Inspection on 31/08/05 for Kent House

This inspection was carried out on 31st August 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kent House 24/10/08

Kent House 16/10/06

Kent House 15/02/06

Kent House 17/02/05

Kent House 04/10/04

Kent House 20/10/03

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

CARE HOME ADULTS 18-65 Kent House 1 Haslerig Close Aylesbury Bucks HP21 9PH Lead Inspector Joan Browne Unannounced 31st August 2005 5:00pm 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. Kent House Version 1.10 Page 3 SERVICE INFORMATION Name of service Kent House Address Kent House, 1 Haslerig Close, Aylesbury, Bucks, HP21 9PH 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) 01296 330101 The Disabilities Trust Mrs Christine Wood Care Home 22 Category(ies) of Physical disability (22), Physical disability over registration, with number 65 years of age (6) of places Kent House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 22 residents with a physical disability, six of whom are over 65. Date of last inspection 17th February 2005 Brief Description of the Service: Kent House is a specialist care home for adults with acquired brain injury. It is registered to provide rehabilitation and long-term care for twenty-two service users from various parts of the country. The Brain Injury Rehabilitation Trust, which is a charitable organisation, owns the home. The home is located in Aylesbury close to shops, pubs the post office and other amenities. The building is purpose built and was first registered in 1994. All the home’s bedrooms are single with en suite facilities. There are four bungalows adjacent to the home for those service users who have greater degrees of independent living skills. They comprise of lounge and dining rooms, bedroom, kitchen area, bathroom and toilet. The home has a garden area, which is wheelchair accessible. There are seating arrangements where service users who smoke like to gather. Kent House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 31st August 2005. The lead inspector was Ms Joan Browne who was accompanied by Mrs Gill Wooldridge. The senior residential worker facilitated the inspection and the deputy manager joined in the process for a short period. The inspection consisted of discussions with service users and staff, examination of care records and documentation, a tour of the communal areas. Two service users gave permission for their rooms to be looked at. The evening meal was observed. Prior to the inspection comment cards were forwarded to the home to be distributed to service users, relatives, care managers and health and social care professionals. Twenty comment cards were received from service users, ten from relatives, the general practitioner and two from care managers. Overall relatives and care managers were happy with the provision of care. Service users stated that they were well cared for and that staff respected their privacy and dignity. Feedback was given to the senior residential worker on the findings of the inspection. What the service does well: Service users visit the home prior to admission and their needs are thoroughly assessed. Rehabilitation plans to promote independence are in place for individual service users and they are reviewed three weekly. The home employs its own clinical psychologist, physiotherapist and occupational therapist. Service users’ reviews take place annually. Risk assessments are in place that outline service users’ assessed vulnerabilities. Monthly service users’ meetings are convened. Service users are well supported by staff. The home’s visiting policy is flexible. The home has its own transport facilities. The home promotes advocacy. The home has a relaxed calm atmosphere. Service users and staff did not appear phased by the inspection. Interaction between service users and staff were positive with humour and lots of smiles from service users. Monthly Regulation 26 visits are carried out. Kent House Version 1.10 Page 6 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kent House Version 1.10 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 Kent House Version 1.10 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, & 5 The home’s Statement of Purpose and Service User’s Guide are kept up to date to ensure that prospective service users have the appropriate information to make an informed choice. The home appears to have a robust assessment procedure to ensure that service users’ needs are identified. Contracts are issued to ensure that service users clearly understand the terms and conditions of living in the home and services covered by fees. EVIDENCE: The home’s Statement of Purpose and Service User’s Guide were recently reviewed. Copies of these documents were forwarded to the Commission prior to the inspection and they appear to reflect the standard. The assessment for the most recent admission to the home was examined. Detailed information was recorded and it was evident that a full assessment of the individual’s needs was undertaken. It appears that the care plan is developed from an assessment procedure. The detail of the care plan should ensure that service users’ needs are met. It was noted during the inspection service users expressed a wish to have a sing a long and this was facilitated by a staff member. Kent House Version 1.10 Page 9 It is evident that the home’s psychologist, and occupational therapist are involved in the assessment process. Service users are issued with contracts and Terms and Conditions of Occupancy, which include services covered by fees. It was noted that fees are reviewed yearly and this information was clearly documented. Kent House Version 1.10 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 & 9 Care plans are in place which should ensure that service users’ needs are met. Risk assessments are in place that outline individual vulnerabilities with contain control measures to enable service users to live independent lives. EVIDENCE: Care plans are in place which contained detailed information. From the outline of the evaluation of care plans described at the beginning of the document this does not appear to be followed through by staff. For example, issues identified as needing to be reviewed three weekly were not evident. Documentation needs to be available with regard to any perceived restriction of liberty. These documents should be reviewed regularly in a multidisciplinary forum and records maintained for inspection purposes. It maybe that these documents are in place however, they were not available in care plans examined. Risk assessments were developed for each individual, which identified any perceived hazards and control measures. They are updated as and when required. It was evident that service users are supported by staff to take risks and to promote an independent lifestyle. The home has an organisation Missing Person Policy which all staff are made aware of. The policy was recently reviewed. Kent House Version 1.10 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) 12,16 & 17 Service users take part in fulfilling activities and leisure options. This ensures that they have variation and stimulation in their lives. There are no restrictions on the activities of daily living providing service users with the ability to be as independent as their needs allow. Meals appeared well managed and varied and incorporated choices for service users. EVIDENCE: Service users are able to access a wide range of amenities, which meet their social spiritual and leisure needs. Staff reported that one service user works in a charity shop. Service users attend the local church, pubs, clubs and classes that meet their individual hobbies and pastimes. The home has its own transport, which makes travelling easier. Service users are able to rise and retire when they wish. Staff stated that they knock and wait for a reply before entering service users’ bedrooms. Two service users gave permission for their rooms to be inspected. Service users Kent House Version 1.10 Page 12 have unrestricted access to all areas of the home and garden with the exception of other bedrooms. The arrangements on house rules are outlined in the contract of agreement that is issued to individuals. Smoking is not permitted in the house but there is an enclosed area in the garden where service users can smoke. All service users are issued with a key for their bedroom. Some service users are responsible for housekeeping tasks as part of their rehabilitation programme. For example, keeping their bedrooms tidy, doing their personal laundry. The evening meal was observed. Tables were well presented with tablecloths, flowers and the appropriate crockery and cutlery. There was a selection of finger food on offer as well as salad, sausages and onion, rolls and bread and butter. Service users with poor appetites were offered milk shake drinks. For desert there was a selection of fresh fruit and yoghurts. Mealtime appeared relaxed and unrushed. Staff assisted service users who required assistance and prompting in a sensitive and discreet manner. Two service users chose to eat out and staff members accompanied them. Healthy eating is promoted in the home and staff are able to get advice and support from the dietician. Arrangements were being made for nutritional charts to be developed for all service users. Kent House Version 1.10 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) 19 &20 Residents’ health care needs to be recorded fully to ensure that there is no potential risk to service users. Medication practice and procedures need to be strengthened to ensure that service users health and well-being are not put at risk EVIDENCE: Convene care was described by staff. However, staff were not able to present a written protocol to support their practice. It was apparent that a particular resident was having a dressing applied every three days. There was no care plan to support this practice. The senior explained that a trained nurse on night duty changed the dressing. There was no evidence to indicate that the staff had been trained to carry out this task. The home uses the Boots Manrex medication system. Medication administration record sheets were examined and no gaps were noted. However, the staff member administering the medication was observed signing the MAR sheets before administering the medication to service users. This practice must cease. The manager is required to ensure that staff familiarise themselves with the Royal Pharmaceutical Society guidelines in the Administration and Control of Medicines in Care Homes section 6.2.3. Kent House Version 1.10 Page 14 There were two instances when medication had been stopped. The staff member recording the entry on the MAR sheets did not record an explanation for example, stopped by GP and date and sign the entry. It was noted that there was a system in place to record when medication had been stopped or antibiotic treatment completed. It was evident that not all staff were being consistent in their recording practices. It is further recommended that handwritten entries recorded on the MAR sheets should be checked signed and dated by two staff members. It is acknowledged that the deputy manager and the member of staff administering medication confirmed that the poor practice will cease and the home’s procedure reviewed. Kent House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The home’s complaints record folder was not accessible to service users and relatives to ensure that comments and complaints are recorded and actioned. Staff demonstrated a good understanding in adult protection and abuse awareness this should ensure that service users are protected from any potential abuse. EVIDENCE: The home displays its complaints procedure on the notice board. The Commission has not received any complaints about the service since the last inspection. Information recorded on the pre-inspection questionnaire highlighted that the home had investigated six complaints and that they were all substantiated. The home’s complaints record folder was not available for inspection purposes. The manager is advised to ensure that the folder is accessible for any future inspections. The home has a vulnerable adult protection policy in place. All staff are made aware of the policy and receive training at induction which is ongoing. Staff spoken to were able to describe the different types of abuse and were aware of their responsibility to report any alleged or actual abuse. Kent House Version 1.10 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 The home is well maintained thus ensuring that service users live in a comfortable and safe environment. EVIDENCE: The location and layout of the home appeared suitable for the service user group. Furniture, curtains and carpets in some areas of the home had been replaced and were of a good standard. All service users’ bedrooms were single occupancy with en suite facilities and accessible to wheelchairs. On the day of the inspection the home was bright, cheerful, clean and free from offensive odours. Service users commented that they were happy with the private and communal areas within the home and that they felt safe and secure in the premises. The temperature in the lounge was quite hot. There were no fans visible however, service users confirmed that they were fans in bedrooms. Kent House Version 1.10 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 The deployment of staff need to be more vigorous to ensure that service users are able to access the wider community at evenings and weekends. EVIDENCE: On the day of the inspection there appeared to be adequate staffing. However, several service uses commented that at weekends and evenings there are occasionally not enough staff to facilitate outings. Staff described that they have access to training which they find invaluable and assist them to provide a quality service. Kent House Version 1.10 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) EVIDENCE: Kent House Version 1.10 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. 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 3 3 x x 3 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 x x x 3 3 Standard No 31 32 33 34 35 36 Score 3 x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x Kent House Version 1.10 Page 20 NO 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 20 Regulation 13(2) Requirement The registered manager must assess staffs competencies in the administration and recording of medication. Copies of assessment undertaken must be available for inspection purposes. The registered manager must ensure that staff administer and record medication in accordance with the Royal Pharmaceutical Society Guidelines. Timescale for action 31.08.05 and ongoing 2. 20 13(2) 31.08.05 and ongoing RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 6 19 Good Practice Recommendations It is recommened that the registered manager should ensure that care plans are evluated appropriately. It is recommended that the registered manager should ensure that a written protocol be developed for convene application and that all staff undertake training in covene care. It is recommended that the registered manager should ensure that when medication has been stopped or antibiotic treatment completed the person making the Version 1.10 Page 21 3. 20 Kent House 4. 20 5. 22 entry should record a short explanation as outlined in the text and date and sign the entry. It is recommended that the registered manager should ensure that handwritten entries recorded on MAR sheets should be checked, dated and signed by two staff members. It is recommended that the registered manager should ensure that the complaints record folder is accessible. Kent House Version 1.10 Page 22 Commission for Social Care Inspection 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR 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. Extracts may not be used or reproduced without the express permission of CSCI Kent House Version 1.10 Page 23 - 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!