personal care needs to be met. Activities may therefore be confined to listening to the residents’ choice of music, spending time in the garden, or watching TV. Activities at weekends are more likely to include outings (e.g. to local shops, or places of interest); or visits to pubs, cafes or leisure centres. A weekly Planner has recently been produced that is required to be completed prior to the service users’ arrival based upon the latest care information available. The second page of the document also serves as a communication both to and from carers and staff about updated information and the first page is copied to carers so they have a record of the activities provided. Activities were evidenced in the daily diaries, and within tasks for staff listed in the shift planners. It was clear that the provision of outings and activities is hampered by a lack of staff members who could drive the mini bus provided for the home and the Inspector recommended that continued efforts are made to attempt to recruit new staff who could drive the mini bus. It was noted that the manager is on the rota for driving and that increased efforts are being made by staff members to use public transport to facilitate outings. See Recommendation 2 Some residents would benefit from the use of sensory equipment, and this provision, following a previous recommendation has been addressed as the home now has portable sensory equipment that can be used in residents’ rooms, as no facilities exist within the home for a dedicated sensory room. Family members and friends are welcome to visit at any time, and staff members encourage residents to maintain any other friendships they may have. Respite care may be planned because the next of kin are on holiday, and therefore attention to facilitating supportive relationships/friendships may well Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 16 be of greater significance. Staff members enable residents to choose whether to join in with activities if they wish, stay in their own rooms, or go on outings, having been risk assessed prior to whatever activity has been chosen. Enabling residents to express their choice in relation to outings, menus and meals and activities are promoted by showing pictures from a recently compiled activities folder. In addition, there is direct reference to specific items and also the historical knowledge that has been built up by staff members about individuals recorded in their care files. Residents were enabled to choose what clothes to wear and hairstyles, and when accompanied by staff members on shopping trips to make choices for themselves in their purchases. It was noted that attempts have been made to personalise individual rooms, but given the transitory nature of the service this is difficult to achieve. Following a previous recommendation by the Inspector, efforts had been made to provide pictures in communal areas that might interest or stimulate those with learning difficulties Standard 17 The files contained detailed information about maintaining nutritional needs, taking into account different food preferences, and specific diets. Menus are planned weekly, according to the different residents coming into the Home for the next week. A set meal is prepared each evening, and a list of alternate choices is kept available (e.g. for soup, sandwiches, jacket potatoes etc.). The Inspector viewed the kitchen on both floors. Both kitchens were clean, hygienic, and well equipped. There was suitable food stored in the cupboards, and items in the fridge were labelled and dated. Fridge and freezer temperatures are recorded every day. Fresh fruit and vegetables are used as much as possible. Staff members take it in turns to do the shopping. Some kitchen cupboards are kept locked, and these include separate locked cupboards for knives and cleaning materials. There are separate hand-washing facilities provided. Both kitchens were identical in design and layout. Training is being planned for permanent staff members to be able to administer “Enteral” feeds, so this facility cannot be provided by the staff of the home until the training has been given and staff members are duly certificated. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive flexible personal support. The physical and mental healthcare needs of residents were met. The medication system for the home was well organised and recorded. EVIDENCE: Standard 18 The two new updated care plans examined showed that systems are in place to identify the personal support required by each resident, and clear instructions are written to enable support staff to know individual needs. Personal care is provided in the privacy of the resident’s own room and en-suite facility, or in the bathroom on their particular unit floor. Two previous requirements to ensure that residents’ privacy was not compromised by ill fitting curtains in their bedrooms and an ill fitting door in one of the bathrooms had been complied with promptly. Both bedrooms and bathrooms have been set up with Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 18 the necessary mobility aids and associated equipment, and service users are supported or supervised according to their individual ability. Another requirement made to ensure that lighting was improved in residents’ bedrooms was also complied with promptly as this potentially compromised attention to detail in personal care and medical attention. Same gender care is always given to female residents and where possible to males, and this is discussed and agreed during the pre-admission assessment period. Residents are assisted with going to bed and getting up at their preferred times, as much as possible, but there is an understanding that the Home has to operate a tight schedule in the mornings, to ensure that residents are ready for their transport to college or Day Centre, and have had their personal items, clothing and medication checked out if they are returning to their own homes that day. Standard 19 There are established systems of liaison between different health professionals, ensuring continuity of care. These include medical and psychiatric consultants, District Nurses, dietician, physiotherapist, GPs, occupational therapists and speech therapists. In addition, there are initial occupational / Physiotherapy assessments before the first admission when required to check for use of wheelchair, use of bath or shower, and vehicle use. Personal support plans show detailed instructions. They can include maintaining pressure relief and prevention of pressure sores; moving and handling instructions; detailed skin care; continence care and mouth and dental care. Charts are used to record weight, bowel care and fluid/nutrition intake if needed. Those records that were examined were comprehensively completed. Standard 20 All staff members are required to carry out basic medication training as part of their induction. However, medication is only administered by the Team Leader on duty at the time, as they have received additional training and a written assessment. A staff member who is nurse trained oversees training and assessment and all team leaders have received updated training in the use of the new protocol and MAR sheets. Medication is stored in lockable medicine cupboards within lockable cupboards located on each of the two units. Medication cupboards were well organised, and each resident’s medication was stored separately. Medication Administration Records (MAR charts) had been redesigned, and those examined were properly completed and signed. The new form had been designed specifically to cater for the particular needs of Kemsing Rd and Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 19 incorporates sections to record medication received on admission and at discharge with signatures and also for any sent to a day centre signed either by the driver or the escort. Individual medication was counted and tallied with the dosage given and the amount brought in at the commencement of care at the home. Every resident has provided for them an individual medication folder, that has their photograph, and their room number entered on to it. There are specific guidelines for each resident for administering their medication. Medication is given to each resident one at a time, in case there is a distraction or an emergency situation at the same time with other Service Users. The manager reported that there is a potential for service users needing peg feeding to be admitted to the home and as staff members are not currently able to manage the care for Residents with Peg, or (Enteral), feeds. The Inspector advised they must have specific training in this aspect of care and have a certificate provided by the nurse trainer to evidence this prior to any such admissions. This training is being planned but then must be updated annually. Residents with epilepsy have a detailed, laminated sheet in their medication folder explaining how a seizure is recognised for that person, and how to deal with it (i.e. this includes the triggers, signs, pattern and other information. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory systems were in place to manage complaints and ensure the protection of residents under “safeguarding adults” policies and procedures. EVIDENCE: Standard 22 The home had policies and procedures in relation to complaint management. An adequate system was in place to record complaints made about the service. A pictorial complaints leaflet has been provided to assist residents understand the facility and a book provided in the entrance area for the purpose of encouraging visitors to the home to register any concerns or compliments in writing. The Inspector examined the complaints log and noted that since the previous inspection in November 2006 there had been no complaints that had been received by the home and none were received by CSCI Standard 23 Two incidents in respect of safeguarding adults have arisen since the previous inspection in November 2006. Both related to allegations made firstly, about the new deputy manager and secondly, about the manager and a member of staff. Both incidents were reported to CLDT and CSCI and were fully investigated under “safeguarding adults” procedures. In both incidents the allegations were not substantiated and the view taken was that they were both Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 21 instigated by a member of staff with malicious intent, although this was not established either, as the allegations were anonymous. The home has a copy of Greenwich Safeguarding Adults protection policies and procedures. Allegations or suspicions of abuse would be referred to the learning disability team for investigation. There was evidence to show that staff had received training on this topic and had read the new procedures and signed a form to indicate that this was done. The Inspector examined the system for dealing with the personal monies of two residents within the home, chosen at random, and found it to be accountable and with a clear audit trail. Additionally, the service is regularly audited by the person in control from Caretech, within the programme of monthly visits undertaken under Regulation 26. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents users live in a homely and comfortable environment that is safe clean and hygienic. Individual and communal accommodation suits residents’ needs. The home had the specialist equipment they need to maximise the independence of residents. The home was clean and hygienic. EVIDENCE: Standard 24 Access to the property, can only be gained by a member of staff opening the front door from the inside, and there are security keypad locks in place on each floor to prevent service users from leaving the building unaccompanied. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 23 The Home was purpose built, and consideration has been given to ensuring suitably wide corridors for wheelchair users, and access to all floors via a passenger lift. Requirements were made at the previous inspection to repair a recliner chair and replace a sofa. Both of these requirements were complied with, although another recliner chair now needs to be similarly repaired and an item of patio garden furniture. See Requirement 2. A requirement was made previously, to replace the dishwasher on the ground floor, and this was complied with. Overall, the standard of decoration was adequate and had been improved following a recommendation in respect of the communal areas. Standards 25 – 29 Individual bedrooms are suitably sized for special equipment. Ground floor bedrooms are fitted with overhead hoisting facilities, and all bedrooms have en-suite toilets and showers. These were fitted with grab rails, handrails, specialised toilet seats and other equipment as needed. All rooms are fitted with a call bell system. Bedrooms were fitted with good quality furniture and furnishings, but looked rather utilitarian, as there is not the opportunity for service users to personalise rooms. The poorly fitting curtain rails in residents’ bedrooms, was addressed following a previous requirement to ensure that the rails be securely fitted, and this was complied with promptly. A previous requirement to replace the economy lighting installed in bedrooms was also complied with, in order to promote safety when mobilising residents. The bathrooms, one on each floor are fitted with specialist baths, enabling service users to have a bath, instead of a shower within their en suite rooms if they prefer. Risk assessments are carried out to specify the level of supervision needed for someone having a bath. At the previous inspection the Inspector noted that the bathroom door and adjacent side panel had a large gap between them that meant that privacy for service users was compromised. This was attended to as a matter of urgency. At this inspection it was noted that an area of tiling had lifted in one of the ensuite bathrooms and a toilet seat requires replacement and secure fixing. Newly fitted shelves to house sensory equipment had angular edges close to head height near door entrances and must be made safe to prevent potential head collision with them. See Requirement 3 Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 24 Standard 30 The laundry room is fitted with 2 industrial quality washing machines and 2 tumble dryers and a red alginate bag system is used for dealing with soiled items. The manager stated that there have been numerous breakdowns requiring service engineers to be called out and on occasions there have been delays in getting the machines repaired. It is recommended that the organisation give consideration as to how best to ensure this does not occur so frequently. See Recommendation 3 Each resident’s laundry is washed separately. The Home was very clean, throughout the building and hazardous substances stored in accordance with COSHH regulations. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Training Action Plan was virtually completed and ongoing training was being planned for the future. Residents who stay at the home are cared for and supported by competent and qualified staff. The recruitment policy and practices was satisfactory. EVIDENCE: Standard 32 The Manager is well supported by a deputy manager who works part time three days per week and another full time deputy who was recently appointed in January 2007. The home has a complement of fifteen carer staff, four, of whom, are team leaders/care coordinators. The home has achieved the minimum requirement of fifty per cent care staff qualified to level 2 NVQ or above. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 26 Standard 34 The personnel file was examined for the most recent and only new member of staff since the previous inspection, the deputy manager. Recruitment practice was found to be in accordance with the requirements of Regulation 19 and Schedule 2 of the National Minimum Standards. Documentation was seen that showed that application forms include a section for previous employment history, with an explanation required for any gaps in employment. 2 written references are taken, and POVA First checks and CRB (Criminal Record Bureau) checks are carried out prior to commencement of employment. The CRB checks are arranged through the Company’s Head Office, and the Manager sees written confirmation of the CRB. Standard 35 The Company have their own comprehensive training programmes for all staff, which includes all mandatory training (fire awareness, moving and handling, basic food hygiene, first aid and infection control), and other relevant courses. Additional training is given in understanding autism, sign-along (communication skills), medication training, and behaviour management (nonviolent crisis intervention). However, there was a considerable amount of training required arising from the CLDT investigation that took place last year. The Inspector noted that nearly all of this training had been implemented. The remainder was scheduled for completion in the next few weeks. A good level of training had been provided and was being planned for. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Following a difficult period the manager has introduced new systems to improve record keeping and communication between staff in response to the CLDT investigation recommendations of 2006. Quality assurance mechanisms were developed and surveys of residents are provided on a regular basis. The Health and Safety of service users are promoted and protected. EVIDENCE: Standard 37 The Manager joined the staff group in February 2006 and is experienced and qualified to run the home. He is currently undertaking the Registered Managers qualification and hopes to have completed this by the September 2007. The Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 28 manager was appointed as the registered manager for the home recently following a successful application to CSCI. The incidence of three anonymous and unsubstantiated “safeguarding adults” allegations made toward management and other staff members is a cause for concern. The Inspector is aware that the manager has attempted to deal with this issue within both supervision and team meetings, and the matter was on the agenda for the team meeting on one of the days of inspection. All staff members must be made aware of the necessity of good teamwork in order to best meet the needs of residents placed at the home and not jeopardise this through making apparently false allegations. Standard 39 The Home provides feedback questionnaires for service users and relatives to complete after each visit, these showed that service users are generally happy with their levels of care, and have the opportunity to raise concerns in a nonthreatening environment. The annual survey conducted by Caretech of the views of carers and involved professionals has just been completed and the results currently being analysed. Initial responses appear to have been generally favourable and in any event the results will be made public and a copy sent to the CSCI. The home is also subject to regular contract monitoring visits by the commissioning unit of the London Borough of Greenwich Social services Department and regular monthly visits by the person in control under regulation 26 and those reports are sent regularly to CSCI. Standard 41 Overall, the standard of record keeping had improved. However, the Inspector noted that the administrative person appointed to assist with the updating of records was leaving and that she was apparently not being replaced. This would appear to be a retrograde step and the Inspector strongly recommends that this be reviewed by the organisation. See Recommendation 4 Standard 42 Records indicated that all gas, fire and electrical systems and equipment in the home are serviced and inspected appropriately and that all internal checks are conducted at appropriate intervals. Accident and Incident records had been completed appropriately and it was noted that, overall, there had been a substantial reduction in frequency since the previous inspection. An Environmental health inspection has not been conducted in the recent past and the manager was advised to check whether the home was scheduled for such an inspection. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 29 See Recommendation 5 A number of areas were picked at random and checked against the pre inspection questionnaire, in respect of routine health and safety checks such as fire drills and other areas requiring maintenance checks. This information provided, was accurately recorded and in accordance with that submitted by the manager to the CSCI. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 30 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 Standard No Score 1 3 2 2 3 X 4 X 5 N/A INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 3 3 X Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 31 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 YA6 & YA2 Regulation 15 (2) Requirement To ensure that all assessments care plans and care files are updated from updated CLDT reviews. Notification of progress made in conjunction with CLDT to be notified to CSCI. Restated as previous timescale of 01/03/07 not met The recliner chair on the ground floor unit must be repaired /replaced as a matter of priority and a patio chair replaced. Some tiles in one en suite need replacing and one toilet seat needs replacing. Shelving for sensory equipment must be made safe for residents. Timescale for action 01/10/07 2. YA24 23 01/09/07 3 YA24 23 01/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard YA2 Good Practice Recommendations 1. Efforts should be made jointly by the home and CLDT to DS0000062951.V340230.R01.S.doc Version 5.2 Page 32 Kemsing Road Respite Service 2. 3. 4. YA14 YA30 YA41 5. YA42 convey to relatives/carers the importance of reviews of not being cancelled unless unavoidable. Continued efforts should be made when recruiting new staff to recruit those who could drive the mini bus for the home. The frequency of breakdowns and subsequent delay in repairs to the washing machines should be rectified. The impact of the imminent departure of the administrative assistant should be reviewed to determine whether the staff can adequately sustain the improvements made to documentation without such assistance. The manager should check with the Environmental Health Department that an inspection will occur at some time. Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Kemsing Road Respite Service DS0000062951.V340230.R01.S.doc Version 5.2 Page 34 - 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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