Inspection on 22/11/07 for Kenrick House

This inspection was carried out on 22nd November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kenrick House 27/05/07

Kenrick House 04/07/06

Kenrick House 15/03/06

Kenrick House 24/10/05

Kenrick House 23/03/05

Kenrick House 11/11/04

Kenrick House 25/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Kenrick House 1777 Pershore Road Cotteridge Birmingham West Midlands B30 3DP Lead Inspector Ann Farrell Unannounced Inspection 22nd November 2007 09:00 Kenrick House DS0000017063.V355248.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 Kenrick House DS0000017063.V355248.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. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kenrick House Address 1777 Pershore Road Cotteridge Birmingham West Midlands B30 3DP 0121 451 2511 0121 246 6833 charmaine_doherty@hotmail.co.uk 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) Mrs Charmaine Doherty Ms Rosemarie Brown vacant post Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Residents must be aged under 65 years Three residents with a learning disability. The home can continue to accommodate two named service user over the age of 65 with a learning disability. That the home applies for a variation on behalf of future service users who each the age of 65 years. The details regarding how the specific care and social needs of the named person must be included in the service users plan. That the named service user`s over 65 years` care plan, is kept under review to ensure that their needs can still be met. 27th May 2007 Date of last inspection Brief Description of the Service: Kenrick House is registered to provide accommodation, care and support for up to three people with learning disabilities. The house is a domestic style twostorey terraced property situated on a main road into Birmingham at Cotteridge. On the ground floor there is a lounge, separate dining room, kitchen, toilet and bedroom. Upstairs are two single bedrooms, office, a bathroom with over bath shower facility and toilet, and a separate shower. The front door gives access directly onto the pavement outside the house, and there is restricted parking on the road outside. There is additional parking in nearby side roads. To the rear of the property is a small, enclosed garden. There is a wide range of local amenities within walking distance of the house, at either Cotteridge or Stirchley, and the area is well served by public transport. Fees are decided on an individual basis according to the service users needs but during 2007/8 are £622.07 and £546.00 per week. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that needs further development. The inspection was conducted over one day commencing at 9am and the home/provider did not know we were coming. The manager was present for most of the inspection. Information for the report was gathered from a tour of the home, discussion with the residents, the manager and a member of staff on the day of inspection. Inspection of records in respect of the management and care of residents were also looked at. One resident who lives in the home was’ case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. What the service does well: There are two residents living in the home and they stated they were happy there. They could access all areas and were obviously relaxed indicating that it was their home. Both current residents are women in their seventies and the staff group is all female. The owner and staff know the residents well and so are able to meet their needs. There is always at least one member of staff on duty and this enables the residents to go out and access local facilities. Staff also support them with maintaining contact with relatives and friends and arrange visits when they wish. The home produces individual plans of residents care for staff to follow. These plans weigh up the benefits and risks involved in ordinary daily events and leisure activities, so that residents can live an active life in relative safety. Both residents have their own large bedroom, which has been personalised and they can use as they wish. There is plenty of space around the home and all areas are accessible to residents. There is a bath and shower facility, so providing a choice of bathing facilities. Residents are registered with a local GP and receive routine health care; so ensuring they retain optimum health. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 6 Residents are helped to keep busy, take part in household tasks if they wish and get out and about regularly. Staff have received further training during the year, so they have the knowledge to meet residents needs. Both residents were relaxed and cheerful and stated they were happy in the home. What has improved since the last inspection? 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. Kenrick House DS0000017063.V355248.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 Kenrick House DS0000017063.V355248.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): 1, 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a stable residents group and there have been no new admissions for a number of years. The owner is in the process of updating the service user guide so residents and their representatives will have information to make an informed choice about moving into the home. EVIDENCE: Currently there are two residents living in the home who are both over 70 years of age and there has been no new admissions for some time. The manager was in the process of updating the information about the home for any prospective residents or their representatives. The manager stated that she had received a referral for a new resident and she is aware of the need to match the age of any new resident close to that of the current residents. On discussion with the manager about the admission she described an appropriate procedure to ensure that the home was able to meet their needs and ensure compatibility with existing residents. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 9 As current residents are over 65 the manager should now consider redirecting to meet the needs of these ‘older adults’ and this may require a change of registration conditions. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a range of information available to staff indicating the support that residents required and staff had a good knowledge of the current residents, so ensuring there needs were met. EVIDENCE: The care records had an extensive range of information about the resident, their likes and dislikes plus risk assessments, which included health, diet, leisure activities, getting about, communication needs etc. Some of the documents had been dated and it was apparent they had been reviewed in January 2007, but others were not dated, so it could not be determined if it was up to date. Some of the documents were not signed to indicate the person who had completed the assessment. There was a separate care plan for each, but this was not comprehensive with the information about the action required by staff to support the resident. It was obvious from the care plan that the resident could make choices, but may Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 11 need support at certain times. On discussion with the residents they appeared relaxed and happy. They were talkative, were able to access all parts of the home and one of the residents made a cup of tea for the inspector. On discussion with the member of staff they were aware of the residents needs and the support required. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support residents with activities, so providing a meaningful lifestyle and enabling residents to maintain contact with family and friends. A choice of meals are offered to residents, so ensuring they receive a nutritious diet. EVIDENCE: Both residents attend a day centre during the week and on the day of inspection transport arrived at approximately 9.30 am to take them to separate centres. They both appeared happy and eager to go and talked enthusiastically about it. On discussion with staff it was stated that residents had contact with family and friends and would visit them at the weekend. This was supported by staff, so they were able to maintain contact with them outside the home. Residents have access to all parts of the home and showed the inspector around the premises including their bedrooms. They were relaxed and it was obvious they considered it to be their home. In house activities include Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 13 watching television and videos, listening to music, knitting and some domestic tasks. They also have a range of board games for use, so that residents receive stimulation. Staff took residents out shopping, they visited the hairdresser, went out for pub lunches and they had recently been away for a short break to Butlins. However, the record of activities was not well maintained to demonstrate the range of activities. On discussion with residents about the food and meals they made no complaints and stated they liked the food. Staff maintained a record of food and drinks taken by residents, but this was not comprehensive. The home has a hands free telephone so that residents can make and receive telephone calls in private where required. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care needs were met with the support of staff whilst encouraging their independence. The arrangements for medication were satisfactory; further input is required to ensure accurate recoding and administration to ensure residents receive the mediation prescribed by health professionals. EVIDENCE: On arrival at the home the inspector met residents and observed them to be presented in a way that reflected their gender, age, culture and time of year. The records indicated that staff had identified health care needs, but it was not always clear as to the action being taken to ensure residents remained healthy. All residents were registered with a local G.P. service and records indicated that there was opportunity for a regular health check; so ensuring residents health was monitored regularly. Records indicated that residents also saw other health professionals as required e.g. dentist, optician, Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 15 chiropodist, continence adviser, so ensuring residents health needs were met and it was found that advise was being followed. Whilst touring the home it was found that pressure-relieving equipment was in place where required, so reducing the risk of pressure sores. Although staff were aware of resident health needs there was no Health Action Plans for residents. This is a personal plan about what a person needs to stay healthy and what healthcare services they need to access. This will need to be developed. The medication was stored in a locked cupboard in the office. Storage was observed to be clean and organized so that medication could easily be located. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (FP10’s) for repeat medication, so they were able to check the prescribed medication against the MAR chart when it entered the home. On inspection of the medication for the current month it was found that the blister system was satisfactory. However, some of the audits undertaken on the boxed medication were not accurate and codes had been used and not explained. It was also noted that some medication had been signed as administered by a member of staff for later in the day. The manager stated that one member of staff had not received training in respect of medication and this was in the process of being arranged. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements are in place to deal with any complaints, concerns or allegations, so ensuring residents are protected. EVIDENCE: At the time of inspection there was no record of any complaints and the manager stated they had not received any complaints. The Commission have not received any complaints about the home. The manager does have a complaints procedure that needs updating and she stated she was in the process of reviewing an easy read version of the policy, so that it was more accessible to residents. The home had a procedure in respect of safeguarding and also a copy of the local guidance with contact details, so that staff had information if there were any concerns or allegations in respect of abuse or poor practice. Resident’s records included an inventory of their belongings, so providing a record of all the residents’ belongings. Family handled Resident’s finances and the home held small amounts of money on behalf of residents. On inspection it was noted that receipts were available for deposits, but receipts were not always available for money spent on behalf of residents. The manager stated that she bought things for residents when undertaking other shopping and the record would be with those Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 17 receipts. The manager must ensure there is a clear audit trail of all money spent on behalf of residents with receipts etc. The money balanced with the records in place. The home uses part of the resident’s money for petrol that is used to transport residents to various places and the owner stated that this had been agreed. The owner will need to ensure there is a record of this agreement on individual residents file. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 18 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, 27, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A considerable amount of improvements have been made to the building since the last inspection, so providing a more homely place for residents to live. EVIDENCE: The home is a domestic style two-storey building that is situated on a main road in Cotteridge and the front door opens directly onto the pavement. The home was clean and odour free. Since the last inspection a considerable amount of work has been undertaken, so upgrading the environment and enhancing the facilities for residents. On entering the home a hallway leads into a pleasant dining room to the rear of the building, which was adjacent to the kitchen. The kitchen was clean and orderly, equipment was in place and a new washing machine, windows, waste bin, fire extinguisher, and saucepans, dishes and glasses had been provided since the last inspection. It was noted that some food items had been opened Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 19 and not dated, the temperature of the freezer was not recorded and the kitchen unit door under the sink was damaged and will need replacing. The kitchen leads out to a small mature garden. Shrubs had been cut back and a new garden gate had been fitted since the last inspection. Access to the gate was by some planks of wood at present and suitable paving slabs or similar will need to be provided to ensure safe access for residents and staff in the future. There was one lounge on the ground floor with a television and a range of seating. It was noted that one of the chairs, used by the resident, was damaged and foam was exposed. This will need to be replaced or recovered to ensure it is fit for use. Access to the first floor is by stairs that has a handrail to aid residents when they climb the stairs. The manager stated an assessment had been undertaken by an occupational therapist and they were planning to have a stair lift fitted to assist residents in the future. Each resident had their own bedroom that was personalised according to their individual taste. They were decorated and furnished adequately and new flooring had been fitted in one of the bedrooms. The manager stated that they also planned to replace the hall and stair carpet when the arrangements with the stair lift were finalised. There was a separate toilet on the ground floor, a bathroom with over bath shower plus a separate shower room on the first floor, so providing a choice of bathing facility and access to a toilet on both floors. The separate shower room had been refurbished and had a small seat for residents if required. The bathroom had been fitted with a new shower, bath seat, grab rail, lighting, mirror and had been decorated. All areas were individually and naturally ventilated. Hot water temperatures were maintained within safe limits and temperatures were checked regularly, so reducing the risk of scalding. Some radiators were covered to reduce the risk of scalding and the manager stated the others are to be completed in the near future. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 20 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, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels were maintained to meet resident’s needs. Staff training has been provided, so developing staff knowledge and skills to enable them to meet resident’s needs. EVIDENCE: Two partners up until recently ran the home and this is in the process of being dissolved. The remaining owner and three other members of staff are employed to provide support to residents. Duty rotas indicated that there was one member of staff on duty during the day and one member of sleep in staff overnight. This provides a staffing ratio of one member of staff to one or two residents depending who is in the home. Staff undertake all tasks e.g. caring, cooking cleaning etc. The manager has only employed one member of staff recently as there has been a very stable staff group. On inspection of a sample of staff files it was found application forms were completed, but there was no health declaration. References had been obtained before employment, but the Criminal Records Bureau (CRB) check had been used from a previous employer. This is not Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 21 appropriate as they are not portable. Where any new staff are employed a CRB and POVA check must be undertaken before anyone commences employment, to ensure residents are safeguarded by the recruitment procedure. On inspection of a staff member’s file that had been in post for approximately eighteen months it was noted that their passport and student visa had expired. The manager stated that this had been renewed. Evidence will need to be obtained and copies kept on individual staff files. The newly employed member of staff had undertaken an induction to the home and had completed NVQ level 3 training in 2006, before commencing employment with the home. It was noted that the induction training did not meet the standards of the Social Skills Council. The manager must ensure that induction training that meets the Social Skills Council is used for newly appointed staff in the future. The manager stated that over 50 of the staff had completed NVQ level 2 training in care, so providing them with the knowledge and skills to meet resident’s needs. Staff had undertaken a range of training that included manual handling, basic food hygiene, fire prevention, first aid and safeguarding, but it was not up to date in some cases. Also staff should have up to date basic training plus training in other areas specific to residents needs e.g. epilepsy, depression continence etc, so that they have an increased knowledge and understanding to meet residents needs. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The remaining owner has taken responsibility for the home and there have been a number of improvements since the last inspection. Systems are in place and the home was run with the residents as the central focus EVIDENCE: The partnership is in the process of being dissolved and the remaining owner has been advised of the need to contact the Commission’s registration unit when it has been finalised, so that the registration of the home can be addressed. However, this has had no negative effect on the residents. The remaining owner has had several years experience in caring for people, has completed NVQ level 4 in care and has commenced the Registered Managers Award. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 23 It was obvious from inspection that residents were relaxed and could access all areas in the home. There was evidence of meetings with residents and the manager stated that she was in the process of sending out some survey questionnaires to relatives in order to obtain feedback about the service. It was recommended that surveys should also be sent out to other stakeholders to obtain feedback, as part of the quality assurance system. When completed a development plan should be drawn up indicating outcomes and any developments for residents. On inspection of a sample of maintenance records it was found that weekly fire tests had been completed in respect of fire alarms in the kitchen and the landing, but not bedrooms. Also there was no evidence of testing in respect of the electrical wiring, electrical equipment or legionella. There was evidence of a gas safety certificate to indicate that the gas equipment was safe for use. The manager will need to address the areas where shortfalls were identified to ensure the home is safe and meets health and safety standards. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 N/A 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 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 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation 15 Requirement Timescale for action 01/03/08 2. YA20 13(2) 3. YA20 13(2) 18(1) 4. YA23 17(2) Sch 4 A comprehensive care plan outlining the action required by staff to meet resident’s needs must be in place for all residents. All documents must be dated and signed by the person completing them and should include a health action plan. Systems must be in place to 30/12/07 ensure the accurate administration and recording of medication so residents receive the medication prescribed to them safely. All staff who administer 30/01/08 medication must undertake suitable training to ensure they have the appropriate knowledge and skills to undertake the procedure. A robust system must be in place 30/12/07 for managing residents finances to include receipts for all money spent on their behalf. An agreement must be in place to demonstrate the arrangements for the use of resident’s money for petrol. A CRB and POVA check must be DS0000017063.V355248.R01.S.doc 5. YA34 19 30/12/07 Page 26 Kenrick House Version 5.2 6. YA35 18(1) 7. YA42 13(4) obtained before any new member of staff commences employment to ensure residents are protected by the employment procedure. Evidence should be available for all overseas staff to demonstrate they are able to work in this country Systems must be in place to ensure all staff receive updated training in all core areas (manual handling, basic food hygiene, fire prevention, fire drills, infection control and safeguarding) to ensure they can meet residents needs. Evidence must be provided to demonstrate testing of; • Electrical equipment • Electrical wiring. • Legionella 30/03/08 30/12/07 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 2. 3. Refer to Standard YA1 YA13 YA17 Good Practice Recommendations Consult the CSCI central regional registration team about reviewing the categories and conditions of registration of the home to fit the people currently accommodated. A comprehensive record of activities should be maintained to demonstrate the range of activities undertaken by residents. A comprehensive record of food and fluid intake should be maintained for residents where there are any concerns to demonstrate if they are receiving an adequate diet and fluid intake. Ensure good hygiene practices in the kitchen to include recording of the freezer temperature, date all food items when opened or frozen and replace kitchen unit door under the sink. Replace worn damaged chair in lounge that is used by DS0000017063.V355248.R01.S.doc Version 5.2 Page 27 4. YA24 5 YA24 Kenrick House 6 7 8 YA24 YA24 YA32 9 10 11 12 YA34 YA35 YA39 YA42 residents. Provide suitable access to the gate in the garden in case of emergency. Continue with the programme of providing radiator covers, so the risk of scalding is reduced. Induction training for newly employed staff should meet the Social Skills Council standards to ensure staff have the knowledge to care for residents when commencing employment. Application forms for employment should include a health declaration to determine if candidates are suitable for employment Training in respect of areas such as epilepsy, mental health etc should be provided to staff to increase their knowledge about residents needs. A quality assurance system needs to be implemented and acted upon to ensure continued improvement for residents. Systems should be in palce to demonstrate checking of fire alarms in resident’s bedrooms. Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kenrick House DS0000017063.V355248.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!