Inspection on 31/05/06 for Kemsing Road Respite Service

This inspection was carried out on 31st May 2006.

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 24/05/07

Kemsing Road Respite Service 22/11/06

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 Key Unannounced Inspection 31st May 2006 09:30 Kemsing Road Respite Service DS0000062951.V306451.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.V306451.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.V306451.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 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) Caretech Community Services ** Post Vacant *** Care Home 8 Category(ies) of Dementia (0), Learning disability (0), Learning registration, with number disability over 65 years of age (0), Mental of places disorder, excluding learning disability or dementia (0), Physical disability (0), Sensory impairment (0) Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2005 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 which 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 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.V306451.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service was registered with the Commission for Social Care Inspection (CSCI) in July 2005, and this was the third unannounced inspection carried out by the Commission. The two previous inspections were carried out on 28/05/05 and 23/01/06, the latter being an additional visit as several concerns regarding staffing levels and complaints had arisen as well as a failure to report a significant event under Regulation 37. Following this inspection a meeting was held between senior Caretech staff and the CSCI on 28/03/06 when it was established that all matters of concern were being addressed. The service also received a specialist Pharmacist Inspection on 24/03/06 in order to advise the home how best to arrange the storage and administration of medication. The Inspector was pleased to note that the recommendations of the subsequent report are being responded to and the organisation has recently approved the finance and implementation of the necessary work to provide additional appropriate medication storage. This inspection lasted from 9.30 am to 4.30pm on 31/05/06 and from 1.30pm –6.00pm on 1/06/05 and the Inspector was assisted during this time by the manager. The Inspector was also able to meet the Deputy Managers and 3 other staff, four service users and two relatives during this inspection. The Inspector noted that all previous requirements and recommendations made from the additional visit inspection had been complied with or were underway. The inspection included, reading documentation, for example, assessment information, care plans, and medication charts, a tour of the premises; inspecting medication procedures, and checking of information in regards to staff recruitment, training, and supervision. The premises were clean, well decorated, and suitably equipped. There were good organisational systems in place, and staff members were clearly familiar with their roles, and committed to meeting the needs of the constantly changing Service Users. The Inspector noted that there was good support provided by the District Nurses, Community Learning Disability Team, and other health professionals. Good efforts were being made to improve communication with the wider Learning Disability Service. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The manager is very aware of the need to update care files for approximately half of the service users who use the service. Previous timescales have not been met but the manager is confident that this will be achieved prior to the next inspection and there is a firm expectation that this will be complied with. This requirement is restated with an agreed extended timescale. A requirement was made to ensure that two signatures are obtained on the MAR sheets in respect of hand written entries, effectively, all of them, because of the short- term nature of the care provided. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 7 The manager is planning to provide mobile sensory equipment in response to a previous recommendation made at the last inspection and this recommendation has been restated and should therefore be implemented as soon as possible. The manager should continue his efforts to recruit bank staff in order to facilitate consistent provision for service users from staff members who are well acquainted with the needs of service users and the current 20 hours staff vacancy should be filled as soon as possible in order to allow flexibility of manning the rota. It is recommended that the complaints procedure should be amended to record verbal complaints and provide outcomes as to whether substantiated or nor or partially substantiated and whether the complainant was satisfied with the outcome. A requirement was made to ensure that fire drills must be conducted at least once in every quarter and all night- time care staff involved in a minimum of two fire drills per annum. Attendance of staff must be recorded. 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. Kemsing Road Respite Service DS0000062951.V306451.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.V306451.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides clear information to enable Service Users and their relatives to make an informed decision about respite care in the Home; and there are good assessment processes in place to ensure that the Service Users’ needs are met. The home is currently updating the Statement of Purpose and the Service user Guide and will send copies to the CSCI. EVIDENCE: The Inspector noted that the contact details both within the Statement of Purpose and Service User Guide should be amended to CSCI, not the NCSC. The manager also confirmed that other amendments were being prepared and agreed to send the amended copies of both documents to CSCI as soon as they are completed. See Requirement 1. The Inspector discussed pre-admission assessments with the Manager, and viewed documentation regarding the assessment process. Many Service Users had previously received respite care at other venues, which have been discontinued, and there were already comprehensive records available for Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 10 these. Some of the staff had been previously employed at these Homes, and this has helped with the continuity of care for some Service Users. New Service Users are referred via a Care Manager and usually in association with the Community Learning Disability Team. The Service User and their next of kin are visited by the Manager, at home or at school (as some may be school leavers) and then invited to visit the Home and meet staff and view the premises. A number of visits may be made either way, according to the individual situations. The Service User would usually be invited to stay for tea and the afternoon/evening, and then for an overnight stay. The respite care would then be developed according to need. The Home has also held a number of open days to enable Service Users and their relatives to visit together, and a number of these visits have included barbecues, providing a relaxed and informal atmosphere. The Home uses a set assessment format, and the Inspector looked at a completed assessment 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 requirements; mobility, and lifting and handling needs; sensory awareness; communication; literacy, social skills; likes and dislikes; and any difficult behaviour patterns or safety issues. Daily routines are noted in order to ensure that ongoing commitments are maintained such as attendance at and college and day centre activities. Individual assessments clarify if any specific equipment is needed. An example of this relates to a Service User who has a tendency to develop pressure sores. When this Service User has respite care, an alternating pressure-relief mattress is obtained and fitted to the bed prior to admission. The Manager arranges for Service Users 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 Service Users for staying with others, and this is taken into account with the allocation of rooms. The Manager operates the bookings on a flexible system, however this is pre determined in terms of overall allocation by the local CLDT team and is currently under review in order that the allocation is shared equitably amongst those who are eligible to use the service. Kemsing Road Respite Service DS0000062951.V306451.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6-10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users’ personal goals are reflected in their care plans, and they are enabled to make decisions about their own lives, and aspects of life in the respite centre wherever possible. EVIDENCE: The Inspector examined four care plans, these are individually contained in ring binders named active files, there are also large ring binders called inactive files that contain historical information not considered currently relevant. It was noted that a previous requirement to ensure that all care plans are updated was not fully complied with owing to reported difficulty in arranging a backlog of reviews with CLDT. The Inspector advised that the staff of the home must conduct their own reviews in the interim period and it was confirmed by the manager that this was in hand. In view of the circumstances an extension was agreed to the previous timescale and a requirement made accordingly. This timescale must now be met to ensure that all care plans and care files are Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 12 updated and relates to approximately half of all the service users who use the respite care service provided by the home. See Restated Requirement 2. Care plans contain a client information sheet supplying an index for easy access of information. The first section is for individual support requirements, and contains detailed information for meeting personal care needs; how to explain different aspects of care to the Service User; communication needs; continence and toileting needs; religious and cultural needs; nutritional needs, and emotional needs. There are lists of likes and dislikes, and the Service User’s usual preferences in regards to going to bed and getting up in the mornings. Personal care support is very precise, ensuring that support staff members are informed about risk areas with skin integrity, use of incontinence pads, and use of hoisting facilities. The section for moving and handling contains specific instructions about the hoist to be used, the type of sling, and how to carry out individual moves, for example: how to use a shower chair, wheelchair or vehicle.) It was noted that a previous requirement to ensure that safe practices are maintained in relation to moving and handling had been complied with. Care plans also contain details of preferred activities, and for college and day centre use. They are discussed with the Service User and next of kin prior to admission, and updated to reflect changing needs. The home requires detailed completion of an admission sheet each time the service user is admitted to the home in order that carers are obliged to ensure that the home is updated with any essential new information or changes, for example, detailed information regarding medication. All carers have been advised in writing of the admission procedure and that admission mat be refused if the information is not provided owing to problems that have occurred in the past because of incorrect information. Service Users are invited to take part in the life of the Home wherever possible, and this may include taking part in tidying clothing, assisting in the garden, or watching/taking part in food preparation in the kitchens. The checking out system includes a form to encourage Service Users and family members to indicate if the Service User enjoyed their stay, and any aspects that could have been improved by the staff members. Risk assessments were seen in respect of different equipment used, for example, hoisting equipment, cot sides and in relation to different activities that may take place, for example, observation of activities in the kitchen, going out in the Company vehicle. Documents are stored confidentially in a locked office. Day to day records are kept on each floor in respect of checking in and out forms, updated changes since the last stay, and feedback information. These records are in individual Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 13 folders, and are inaccessible to Service Users, but available for staff to be quickly updated with changes in care for different Service Users. Kemsing Road Respite Service DS0000062951.V306451.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11-17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home enables Service Users to follow their preferred lifestyles, taking part in different activities, continuing with college and day centre placements, and accessing the local community. Attention is given to maintaining dietary needs by providing a well-balanced and varied menu that includes any special dietary needs. EVIDENCE: Any decisions required about promoting and developing practical life skills are taken by a multi-disciplinary team, in conjunction with service users’ carers. Any updates for changes in the support plan are obtained at each admission of a service user, and if recommendations for change are made these, should, have been communicated by either the family, Care Manager, Community Learning 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 Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 15 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 updated information to assist and inform the care staff. Some Service Users 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, pottery etc. Most Service Users are at college or Day Centre from Monday to Friday, and the staff members 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 Service User’s 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. Some service users would benefit from use of sensory equipment, and this matter is being actively considered, following a recommendation made in the previous report and should be implemented as soon as practicable. See Restated Recommendation 1. Family members and friends are able to visit at any time, and staff members encourage service users to maintain friendships. Respite care may be planned because the next of kin are on holiday, and therefore attention to facilitating supportive relationships friendships may well be of greater significance. Staff members enable service users to choose whether 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. 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 Service Users 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. The service has a Company van, and most staff are registered as drivers, and 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 from the kitchen sink and both kitchens were identical in design and layout. Staff members are able to manage the care for Service Users with Peg feeds, as they have been specifically trained in this aspect of care, and this training is Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 16 updated annually. The Dietician, and a Nurse from the Enteral feed company have given training and advice, and are accessible for any concerns. Peg feed pumps are set up by the District Nurses. The Inspector saw that clear guidelines are in place, and very detailed instructions. A record is kept of the feed and fluid intake. Kemsing Road Respite Service DS0000062951.V306451.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18-20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users are given personal support and health care in a way that promotes their dignity, and meets their assessed needs. There are good systems in place for the administration of medication, ensuring that Service Users are given medication as prescribed. This will be further improved when the new facilities are installed for storage and handwritten entries on MAR sheets are countersigned. EVIDENCE: The four care plans examined showed that systems are in place to identify the personal support required by each Service User, and clear instructions are written to enable support staff to know individual needs. Personal care is provided in the privacy of the Service User’s own room and en-suite facility, or in the bathroom on their floor. These rooms have been set up with the necessary equipment, and service users are supported or supervised according to their individual ability. Same gender care is given as much as possible, and this is discussed and agreed during the pre-admission assessment stage. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 18 Service Users 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 service users are ready for their transport to college or Day Centre, and have had their personal items, clothing and medication checked out if they are not returning to the respite centre that day. There are good systems of liaison between different health professionals, ensuring continuity of care. These include medical and psychiatric consultants, District Nurses, Enteral - feed nurses, dietician, physiotherapist, GPs, occupational therapists and speech therapists. Initial, Occupational Therapy assessments, prior, to the first admission to the home, are carried out by an OT, when required, checking for use of wheelchair, use of bath or shower, and vehicle use. Personal support plans show detailed instructions for 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. A previous requirement made to ensure that all health care needs are met had been complied with. All staff members are required to carry out basic medication training as part of their induction, however, medication is usually 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. Medication is stored in a locked room, in 2 separate locked metal cabinets – one for each floor. Each Service User has a separate medication folder, which has their photograph, and their room number entered on to it. There are specific guidelines for each Service User for administering their medication. This is given to each Service User one at a time, in case there is a distraction or an emergency situation at the same time with other Service Users. Service Users 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 description of seizures for that person.) There are specific instructions regarding the use of rectal diazepam, and all staff members are trained in this. Some medications (such as enemas) are administered by District Nurses. Medication cupboards were well organised, and each Service User’s medication was stored separately. Medication Administration Records (MAR charts) had been properly completed and signed, with the exception that hand written entries on the MAR sheet had not been countersigned, this is a requirement for there to be two signatures and particularly so, as all entries are hand written given the short term nature of respite care. See Requirement 3. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 19 It was noted that a previous recommendation that a list of staff signatures and initials is put in place to trace accountability had been complied with and also previous requirement that MAR sheets be reformatted to ensure greater space and clarity for recording had also been complied with. The Manager stated that random audits of medication are conducted on a regular basis (e.g. once/twice per week.) Following the previous inspection the home received a pharmacist inspection at which recommendations were made about the facilities for the storage of medication on 24/03/06. The Inspector was informed that the subsequent recommendation made to provide alternative locations, one on each of the two units, has been acknowledged and that arrangements were in hand to both purchase the necessary equipment and for it to be installed appropriately were in hand. The documentation to evidence this was seen by the Inspector. It is recommended that these new facilities be implemented as soon as practicable. See Recommendation 2. Kemsing Road Respite Service DS0000062951.V306451.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is largely satisfactory, and service users are enabled to voice any concerns. However, verbal complaints must be logged and a format reflecting the questions asked in the Pre Inspection questionnaire be adopted in the written log of complaints, that clearly states outcomes in writing. Staff members are trained in the recognition and prevention of adult abuse, protecting service users from harm. EVIDENCE: The Home has an almost satisfactory complaints procedure in place, and a copy of this is included in the Service Users’ Guide, which is given to out prior to the first admission. A file has been implemented for recording any complaints, and the action taken to resolve them. However it was noted that minor verbal complaints received had not been recorded in such detail and did not differentiate whether they were substantiated, partially substantiated, or not substantiated. All complaints should be dealt with in this way and should indicate the date of response by the home in writing and record whether the complainant was satisfied or not with the outcome of the investigation of the complaint. See Recommendation 3. The Inspector noted that the complaints procedure is now on display for visitors to the Home in the entrance area by the signing in book, following a recommendation made at the previous inspection. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 21 The Manager stated that all staff had been trained in adult protection procedures, and in the recognition of different types of abuse. The Inspector has also noted that the manager has also ensured that good communication with CSCI has taken place regarding any incidents that have occurred by way of Regulation 37 notifications and other communications with the with the Inspector. A previous recommendation that these notifications be improved and staff made aware of the importance of them was complied with. The home has a current adult protection investigation underway, the Inspector has been kept informed of progress made but the final outcome is not known at the time of writing this report. However, the Inspector is satisfied that the correct procedures have been complied with and that service users are protected by the adult protection policy and procedures in place within the home. Any implications regarding practice in the home arising out of this investigation will be reported in the next inspection report. Kemsing Road Respite Service DS0000062951.V306451.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well presented, clean and well decorated, and provides an attractive and homely environment. There are good quality furniture and fittings, and suitable toileting and en-suite facilities. Shared space meets the national minimum standards, but is a little restricted in practice. EVIDENCE: 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. Staff rooms, clinical room and laundry facilities are situated on the top (second) floor, and this is not ideal as staff have to leave service users every time they need to access paper work and documentation, to fetch medication, and to carry out laundry care. Medication processes may be improved by the addition of purpose designed medication cabinets on each floor in the near future, mentioned earlier in the report. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 23 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 bare as there is not the opportunity for service users to personalise rooms. 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 check the level of supervision needed for someone having a bath. 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. Each flat has a lounge leading through to a dining area, and a separate kitchen. The communal lounge/diners do not allow much space if the home is full and service users choose to use the communal accommodation. This is especially difficult if there are a number of wheelchair users in residence, or if any service users are exhibiting challenging behaviour. There is no sensory room or quiet area, and the Inspector was informed that portable sensory equipment will be provided to maximise usage and to provide flexibility. This provision was a recommendation at the previous inspection and has, been responded to positively. The laundry room is fitted with 2 washing machines and 2 tumble dryers. Washing machines have an integral sluicing facility, and a red alginate bag system is used for dealing with soiled items. Each service user’s laundry is washed separately, and this means that with the high turnover of service users, that these machines are in constant use. The Home was very clean in every area. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 24 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): 31-36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff members interviewed showed a good understanding of the service users’ support needs, and work well together to provide effective care. Good systems are in place to enable satisfactory training for staff and the recruitment process well organised. Staffing levels are satisfactory but must continue to be monitored in order to ensure that any challenging behaviour receives additional staff support. Staff members are regularly supervised and good opportunities provided for staff members to contribute to the development of the service. Service users are encouraged to comment on the service provided. EVIDENCE: The Manager is well supported by 2 Deputies; one of these works full time hours and oversees “hands-on care”, and the other works 2 days per week and oversees medication procedures, staff training and other areas as required. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 25 There is a Team Leader allocated to each floor for each shift, and these staff are fully aware of the additional responsibilities in ensuring checking in and out procedures are properly carried out, medication is administered, and other staff are supervised appropriately. There is ample opportunity given to staff to share ideas and concerns, and the Manager has an open door policy and is usually available for individual conversation. Staff members were seen to be relating well to each other, and supportive of each other’s roles. Team meetings are held regularly and the minutes of these showed a comprehensive agenda and good participation from staff members. The staff members interviewed had a good understanding of the Service Users’ support needs, and work well together to provide effective care. Good systems are in place to enable satisfactory training for staff. Staffing levels are satisfactory but this will require continued monitoring to ensure that at times when challenging behaviour is presented that adequate supervision is provided. The current 20 hours staff vacancy should be filled as soon as possible in order to allow flexibility of manning the rota and the manager should continue his efforts to recruit bank staff in order to facilitate consistent provision for service users from staff members who are well acquainted with the needs of service users. See Recommendations 4 & 5 The Inspector was able to view four staff files at this visit. 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, and the information included. 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). Courses are arranged with the Community Learning Disability Team, and with the dietician (nutritional training). Several staff had completed NVQ 2 or 3 training, however the company will need to carefully monitor that the required 505 of staff qualified to NVQ level 2 is achieved as soon as possible. Supervision is conducted regularly on a monthly basis, and records examined showed that this area was fully met. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 26 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. Comprehensive written policies and procedures were in evidence and all accessible to staff members. Records were well completed and were appropriately stored in order to maintain confidentiality. Kemsing Road Respite Service DS0000062951.V306451.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37-42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager provides clear leadership throughout the Home, and is supported well by senior staff all of whom have allocated roles and responsibilities. There are systems in place to enable Service Users and relatives to feed back their views, and these are acted on appropriately. EVIDENCE: The Manager had only recently joined the staff group in February 2006 and is well experienced and qualified to run the home. He is currently undertaking the Registered Managers qualification and hopes to have completed this by the middle of 2007. The manager hopes to be appointed as the Registered manager for the home and had just submitted his application to the CSCI. The Inspector gained positive feedback from four staff members interviewed that the manager is approachable and that good procedures are being adopted in Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 28 the running of the home. The Inspector felt that the manager was motivated to provide a good standard of service and evidence was available that he was engaged in the process of seeking advice from various professionals within the local Community Learning Disability Team in order that the home could achieve better communication with them. The service was registered with CSCI last year in 2005 and the Inspector was pleased to see that after a difficult period between the previous manager leaving and the new one commencing service a good efforts have been made to respond to requirements and improve the running of the home and the service provided. 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. Records were well completed and were appropriately stored in order to maintain confidentiality. A comprehensive manual of written policies and procedures were seen, these are easily available to all staff members and evidence was available that these are amended and updated as required. Records were well completed and were appropriately stored, except for the need to update some care files referred to earlier in the report and this is being addressed. Staff members were trained in safe working practices and this was substantiated when interviewing four staff members and through observations made by the Inspector. Chemicals for cleaning and laundry were kept in locked cupboards, and COSHH leaflets were available. Storage for wheelchairs and hoists was limited, but these items of equipment were stored where there was minimum health and safety risk. A monthly health and safety check is carried out for the building and was seen by the Inspector. Several other records to do with Health and Safety were examined and picked at random by the Inspector and those seen showed that staff members record information comprehensively and in accordance with required timescales. However, it was noted that fire drills had not been entirely carried out entirely within the Standard and a requirement was made that these occur at least once within every quarter year and that all night time care staff must be involved in at least two fire drills per annum and all staff in attendance at fire drills must be recorded. See Requirement 4. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 29 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 2 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 3 3 LIFESTYLES Standard No Score 11 3 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 2 x 3 3 3 3 3 2 x Version 5.2 Page 30 Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc 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 YA1 Regulation 4 & 6 and Schedule 2 Requirement To ensure that the Statement of Purpose and Service User Guide are updated as soon as possible and include the contact details for the CSCI. Both documents to be sent to CSCI when completed. To ensure that all care plans and care files are brought up to date in respect of daily care of service users. Restated Requirement, previous time scale of 31/12/05 not met Handwritten entries on MAR sheets must be countersigned Fire drills must be conducted at least once in every quarter and all night- time care staff involved in a minimum of two fire drills per annum. Attendance of staff must be recorded. Timescale for action 31/08/06 2 YA6 15 (2) 31/08/06 3 4 YA20 YA42 13 23 01/08/06 01/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 31 No. 1. 2 3 Refer to Standard YA29 YA20 YA22 Good Practice Recommendations To provide sensory equipment for service users. The relocation of medicine cabinets should be implemented as soon as practicable. The complaints procedure should be amended to record verbal complaints and provide outcomes as to whether substantiated or nor or partially substantiated and whether the complainant was satisfied with the outcome. The current 20 hours staff vacancy should be filled as soon as possible in order to allow flexibility of manning the rota. The manager should continue his efforts to recruit bank staff in order to facilitate consistent provision for service users from staff members who are well acquainted with the needs of service users. 4 5 YA33 YA33 Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Kemsing Road Respite Service DS0000062951.V306451.R01.S.doc Version 5.2 Page 33 - 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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