CARE HOME ADULTS 18-65
Kenilworth 117 Balcombe Road Horley Surrey RH6 9BG Lead Inspector
Penelope Calthrop Unannounced 19 April 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Kenilworth Address Kenilworth 117 Balcombe Road Horley Surrey RH6 9BG 01293 784299 01999 999999 www.theavenuestrust.co.uk The Avenues Trust Limited River House, 1 Maidstone Road, Sidcup, Kent, DA14 5TA Joanne Wood Care Home (CRH) 6 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of Learning disability (LD), 6 registration, with number of places Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 30 - 45 YEARS 2. 3. 1 Named Service user may be aged over 45 years 2 named Service users may have a sensory impairment Date of last inspection 6 September 2004 Brief Description of the Service: Kenilworth provides a home for six adults with a moderate to severe learning disability and behaviours that may be challenging. Currently there are four males and two females living at Kenilworth. The home is owned and managed by The Avenues Trust, which has a number of similar homes in the Southeast of the Country. Kenilworth is a converted two floor house situated in a residential area of Horley, within reach of the town centre with its amenities. The property has six bedrooms across both floors, with communal areas consisting of bathrooms, kitchen, dining room and lounge. There is also a large garden with a summerhouse, that has been partially converted for use as a sensory room for service users to relax in. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on one day, over a period of five and a half hours. The manager was not on duty in the home at the time and the senior carer ably assisted with the inspection process. Five of the six service users were seen and were present during the inspection. Four members of staff were spoken with during the course of their duties, one in depth. A relative of one of the service users who was visiting, provided some positive written comments about the home. A tour of most of the premises occurred, although not all bedrooms were seen on this occasion. What the service does well:
The home benefits from a core of stable staff that understands the service users and their needs well. This is particularly important in this home, as the service users are very limited in speech and being able to say what they want. Although communication is mainly through non-verbal means, individuals were observed to confidently approach staff and make their wishes known to them. Staff work hard at ensuring appropriate levels of support are given to individuals in the home. Some of who have behaviours that at times require speedy and appropriate responses. Day to day choices were seen to be promoted by staff, for example whether an individual wants tea or coffee when asking for a hot drink. Feedback from a visiting relative to the home during the inspection, was very positive in respect of the level of care given and the staff team providing it. Comments made were ’’Excellent care provided-a marvellous caring team-first class. My relative is very happy at Kenilworth.’’ Attention to diet was judged to be good, with evidence of input from a dietician in regard to portion control and menu planning. From comments made, it was apparent that staff pay attention to service users diet and for example are conscious of the need to monitor less healthy snacks. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better:
The manager must as a priority, continue to address those areas raised as needing some attention at the time of the last inspection. Although some things have been completed, others require more work to complete them. The manager’s absence from the home for a period last year, may have contributed to this. Information available to prospective service users needs to be kept up to date and it must be clear on their contract which bedroom a service user will occupy at the home. The new type of care plans partially complete for two service users, need to be completed for everyone. Information held on different parts of the current care plans is difficult to negotiate around and it is not clear whether some of it is up to date or not. Some information is missing, such as what each service user’s wishes are should they become very ill. It also needs to be documented what happens if an individual at the home has to undergo treatment where consent is needed. For example an operation, or needing to have routine dental treatment. Record keeping must be accurate and up to date. There is a tendency for reliance on staff ‘knowing what to do’, rather than ensuring records are updated and amended as changes occur. The manager must ensure that staff working at the home have regular opportunity to meet with someone senior in experience to them, for supervision. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 7 The home experiences heavy wear and tear to its immediate environment. areas need to be maintained in terms of decorating and repairs where required. All Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 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 standard(s) 1 & 5. Information is available about the home, but due to the nature of their disabilities, service users cannot understand the document. Further work is needed to ensure that individual contracts comply with a requirement and recommendation previously made. EVIDENCE: The statement of purpose was reported to have been updated and to be at The Avenues Head Office awaiting reprinting. The previous version is available in the home in the meantime. As the home provides care for service users who are unable to read and write, they are unable to make sense of these documents. The home manager should consider whether a simplified version would be beneficial to service users. The service users contracts do not fully meet the requirements of this standard. The home has separate ‘terms and conditions,’ which would be more appropriately made into one document, together with the information that currently forms the contract. The bedroom a service user occupies was not found to be stated on the contract. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9. Current care plans contain plenty of information, but can be confusing for the reader. New ones are planned and have been commenced. Reviews in some areas were irregular. It was unclear whether a recommendation for advocacy involvement for one individual had been followed. EVIDENCE: Samples of care plans were viewed. It was reported that some further progress in introducing the new type of care plan had been made which was positive to note. Two service users files indicated this. Although the home has lots of information about each individual living at the home, the way that current information is held can be confusing i.e. differing files, unlabelled sections within files. This can make it time consuming and off putting for anyone, particularly if unfamiliar with the documents, to try to locate something specific. It is likely that with the change to the new person centred planning, this area will improve. Therefore the previously made recommendation that this be completed for each service user as soon as possible remains. Risk assessment documents were very out of date in some individual’s files, with no evidence of reviews in some cases for several years. Although some risk assessments may not have changed during this time, the home needs to
Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 11 record that this is so. Where the original assessment is dated several years ago, this should be re written. General risk assessments of, for example potential dangers in the home environment had been reviewed. Most of the service users living at the home need some help to make decisions about their lives. There was evidence that where there is family involvement, the home will consult with family when needed. Where a care manager is involved from a local authority they may also be involved, with others such as the GP as necessary. Day to day decisions are made by service users, with the help of staff at the home and there was evidence of this recorded in individuals daily notes. A recommendation was previously made that one individual with little family contact be referred to the local advocacy service. This would provide a trained volunteer to befriend them and assist with decision making. It was unclear in the absence of the home manager whether this had been done. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16, 17. There is attention to developing individual lifestyle programmes for service users. EVIDENCE: Each service user has a plan of their own personal goals, with how they can work to achieve these. Examples might be to increase their independence, by learning to make themselves a hot drink safely. There are progress charts, which staff complete. Sometimes, if the house is very busy staff reported these activities might not happen. Records showed that there were gaps, but this may have been due to the progress chart not being up to date. Daily record sheets viewed showed that staff record on the ‘shift plan’ any activities individuals have undertaken. This demonstrated that service users were being involved in daily activities and aspects of personal development addressed by staff. Each service user has a weekly plan of activities in place. They can indicate which they wish to attend or not. Most individuals have activities of a shorter duration, rather than a half or whole day. This is based on their needs, as most would not cope with longer sessions. The increased staffing on weekdays, has allowed for more consistency in service users being able to attend activities, which was positive to see. Some use is made of local
Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 13 facilities, such as the shops, pub and church. Also for local walking. All individuals have at least one day a week at the home when they can do things like going shopping with their key worker, or helping with cleaning their room. Activities plans were found to be out of date and need to be kept updated, particularly for the benefit of staff that have been off, or are new. Most service users have contact with their family and some go to their relative’s home on visits and are taken for trips out. On the inspection day, a relative visited and took one of the service users out. For those who do not visit so often, contact is maintained by telephone. The main meal of the day is in the evening and is cooked by staff. Service users are able to participate in a limited way. One individual has to follow a special diet and advice is being sought on this. During the inspection, one service user was repeatedly asking to make scones and started to smile when the ingredients were repeated out loud. A staff member reported they had undertaken this activity once previously with them and would consider this again. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 20 & 21 Service users have their personal care needs met. A recommendation remains relating to external medication training for staff. Further work is needed on ensuring that the wishes of service users in respect of healthcare needs are documented. EVIDENCE: Care plans showed that the amount and type of help that a service user needs with personal care, is recorded. Preferences are noted down and staff reported that some service users would come and indicate the staff member they want to help them. Service users can choose their own clothes, although staff made the observation that they would advise them if dressing inappropriately for the weather. Times for getting up and going to bed were reported to be flexible, although this can be in part dictated by any activities booked. At weekends service users were reported to enjoy having a lie in. The medication outcome was not looked at, other than to note an outstanding recommendation in regard to staff having some training provided by an outside agency. Medication will be looked at in full on the next inspection. A previously made requirement relating to documenting service users wishes in respect of illness or death has been addressed. Letters have been sent to parents. A previous requirement that consent to medical treatment be established for each individual, is under way.
Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 15 Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Service users in this home are adequately protected by the systems that are in place. EVIDENCE: Training in the protection of vulnerable adults has taken place for some staff and was seen to be booked for others. The manager has attended the local authority multi agency training. There was evidence of an awareness of the vulnerability of service users by staff. Methods of ensuring service users finances were protected were seen to be operational within the home. Since the last inspection, the home has had an investigation under the vulnerable adults procedure. Recommendations were made at the time and have been complied with. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28 & 30. The environment is generally appropriate to the needs of the service users. An unmet requirement regarding the mending of the garden fence remains. EVIDENCE: Some areas of the home had been redecorated since the last inspection. The home appeared clean and there were no unpleasant odours. Bathrooms and toilets were looking much cleaner and fresher since being painted. A drawer front had come off in the kitchen and was waiting to be re attached. In the ground floor toilet, some patching of the plasterwork had failed and needed re doing. It was also noted that the toilet door needed attention as it was sticking. The hallway on the ground floor was grubby and tired looking and needs redecorating and new flooring. The dining room carpet was stained and grubby looking and needs cleaning or replacing. Requirements have been made in relation to these. Outside, the home benefits from a large garden at the rear. No regular gardener is employed and the garden tends to being overgrown and needing some attention. The front garden would also benefit from some tidying. Staff reported that the homeowners are considering about what to do about the neglected bottom section of the back garden. There is a fence panel that needs repairing in this section, which was a requirement of the last inspection
Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 18 and will remain on this report as it has yet to be done. Potentially, a service user could get through the current hole into the adjoining property, so this must be attended to. Service users bedrooms were not viewed on this visit and will be inspected on the second visit later in the year. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35 & 36. The staff team at the home currently meet the needs of the service users. Of the seven requirements relating to staffing made following the last inspection, all but one have been met. EVIDENCE: The staff team are currently working without two of their permanent and experienced staff. Some use of bank or agency staff therefore has to be made, but it was reported that the same individuals are used so that they get to know the service users and the home. The home has increased its staffing levels at key times during weekdays. This has allowed for greater consistency in access to activities for the service users during the week. There was evidence of attention to training, with some staff having attended courses and others booked onto them on the home’s training schedule. Please see also comments made under standards 22-23. Although there was evidence of staff appraisals, it is of concern that regular one to one staff supervision is still not occurring. This was a requirement following the last inspection and will remain. Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 41 & 42. The home manager is experienced in the running of a home. All records need to be maintained. Generally health, safety and welfare is attended to, but a requirement was made relating to the safety of hot water outlets. A previously made requirement remains in respect of a broken fence panel. EVIDENCE: Some documents held at the home are out of date. Examples seen included general risk assessments, which had not been reviewed recently and activities plans, which were incorrect, as they had not been updated. There was evidence of general attention to health and safety within the home. However, water temperatures from hot water taps were found to fluctuate within different rooms in the home. In two toilets/bathrooms downstairs, the water was too hot to comfortably hold a hand under. In one of the bedrooms it was tepid. An immediate requirement was made that the home manager addresses this. This was observed to be particularly relevant as during the inspection, one of the service users went and ran a bath and got into it unobserved by staff. Please also see comment and requirement made under
Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 21 standards 24-30 in relation to the broken fence. 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x 2 Standard No 22 23
ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 2 x 2 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x x 3 3 x 3 Standard No
Kenilworth Standard No 31 32 Score 3 x
Version 1.20 Page 22 H58 S13689 Kennilworth V221198 190405 Stage 4.doc 11 12 13 14 15 16 17 3 3 3 3 3 3 3 33 34 35 36 3 x 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 3 2 Standard No 37 38 39 40 41 42 43 Score x x x x 2 2 x Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 23 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 5 Regulation 5 Requirement That service users contracts incorporate those items listed in Standard 5 of The National Minimum Standards for Care Homes for Adults(18-65 Years). Pictorial format should be considered. (Previous timescale of 22/7/04 not met.) That the matter of consent to medical treatments be considered and established for each service user. (Previous timescale of 18/10/04 not met, but reported to be partially complete.) The broken fence panel at the end of the garden must be replaced.(Previous timescale of 18/10/04 not met.) Redecoration and repair must be carried out in the hallway, downstairs toilet and dining room as detailed in the body of the report. Full staff records as specified in schedule 4 Regulation 17(2) must be available for inspection.( Previous timescale of 18/10/04 given. Reported to be completed but not checked on this unannounced visit.) Timescale for action 30/6/05 2. 19 12(2) 30/6/05 3. 24 23(2)(o) 30/6/05 4. 24 23(2)(d) 19/7/05 5. 34 17(2) 30/6/05 Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 24 6. 36 18(2) 7. 42 13(4)(a) All staff must receive regular supervision a minimum of six times a year.(Previous timescale of 6/10/04 not met.) Hot water outlets must be maintained at or close to 43 degrees centigrade. 30/6/05 26/4/05 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. 3. 4. 5. 6. 7. Refer to Standard 1 6 6 7 14 20 24 Good Practice Recommendations Consider whether the homes statement of purpose could be produced in a format service users could understand. That the Person Centred Planning commenced is completed for each service user as soon as possible. (Carried forward from previous inspection.) Support plans should be periodically re written, even if there are no changes to record. That consideration is given to referring those service users with limited, or no family contact to the advocacy service. (Carried forward from the previous two inspections.) That the service users activities charts for use by staff are kept up to date. That external medication training is accessed in addition to that provided by The Avenues Trust.(Carried forward fronm the previous two inspections.) That consideration is made to employing a regular gardener. (Carried forward from the previous inspection.) Kenilworth H58 S13689 Kennilworth V221198 190405 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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