Inspection on 18/06/07 for Kenmore Home - Leonard Cheshire Disability

This inspection was carried out on 18th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kenmore Home - Leonard Cheshire... 10/06/09

Kenmore Home - Leonard Cheshire... 18/01/07

Kenmore Home - Leonard Cheshire... 05/01/06

Kenmore Home - Leonard Cheshire... 23/09/05

Kenmore Home - Leonard Cheshire... 17/03/05

Kenmore Home - Leonard Cheshire... 07/09/04

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

CARE HOME ADULTS 18-65 Kenmore Cheshire Home 100 Whitcliffe Road Cleckheaton West Yorkshire BD19 3DR Lead Inspector Helen Battle Unannounced Inspection 18th June 2007 10:30 Kenmore Cheshire Home DS0000001087.V333434.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 Kenmore Cheshire Home DS0000001087.V333434.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. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kenmore Cheshire Home Address 100 Whitcliffe Road Cleckheaton West Yorkshire BD19 3DR 01274 872904 01274 851996 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) www.leonard-cheshire.org.uk Leonard Cheshire Mr John Hrynczyszyn Care Home 29 Category(ies) of Physical disability (29) registration, with number of places Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Day care - 5 Date of last inspection 18th January 2007 Brief Description of the Service: Kenmore offers nursing care for up to twenty nine people, aged 18 to 65 years, with physical disabilities. The home is a detached Victorian house set in its own grounds and has been extended to provide single room accommodation on the ground and first floor. The first floor is accessed by a passenger lift. It is situated in a residential area of Cleckheaton close to local amenities and easy access to the motorways. Kenmore is one of nineteen services run by Leonard Cheshire Services, a charity that provides services for people with a disability. The provider informed the Commission for Social Care Inspection on 16th April 2007 that the fees range from £546.00 to £1133.00 per week. There are additional charges for hairdressing, newspapers, and magazines. Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this full inspection a visit to the home took place. The inspector, Helen Battle, visited the home unannounced from 10.30hrs to 15.30hrs. Whilst at the home, key documents such as care assessments, care plans, daily records and the staff records were looked at, and so were the rooms and garden. 4 members of staff were spoken with, along with the registered manager. 3 people living at the home were spoken with. The manager had been asked to complete a questionnaire with information about the service, the people who live at Kenmore, and the staff working at the home. This was returned to the Commission prior to the visit taking place. Surveys were sent to five people living at the home. Four of the surveys were returned; all were generally positive. Comments included: “Quite happy due to having own independence and decision making”, “I am very happy here all the time”. What the service does well: What has improved since the last inspection? All staff have had training in relation to safeguarding adults, fire safety and moving and handling. This has ensured staff are up to date and has improved the safety of people living at the home. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 6 The practice of storing, administering and disposing of medication has improved dramatically at the home. New systems have been put in place and this has improved the safety of the people receiving medication. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People are properly assessed before moving into the home with the assurance that their needs will be met. EVIDENCE: Community Care Assessments carried out by the multi disciplinary team (this may consist of social worker, nurse doctor, physiotherapist etc), are completed prior to any service user moving into Kenmore Cheshire Home. Copies of these documents were seen in the three care record files examined. Evidence was seen of letters sent out to prospective service users confirming whether the home can meet their needs. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit. Plans of care are in place but not all reflect the current needs of the people living in the home. People make decisions about their lives and take risks as part of a more independent lifestyle where possible. EVIDENCE: The care plans of four people living at the home were examined. Three of these did not accurately reflect the current needs of people. The care plans had not been adequately reviewed and there was conflicting information regarding the current needs of the individual. Not all entries had been dated and therefore did not indicate the current situation. One individual had complex needs referred to on their pre-admission documentation, however the care plan did not reflect any of these needs. Following discussion with the manager it became apparent that this individual is very independent, however there was no supporting evidence in the records. This is not acceptable and is unsafe practice. There were no risk assessments in place regarding this person, for example in relation to mobility, nutritional status, risk of developing pressure Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 10 ulcers. There was evidence of people being involved in the formulation and review of their care plans. Entries in the daily records varied in detail. A small number of entries were adequate and indicated what care and support had been given to individuals on a daily basis. The majority of entries, however, were poor and did not detail any information which indicated what care and support had been delivered. In some of the records there were gaps in information where there were no recordings for up to three consecutive days. This is not acceptable as there is no reference to how that individual is on a daily basis or how their needs have been met. One of the care plans had recently been updated and was of a good standard. This needs to be consistent for every resident. The care records examined, however were not reflective of the good standard of nursing care delivered. It was evident from speaking to staff and from feedback from people who live in Kenmore, that good nursing care is delivered. People were observed to have their needs met in a competent manner during the visit, and staff seek advice and support from specialist nurses such as tissue viability and diabetic liaison nurses when required. People looked comfortable and relaxed throughout the visit. Due to the increase in dependency levels of the service users living at Kenmore Cheshire Home, and the severe physical disabilities, it is difficult for service users to take risks as part of an independent lifestyle. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People living in the home take part in appropriate activities and are part of the local community. Appropriate relationships are maintained. Peoples’ rights and responsibilities are respected. Meals provided at the home are of a good standard. EVIDENCE: People living in the home take part in a variety of activities suitable for their needs. On the day of this visit, people were seen to be spending time in various parts of the home reading, watching television, listening to music and receiving visitors. Two people were baking, and one person volunteered to taste the fresh radishes grown at the home. People living at the home had also been planting sunflower seeds, and had varying levels of success with this! Trips are arranged for people and include places such as Batley Park and Leeds/Bradford airport. Making collages and other artwork, games, quizzes, computers, library and in house training are examples of activity available for people. Since the last visit a dedicated activities co-ordinator has been Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 12 recruited to work at the home. This has had a positive impact on the quality of the variety of the activities participated in by people. The gardens are easily and freely accessed by people. People were seen to be treated with respect and their privacy and dignity maintained by staff during this visit. People are supported to maintain links and relationships with friends and family where possible. People who spoke with the inspector stated that they are allowed to see visitors at any time and the home has evidently worked hard with people to support them with maintaining relationships. The meals provision at the home is good. Feedback from people living at the home was very positive. The menu indicates that there is a good variety of nutritious food, and some people were seen to be enjoying their breakfast at the start of this visit. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People receive support in a way they prefer and require and their emotional and health needs are met. People living in the home are protected by the home’s policy and procedure for dealing with medication. EVIDENCE: People spoken to stated that the staff are kind and provide personal assistance in a discreet manner which promotes privacy and dignity. People also stated that they are able to choose what times they get up and go to bed. There was evidence in the care records that support is also provided from specialist nurses. The medication of four people was checked and all were found to tally with the records held. There has been a complete review of the policies and procedures regarding the management of medication at the home and this has made a vast improvement to the system and in promoting the safety of people receiving medication. The staff should be commended on the effort made to resolve the previous issues raised regarding medication. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 14 All the medications checked had been booked in properly and accurate records maintained. Medication is stored correctly and disposed of correctly in order to ensure the safety of people living in the home. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. Generally, people feel their views are listened to and acted on. People are protected from abuse, neglect and self-harm. EVIDENCE: The people who responded to the surveys felt that they could speak to any member of staff and that they would be listened to. There have been no formal complaints made to the home since the last visit. The complaints procedure is displayed in the home. Since the last visit all staff have received training regarding safeguarding adults. Staff spoken to were clear about safeguarding adults and the procedure for this. The personal monies of one person were checked and were found to reconcile with the records held. Lockable facilities are available in people’s rooms for valuables. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. Generally, the people live in a comfortable and safe environment. The home is generally clean and hygienic. EVIDENCE: A sample of people’s rooms were seen to be personalised according to the personal taste of individuals. Two rooms were in need of new carpets and these were identified to the manager at the time of the visit. During this visit the dining room was in the process of being decorated. This has been managed well, to cause the least disruption possible to the people living in the home. The decorating work is to continue and will include the smoking lounge, one other lounge, the entrance hall and reception area and the ground floor hallways. New floor coverings are also planned to be fitted. People living in the home have been consulted about the colour schemes for the decorating. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People are supported by competent and qualified staff, and are protected by the home’s recruitment practices. Staff are now receiving mandatory training within recommended timescales. EVIDENCE: It was reported that all staff have had training regarding the protection of vulnerable adults, fire safety and moving and handling theory. Seventy five per cent of staff have also had practical moving and handling training, with dates set for the remainder of staff to receive this training by the end of June 2007. This is a vast improvement from the last inspection. Staff spoken to had a good understanding of issues around safeguarding adults. Training records supported this. NVQ training is also continuing at the home with 65 of care staff having achieved NVQ level 2. Other training which has taken place includes disability, equality and the law, individual service planning, key working, infection control, food hygiene and first aid. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 18 Staffing arrangements are in place to meet the needs of a very dependent group of people who have extremely complex needs. Rotas examined, indicated that on a morning there are two nurses and seven care assistants, on an afternoon/evening there is one nurse and five care assistants, at night there is one nurse and two care assistants. Due to the complexity of the needs of the people living in the home, these staffing levels should be continually reviewed to ensure that they are sufficient to continue to meet the needs of the people living at Kenmore Cheshire Home. The recruitment process at the home protects the service users living at the home. The records for four members of staff were examined and all had the required records and checks in place. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit. People benefit from a well run home. Peoples’ views underpin development at the home. The health, safety and welfare of people are protected. EVIDENCE: The manager of the home has many years of experience in looking after people with a physical disability. Peoples’ views are listened to and underpin any development of the home’s policies and practices. Monthly management visits are carried out and the organisation carries out annual quality audits. This includes seeking the views of the people living at the home via a survey. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 20 There were no apparent health and safety issues observed during this visit. Weekly tests of the emergency lighting and fire alarm systems are recorded as are hot water temperatures in order to promote the safety of people living in the home and working there. Training records indicate that all staff have recently received fire safety training. Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 21 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Kenmore Cheshire Home DS0000001087.V333434.R01.S.doc Version 5.2 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(1) Requirement Care plans must include the current needs of the service users and provide an accurate plan of care for staff to follow. Timescale for action 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations The decoration work should be completed as planned. 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