CARE HOMES FOR OLDER PEOPLE
Keneydon House 2 Delph Street Whittlesey Cambridgeshire PE7 1QQ Lead Inspector
Don Traylen Key Unannounced Inspection 10:30 23rd May 2006 X10015.doc Version 1.40 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 Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Keneydon House Address 2 Delph Street Whittlesey Cambridgeshire PE7 1QQ 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) 01733 203444 01733 202648 ADR Care Homes Ltd Eileen Redhead Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21) of places Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Old Age not falling into any other category (OP) - 21 (both sexes) Dementia - over 65 years of age (DE(E) - 21 (both sexes) Date of last inspection 10th January 2006 Brief Description of the Service: Keynedon House is a care home registered to provide for 21 people over the age of 65 years. The home is situated in the town of Whittlesey, near Peterborough and is close to local amenities. The home is an older property built approximately in 1890. The accommodation is on two floors accessible by stairs or a chair lift to the first floor. A ground floor extension housing six bedrooms was built approximately 15 years ago. There are 13 single and 4 double rooms and a large garden to the rear of the building. The home provides day care provision on Mondays, Wednesdays and Fridays for 1-3 people as well as preparing and delivering meals for up to 14 people who live in the immediate vicinity. The day service users share the same facilities enjoyed by the permanent service users living at the home. According to the Service User Guide the fees asked by the home at the time of this inspection ranged between £357 per week and £385 per week. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspectors carried out the inspection of the home on the 23/05/06 at 10:30 am. The manager showed both inspectors around the home. Four service users were spoken to and time was spent with service users and staff in the lounge and dining areas of the home. Lunch was observed being served as was the preparation of the meal. The registered manager and the registered provider were present during the inspection until the registered provider left just after midday. Feedback of the inspection was given to the manager prior to both inspectors leaving at 2:30 pm. What the service does well: What has improved since the last inspection?
The home has responded in writing by providing an action plan and has addressed each of the 11 requirements made in then last inspection report of the 10/01/2006. It is considered that 10 of the 11 requirements have been satisfactorily met and a further requirement, No 2, concerning the adult abuse policy has been addressed and partially met. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 6 Other improvements that have been achieved include redecorating of 3 bedrooms and a further double room being redecorated on the day of inspection. New flooring suitable for service users and chosen by them or their relatives had been laid in all rooms that had been redecorated. New bedroom furniture including beds and wardrobes have been provided. Although a written plan of these improvements and future improvements was not available the manager and registered provider explained their intention to carry out further improvements subject to their priority and to financial consideration. Care staff expressed their enthusiasm about the improvements and informed the inspector about the registered provider’s plans to make further redecoration. The manager and provider have discussed and recorded their intentions to bring about improvements. The manager and the registered provider meet monthly and have taken decisions to increase staffing by intending to employ one additional care assistant from Mondays to Fridays between 10am and 5pm. Maintenance issues and staff training issue have also been an agenda items for discussion and a plan to redecorate rooms when necessary and when they become vacant has been recorded in the minutes of the manager and provider meetings. Staff training for a 13-week dementia care course was a significant aspect of the further training arrangements made by the manager. Staff recruitment has become more thorough since the last inspection report (10/01/06) so that the process ensures the CRB and ‘Pova First’ vetting is known to the manager and complies with The Care Homes Regulations 2001. Record keeping for Regulation 26 reports and & Regulation 37 events are now retained at the home. Record keeping continues to improve and other records maintained by the home were easily found, clearly identified, neatly maintained and kept up to date. One new care assistant has been recruited. What they could do better:
1. A requirement has been made for the home to include their address in the Statement of Purpose and Service User Guide. 2. The home must include in their policy to protect vulnerable persons their agreement and compliance with the two Local Authorities guidance to care services about protecting vulnerable persons from abuse. This was discussed with the manager and it was agreed that whilst the home clearly understood and practised the Local Authority guidance, it was not
Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 7 explicitly declared in their written policies. A requirement has been made relating to this action and a recommendation to refer to the home’s policy in their Statement of Purpose. 3. Overall the main subject for improvement is the condition of the building and decorative state of the interior and some of the exterior parts. The registered provider explained he is very aware of the need for improvement and the various aspects of the old building he would like to change. He is aware of the decorative need, the worn fittings and electrical wiring that need replacing. It is recommended that the manager and/or provider make a written plan of their intentions to improve the internal and external environment by redecorating or other means. Their intentions were spoken about during the inspection by the registered provider and by care staff who had been consulted and informed of some of the ideas and plans the registered providers would like to bring about. Given the likelihood that the home will have changing priorities for any planned improvements, it would be a sign of quality assurance and control if a written plan to improve the structure or decorative state of the building were made. 4. It is recommended that the initial induction offered by the home during the first few days when a new member of staff commences employment should include the topic of protecting vulnerable adults from abuse. However it should be noted that the longer induction period for the training arrangements made for new staff during does include training in the protection of vulnerable adults and subsequent training in this topic is provided by the Local Authority(ies). 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. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, The quality outcome for the group of Standards assessed is good. Service user needs are appropriately assessed and the home endures they are able to meet their needs prior to admission. EVIDENCE: At the time of inspection there were 18 service users living in the home of whom 5 were privately funding their care and 13 were part funded by their Local Authorities. Fees for care and accommodation at the time of this inspection ranged between £350 and £385 per week. The home has previously met most of the Standards in this group and continues to do so. The Statement of Purpose and Service User Guide have both been reviewed although neither included the address of the home or the date of review but this was agreed by the manager to be added with immediate effect. The Service User Guide included the range of fees charged. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 10 It was discussed with the manager that the home could include in their Statement of Purpose their recruitment policy that is designed to protect service users and also to indicate their adherence to Cambridgeshire County Council’s and to Peterborough Primary Care Partnership’s guidance to care services about protecting vulnerable adults from abuse. Care Management assessments are supplied to the home prior to any planned admission. A trial period for prospective service users is arranged and an assessment by the registered manager is carried out. One new service user informed the inspector that he was pleased to be living at the home. One service user’s contract revealed the charges are within the above stated range of fees. As a financial and contractual consideration, it is relevant to report that the home does not manage service users’ finances. Intermediate care is not provided. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, The outcome for this group of Standards is good. Up to date records and plans of care are maintained and service users are held in respect. EVIDENCE: Three Care Plans that were read were judged to be focused, very well presented and practical so they could be used by care staff. An introductory page that described the service user as a person is considered by the inspector to be a good practice that recognises the person. References contained in the plans about the likes and dislikes and eating habits and a record of food eaten provided valuable and essential information. Weight charts were read of 2 monthly weight checks. Service users use local dentists and chiropodist and are accompanied by care staff when this is arranged for those service users who are physically fit to travel to these local facilities. Medication Administration Records (MAR) records were inspected and revealed accurate recording. A member of care staff described satisfactory methods of administration. It was notable that very few service users were receiving prescribed medication. No service users were self- medicating. The home’s medications policy was read and considered adequate.
Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, The quality outcome for this group of Standards is good. Service users experience a quiet daily routine and are visited by their relatives. EVIDENCE: One service user stated he was pleased with the daily routine, meals and mealtimes and his room. Another service user stated she was happy with living in the home. Family can visit at any time they choose. One service user said she did not feel that she was offered a choice about the food provided. The lunchtime meal was observed being prepared on plates and this may not allow service users to make judgements about helping themselves or socialising around food. However, observations made during the mealtime showed that service users were relaxed and some chatted to each other whilst others were quiet. Two care assistants were seen to gently assist two service users who required assistance to eat their meal. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, The quality outcome for this group of Standards is adequate but would be considered good if an appropriate policy to protect service users from abuse was available. EVIDENCE: The home has posted information about making a complaint on a notice board near to the front entrance. The home has written a new policy entitled, “Policy on Application of the Protection of Vulnerable Adults Register”. The policy is a comprehensive statement about their agreement to refer to the Pova register should it be considered necessary. However, the policy did not sufficiently relate to the home’s overall philosophy of protection towards vulnerable service users or their agreement with the (two) Local Authorities guidance issued to care providers about protecting vulnerable adults. The manager and care staff and provider are clearly in agreement with the Local Authority policy and stated their desire to protect vulnerable persons from abuse but had not written a statement to announce this. It was discussed with the manager that she should arrange with the provider to write this policy statement. A Requirement has been made to ensure this policy is written. Please refer to text in staffing section for details relating to staff training in protecting vulnerable adults. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26, The quality outcome for service users for this group of Standards is adequate although there are a number of aspects of the environment that should be improved. EVIDENCE: The home is an older property that is generally in need of decorative and some structural improvements. The home has different levels and stairways and steps to small recessed area that is a feature of the older style building. The decorative condition in parts of the home is worn and in need of general redecoration. For instance one bathroom had wallpaper that was peeling off a crack in the sink, a loose toilet seat and a carpet that was stained although it was kept clean. One other bathroom had a specialist deep bath that is not used by service users and is not in working order. The bathrooms mostly used are the bathrooms on the ground floor and these were in a better state of repair and decoration. The registered provider did not reveal his intentions for these bathrooms but stated that he would like to afford to improve the entire home. There are sufficient bathrooms and toilets at Keynedon House.
Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 15 A loose chandelier in the lounge was noticed by the inspectors and made known to the manager who arranged for the handyman to immediately secure the fitting. Two first floor windows were not fitted with working restrictors. The manager arranged for the handyman to immediately fit the broken restrictors during the inspection. 6 new chairs and a DVD player had been purchased for the lounge and the dining room carpet was being cleaned at the time of inspection. There is evidence of the registered provider’s intentions and plans to improve the environment. The plans were verbally stated to the inspectors and include potential rewiring of the home’s electrical circuits and their various fittings and the redecoration of a number of rooms and the replacement of floor coverings and furniture. The minutes of the monthly meetings held between the manager and registered provider recorded their discussion about improving the environment. Two care staff and a domestic cleaner informed the inspector they were aware of the provider’s intentions to improve the dining room and lounge areas of the home and replace furniture and redecorate bedrooms whenever this was possible. They stated they had been consulted during the team meetings about some aspects of the plans. The cleaner commented on how much easier it was to keep the home cleaner when vinyl floor covering had been laid in place of worn carpeting. New weighing scales have been purchased and 8 sets of bedroom furniture and 10 new beds. There were no offensive odours on the day of inspection. Service users rooms were personalised and comfortable and a number had been laid with new flooring and had been repainted. A handyman works for two mornings each week. The amount of work he is expected to undertake is probably more than he has time to devote to the tasks necessary to be undertaken. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, The quality outcome for this group of Standards is good. Staff recruitment and training arrangements are given appropriate priority by the registered manager and registered provider. EVIDENCE: There were three care assistants, the manager, the cleaner and the cook working at the time of the inspection. Observation indicated that service users were given appropriate attention and assistance when requested or deemed necessary and that staff ratios to service users needs were satisfactory. Staff training promotes safety for service users through correct moving and handling procedures, handling food, nutrition, safety and health and dementia care. 3 New staff have been appointed since the last inspection. All commenced employment after POVA first checks and two references were obtained. Photographs of staff are kept in their file and are also displayed on the wall near the entrance. Staff induction records were read and revealed a sufficient range of essential training is carried out after the initial 4- day induction programme. Induction in care tasks and care skills is provided through Greater Peterborough Primary Care Partnership (GPPCP) for all care staff employed by the home. An adult protection booklet called, ‘PIP to the Post’, was shown to the inspectors and the manager agreed that she would allow newly employed care staff to be instructed by this during their initial induction period.
Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 17 Most staff have had training in adult protection provided by (GPPCP) and the remaining 3 new staff are awaiting training dates to attend this training. The manager stated that she will undertake the Key practitioner training offered by Cambridgeshire County Council adult protection training. Training in a 13 week course called ‘Positive Dementia Care’ provided Dementia Care Matters organisation has been completed by all care staff apart from the 3 new care assistants. The course is a distance learning course with a test to be passed at the end of the course. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38, The quality outcome for this group of Standards is good. The management of the home has improved. EVIDENCE: The manager leads by example: she is enthusiastic and friendly and has a good relationship with the care staff and knows the needs and personalities of the service users. At the time of inspection she was completing an NVQ level 4 in management award. The manager stated that the registered provider who is based at the home for approximately two days each week supports her. Relatives meetings and staff meetings are regularly arranged and relatives have been consulted about the colour scheme and choice of flooring to be laid in the service users rooms. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 19 The manager has recorded the meetings she has with the registered provider that have indicated the plans to bring about improvement to the quality of the service. Overall the records constructed and maintained by the home were up-to-date. Records read included the complaints logbook and complaint policy, Care Plans, Regulation 26 and 37 reports and Medication Administration Records. The home has recently rewritten most of their policies. Staff supervision is arranged for all staff every two months and supervision records for 5 care assistants were read. Relatives meetings have been arranged and the last one was held on the 21/05/06. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 6(a) & Schedule 1 Requirement The Statement of Purpose and Service User guide must contain the address of the home. Timescale for action 01/07/06 2 OP18 13(6) The manager must ensure the home has a written Adult Abuse policy and procedures that includes the fact the home agrees to the guidance issue by Cambridgeshire County Council and Greater Peterborough Primary Care Partnership about protecting vulnerable adults. 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP19 Good Practice Recommendations The home should refer to their adult abuse policy in their Statement of Purpose. The manager and the registered provider are invited to
DS0000061370.V291380.R01.S.doc Version 5.1 Page 22 Keneydon House 3 OP30 share with the CSCI, in writing, their intentions to make improvements to the home. The induction programme for new care assistants should include in the first few day an awareness of adult abuse and a strong awareness of the home’s policy and procedures in these matters and re-enforce the responsibility expected of new care staff. Keneydon House DS0000061370.V291380.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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