Inspection on 26/04/05 for Kenilworth (Banstead)

This inspection was carried out on 26th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kenilworth (Banstead) 26/11/08

Kenilworth (Banstead) 30/11/07

Kenilworth (Banstead) 17/08/06

Kenilworth (Banstead) 10/11/05

Kenilworth (Banstead) 17/12/04

Kenilworth (Banstead) 27/07/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

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33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Kenilworth (Banstead) 74 Diceland Road Banstead Surrey SM7 2ET Lead Inspector Ms S Magnier Unannounced 26 April 2005 15.00 th 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 (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Kenilworth (Banstead) Address 74 Diceland Road, Banstead, Surrey, SM7 2ET 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) 01737 361858 0208 786 7008 GAMWIJ@AOL.COM Mr Gamini Wijewardena Mrs Balapuwaduge Wijewardena CRH Care Home 3 Category(ies) of LD Learning Disability, 3 registration, with number of places Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age range is 45-64 years of age for all 3 residents. Date of last inspection 17 November 2004 Brief Description of the Service: Kenilworth is owned and run by Mr and Mrs Wijewardena It is a large detached property within walking distance of Banstead town. The accomodation covers two floors and provides care and services to three clients with learning disabilities. Each client has their own single bedroom one of which has an ensuite facility. There are two lounge areas, a dining/kitchen area and an office on the ground floor. There is a private secluded garden with patio area and car port to the rear of the garden. There are local amenities nearby. The home also provides transport to the clients if they do not choose to use public transport. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours during the late afternoon and evening. Two clients were spoken with and four staff inclusive of the Registered Provider and Registered Manager. Care plans, risk assessments and other documentation was seen and a tour of the ground floor premises and garden was undertaken. What the service does well: What has improved since the last inspection? What they could do better: • • • • The home must make sure that the statement of purpose and the clients guide to the home is up to date to reflect the facilities and care offered. Make sure that the clients are involved in the reviews of their care and that their aspirations and goals are recognised. The home must look into a way in which clients can complain or let people know that they are not happy with something in their home. That staff working in the home have had all the necessary recruitment checks to make sure the clients are safe and being cared for by trained competent staff. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 6 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. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 7 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 (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 8 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) 1,2 The home would not be able to provide prospective clients or their representative an informed choice about the home, as the information available is not up to date. EVIDENCE: No new clients have moved into the home since the last inspection in November 2004. However prospective clients would not have sufficient up to date information to make an informed choice as the statement of purpose is not adequate. The requirement made at the last inspection has not been met and the Registered Manager must update the homes statement of purpose to include all the information in Schedule 1 of the Care Homes Regulations (as amended) 2001. The amended copy must be sent to CSCI local Eashing office by the timescale set. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 9 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) 6,7,8,9,10. The home continues to meet the individual needs and choices of clients but must continue to develop these rights in addition to matters of confidentiality of client information. EVIDENCE: One person spoken with in the home said that ‘when you are in the community its not nice being called a patient a client sounds better’. The individual care plans and risk assessments for each client reflect the everyday living activities and the help and support the clients need to achieve their aspirations and goals. Records are also kept of the daily events in the client’s lives. For one client a special support is in place and there are clear written details to help support them through a time that may be particularly distressing. There is written guidelines of ways of coping for both the client and the staff member, which prove to be helpful to the client during times of stress. Additionally a client attends a special group, which has been arranged via the medical professionals help with this particular difficulty. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 10 There was no evidence to indicate that the clients had been involved in the reviews of the care plans and a requirement has been made that each client reviews their own care plan with a staff member on a regular basis. The clients help around their home with the cleaning, washing up, laying tables and doing the gardening. On arrival to the home and speaking with a care assistant the clients care plans could not be located. When the Registered Manager arrived at the home it transpired that the clients care plans had been taken from the service by the Registered Manager in order to assist them in their Registered Managers Award. A requirement has been made that no records related to the clients must be removed from the home and information shared unless written permission is gained from the client or their representative in order to ensure clients rights to confidentiality, dignity and respect. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 11 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 The home offers the clients freedom of choice and a fulfilling lifestyle. EVIDENCE: On arrival for the inspection all the clients were out either at work or attending college or a day centre. One client had been at college and said’ we take pack lunch and a drink when we go out from the college, I like the college and enjoy it, know the teachers well’ The courses include Healthy eating and Living in the community and also involve shopping, budgeting and visits to places of interest like the Natural History Museum and St Paul’s Cathedral. One client shared a letter of praise they had received from their employer at a local hotel where they work in the kitchen saying they were ‘an asset’. Another client had been to their job working at a garden centre and also takes a keen interest in their garden at home. Another client came home from work and also went out in the evening. One client said I’ve got two good friends from church and they are always there for me, I could call on them anytime and they are there for me’ Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 12 One staff member prepared the evening meal. There was no set menu available. The record of the meals served recently demonstrated that choice of meals are offered to clients if they do wish to have the main meal. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 13 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) 18,19, The clients receive the specialist support required for their Personal and Health care needs and staff support them to have these needs met. EVIDENCE: The care plans and risk assessments evidenced that the clients are able to care for themselves and where necessary staff members will assist them. Visits to their General Practitioner, Care Manager, Community Nurse, dentist and other health care specialists are arranged with the clients and the staff. One client said ‘ I didn’t have a Care Manager then and I didn’t know who to go to, I did tell George, but I needed a lady to talk to which I have now’. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 14 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) 22,23 Both requirements made at the last inspection have not been met with regard to client’s having up to date information if they wish to make a complaint: also with regard to the homes policy and procedure for staff to report any issues regarding the protection of vulnerable adults. EVIDENCE: No complaints have been received by the home. When speaking with one client they were unsure of how to complain. The Registered Manager told the inspector that each client is told about the complaints procedure when they come to live at the home and that how to complain is also written in the residents handbook. One client told the inspector ‘I always talk to George I’ve known him 20 years and he will always sort things out for me’. The home is not currently proactive in making sure that clients understand their right to complain as one client said, ‘I didn’t know I could talk to the inspector’ A further requirement has been made that the Registered Manager develop a complaints procedure. This must be available in large print for the clients, and include all the people they could complain to if they were unhappy about anything in their home or their lives. A periodic reminder should be made with clients to advise them of what to do if they are unhappy. A copy of the client’s complaints procedure must be sent to CSCI local Eashing office. The home had only partly met the requirement made for a policy detailing the responsibilities of the staff team with regard to the reporting of any issues Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 15 regarding protection of vulnerable adults. A further requirement has been made that this is attended and a copy sent to CSCI local Eashing office. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 16 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) 24,29,30 The areas seen during the inspection were clean, well maintained and comfortable for the needs of the clients. EVIDENCE: The downstairs area of the home was inspected and offered a homely comfortable safe environment. The furnishings and fittings of the home were in good order and requirements made from the previous inspection regarding the environment had been met. The home does not use any specialist equipment and the premises were clean and hygienic. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 17 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) 31,32,34,35 The evidenced gathered fell short of the expected standards to ensure that suitably recruited, trained, competent staff supports clients. Requirements have been made to meet these major shortfalls. EVIDENCE: The care home is small and has been operating for many years. Care staff have known the clients for a long time and have established rapport with them. An observation by the inspector was that while the staff interactions with the clients was friendly, it could be interpreted as over familiar and unprofessional. It is recommended that the whole staff team including the Managers, seek to address this observation to ensure that clients are spoken with in a manner that reflects dignity and respect. The staff personnel files evidenced major shortfalls in the homes recruitment and selection process. Staff files of individuals newly appointed did not contain a photograph, evidence of interview, insufficient references, no training records and CRB attained from Kenilworth prior to appointment. Requirements have been made that these documents and issues are addressed and all staff files are in compliance with Schedule 2 of the Care Homes Regulations (as amended) 2001. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 18 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) 37,39,40, All the clients met during the inspection spoke positively and were observed to be happy with the way in which the home was run. EVIDENCE: The Registered Manager is currently undertaking the Registered Managers Award. During the inspection it was evident that both the Registered Manager and Registered Provider manage the home. A requirement has been made that the Managers develop a Quality Assurance process in which to ensure that the client’s and their representative’s views about the home can be obtained. The health and safety checks of the home including bath water temperatures, fire drills, and environmental health visit and visit from the fire officer had all been maintained. The home has updated all the policies and procedures, which are kept under annual review. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 x x x Standard No 22 23 ENVIRONMENT Score 1 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 1 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 2 1 x 1 1 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Kenilworth (Banstead) Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x 2 3 x x x H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 20 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 1 Regulation 4.(1)(c Schedule 1 1.2.3.4. Requirement The Registered Manager must ensure that the Statement of purpose includes all the information in Schedule 1 of the Care Homes Regulations (as amanded) 2001. A copy must be forwarded to CSCI local Eashing office. Timescale of 17.12.05 not met. The Regisitered Manager must ensure that clients are given the opportunity to update care plans with staff and arrange new goals if they choose. The Regisitered Manager must ensure that any records related to the client are available at all times in the care home and must not be taken from the home without prior consent from the the client or representaive. Brought forward from 30.11.04. The Registered Manager must develop a complaints procedure which is appropriate to the clients needs. A copy must be sent to the local CSCI Eashing office. Timescale of 30.11.04 not met. Partly met from 17.12.04. The Registered Manager must Timescale for action 10.5.05 2. 6 15.(2)(c (d) 10.5.05 3. 10 17.(3)(b) Schedule 3 28.4.05 4. 22 22.(2) 10.5.05 5. 23 12(1)(a) (4)(a)(b) 10.5.05 Page 21 Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 6. 34 7. 35 8. 39 develop a policy and procedure for staff in the home to be aware of the responsibilities of reporting issues related to the protection of vulnerable adults. A copy must be sent to the local CSCI Eashing office. Timescale of 17.12.04 not met. 7,9,19. The Registered Provider and 26.5.05 Schedule Registered Manager must ensure 2 that all pre employment checks, including a formal documented interview process (as required in last inspection 14.12.04) are carried out prior to staff commencing employment at the home, this must include any other person in one to one contact with the clients. Timescale of 14.12.05 not met. 26.7.05 18.(1)c (i) The Registered Provider and Registered Manager must ensure that all staff including the Registered Manager receive training appropriate to the work they are to perform including structured induction and all mandatory training, e.g. basic food hygiene, fire, health and safety, first aid and moving and handling. All certificates of training must be held on staff files. 24(1)(a)( The Registered Manager must 26.7.05 b) (2)(3) establish a system to review the quality of care offered by the home in consulatation with clients and representatives. (5)(a)(b) 13 (1-8) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 22 Kenilworth (Banstead) 1. 31 It is recommended that the whole staff team including the Managers seek to address an observation to ensure that clients are spoken with in a manner that reflects dignity and respect. Kenilworth (Banstead) H58_s13690_Kenilworth_v223733_260405 Stage 4.doc Version 1.30 Page 23 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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