CARE HOMES FOR OLDER PEOPLE
Kent House George Street Okehampton Devon EX20 1HR Lead Inspector
Anita Sutcliffe Unannounced Inspection 08:15 31st March 2008 X10015.doc Version 1.40 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 Kent House DS0000032744.V361229.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 Older People. 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. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kent House Address George Street Okehampton Devon EX20 1HR 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) 01837 52568 01837 55280 kenthouse@stone-haven.co.uk WWW.stone-haven.co.uk Stonehaven (Healthcare) Ltd Mrs Julie Sarah Smith Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th June 2007 Brief Description of the Service: Kent House is a large detached Victorian house located in the centre of Okehampton. It is registered to provide accommodation with personal care for 25 older people who may also have dementia or a physical disability. Of the twenty-one single bedrooms nine have en suite facilities; of the two double bedrooms neither do. Bedrooms are on two floors with a lift between the ground and first and a chair lift to a mezzanine. There is one shower room. The home benefits from 3 ground and one first floor lounges. There is a small garden at the front and patio to the side of the home. The home has been under the ownership of Stonehaven (Healthcare) Ltd since 30th Sept 2002 and the management of Julie Smith since October 2006. Current information about the home: Fees, as taken from the Service User’s Guide, are £400 - £750 per week. The home’s brochure (Service User’s Guide) says that there is an additional charge made for personal items such as non-prescribed medicines, hairdressing, chiropody, opticians and dentistry. It contains all information about the home plus there is a web site. The most recent inspection report is displayed in the entrance hall. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. That means the people who use this service experience good quality outcomes. This key inspection was to check the home’s compliance with the National Minimum Standards for Older People by finding out what it is like to live at Kent House. We (the Commission) sought opinion form people who use the service and their family when we visited. Health care professionals in regular contact with the home also gave their opinion of the care provided. The home received one unannounced visit. The care of two residents was examined in detail and a third in less detail. In all ten people who use the service spoke about the home to us. Discussion was held with five staff, the registered manager and a representative of the organisation. Staff were observed going about their duties. Staff recruitment, training and supervision records, and care and medication records were examined. What the service does well:
Comments from people who use the service were all positive. It is a happy home, with good staff / resident relationships. Staff report that what the home does best is: - Friendly place. - Food’s pretty good. - Nice atmosphere. - Friendly staff. The location of the home makes it ideal for those who wish to be part of a busy town, with a post office next door, shops and churches nearby. The home itself is comfortable, with a variety of sitting rooms offering quiet space or social contact. Bedrooms are pleasant, well furnished and very individual. The front garden has seating and provides the oppportunity for involvement with the local community. People benefit from a good variety of activities. Entertainments, quizzes, birthday celebrations, shopping in the town and the sensory room help people lead an interestnig life. The home is known for its friendliness. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 6 There are good systems in place to monitor the quality of the service provided. People are encouraged to be involved in the running of the home. Policies and procedures to protect people from abuse are well known to staff and people are able to take concerns to staff and management knowing they will be listened to and acted upon. Staff receive training relevant to the tasks they are to perform. Each is encouraged to take National Vocational Qualification (NVQ) in care. There is an ongoing commitment to improvement in the fabric of the building which continues to be upgraded, being made both safer and more pleasant for people. What has improved since the last inspection? What they could do better:
There is the need for a robust cleaning routine to ensure that the kitchen and food storage areas are kept properly clean at all times.
Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 7 Where ‘as necessary’ medication is prescribed its use needs to be part of planned care, so that staff have clear guidelines as to when they can use it. We have made no requirements or recommendations following this visit. 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. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 (Standard 6 does not apply to Kent House). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have available to them the full information from which they are able to decide if the home can meet their needs and requirements. They can be assured that a full assessment will be untaken prior to admission so that needs are known and care can be planned. EVIDENCE: The home provides written information which is to inform people about the service it can provide. It is clearly presented and contains some good detail. At the last review of its contents some changes were made that now give a more accurate impression of the home. Written information about the home (the Statement of Purpose, Service User’s Guide, and a copy of the last report) is kept at the entrance of the home and given to every person who makes enquiry or is admitted.
Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 10 The admission of two recently admitted people was examined, one in detail. Julie Smith, the registered manager, assessed their needs. Once she has confirmed the home is suitable, the manager writes to confirm this. Where a person has been admitted through Local Authority or from hospital those assessments were also in place. Where additional information is needed this is sought. The assessment includes risks, such as falling and pressure sores, and we saw some very detailed social history, which is particularly important where people’s ability to communicate is limited. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have their personal care needs fully met and their health care needs properly managed. People are treated with respect and dignity. EVIDENCE: Plans are required to be clear so that staff can look after people in the correct way, and as they wish, once their needs have been assessed. We found that the standard of care planning now contains more detail so that that staff are better informed of what they must do. We also found that the expectation of what staff should do was clearer, for example, ‘check feet daily and report any concerns to the manager’. When we asked staff why they were checking people’s feet and what they were looking for they were quite clear about it and their information was correct. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 12 The home currently has some very dependant people living there who are at risk from complications from their medical conditions. However, their needs are being properly met. A district nurse in regular contact with the home said: “Things have improved”. To ensure effective communication between the home and the district nursing service a communication book is now used so no messages will be missed. Individual risk assessments contained more detail than previously. Steps, which would reduce risk, were clearly recorded for staff to follow. However, we discussed additional risks that had not been considered and therefore not assessed. Medicines are kept securely and information is available to staff about those used. Currently no people who use the service are able to manage their own medicines. Records were clear with additional measures taken to reduce the likelihood of mistakes: two people checking that a hand written entry is correct. However, we found a couple of gaps in the signatures of when a medicine has been given. Medicines are checked into and out of the home, so that their correct use can be monitored. We discussed the requirement that any ‘as necessary’ medicines must be included within the plans of care so that they are used in a consistent way, especially where people are unable to communicate their needs fully. All people spoken with spoke very highly of staff, several mentioning their kindness. When asked if staff knew what they were doing / were competent in their work, all said yes. Staff were observed being polite, courteous and treating people with respect. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service are enabled to lead interesting and fulfilled lives in line with their choices and preferences. EVIDENCE: With three ground floor sitting rooms, and a large dining room, there is choice of communal rooms in which people can meet or spend quiet time. We were told that one of the quiet rooms is now used as a ‘sensory room’ where nice lights, music and scent is relaxing, pleasant and reduces stress. There is also a nicely tended garden at the front of the house with attractive garden furniture. Recent activities have included: • • Easter bonnet and egg hunt. Birthday parties. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 14 • • • • • An activities worker employed to visit alternate weeks who leads quizzes, music and movement, sing-a-long and games. Visits to the town or local park. Bingo every Friday PAT dog visits alternate weeks. Some people attend a day centre. Currently a VE day celebration, jumble sale and coffee morning are planned for the near future. We saw people reading, knitting and watching television. More detailed information about people’s history is now collected and part of care planning. This helps staff understand what people like and do not like, and events and dates of importance, such as family anniversaries. Where people are unable to communicate this is very important. A dedicated member of staff organises activities at the home and care staff have encouraged people, who tend to spend all their time in their room, to go out into the town. The home meets the spiritual needs of people through contact with a local Christian church. Written information about visiting the home makes it quite clear that, if a person wishes, they may be visited at any time. A comment heard over and over about Kent House is how friendly and homely it is. When asked about the food one person did not like it, but all others were very satisfied. People are consulted about the menu and a second choice always available should they wish. Several did so the day of the visit when the first choice was lasagne. People said there was plenty of food available. Staff understand the importance of nutrition and monitor a person’s diet if they feel there is cause for concern. People confirmed that they are not expected to do things they do not wish and we witnessed choices being offered. Individuality and independence are promoted. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express any concern, and have access to a robust and effective complaints procedure. They are protected from abuse. EVIDENCE: The home’s complaints procedure was found in each bedroom visited, in the hallway and is included in the guide to the home. It includes contact details for the Commission so that a complaint can be made away from the home if preferred. None have been received. People said they knew who to speak to if they were not happy, how to make a complaint and that they felt quite safe in the home. There is also a suggestions box in the entrance hall, plus meetings where opinion can be voiced. No complaints have been received by the home since the last inspection. The registered manager has a satisfactory understanding of the types of abuse and is aware of what actions she should take should any allegation, which might be abuse, be made. She says there have been none.
Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 16 Staff were also able to describe types of abuse and knew what actions they should take if they have concerns. This information is displayed in the staff room and the manager’s office, so regularly viewed by them. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is pleasant, safe, adequately maintained and meets the needs of people who currently use the service. Vigilance is required to ensure cleanliness is adequate. EVIDENCE: There has been an ongoing programme of redecoration at Kent House and this has taken into account the specialist needs of people with dementia who have the use of pictures, signs and colour to help them find their way in the building. New wheelchairs and fire safety mechanism for doors have been purchased, and a new shower room, replacing one of the bathrooms. We found the home to be fresh and clean, with the exception of the kitchen, where cleanliness was rather superficial; a more thorough clean was needed.
Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 18 This was underway immediately. People who use the service felt the home was clean but a visitor said sometimes this could be improved. Bedrooms we visited were all attractive, homely, very individual, each containing items of importance and personal value. People, asked if they were warm enough in the home and if their beds were comfortable, all said yes. The varied sitting rooms, small but pleasant garden, outlook and features of Kent House give it a domestic feel. Bedrooms have lockable storage space, radiators are covered to prevent contact burns and windows have been made safe to prevent falls. The lift and chair lift, ramps and handrails help residents with mobility problems move about the home. Each had been serviced within the last year so they were maintained as safe to use. Specialist equipment, for example lifting hoists and pressure relieving mattresses, are available to ensure care needs are met. All rooms visited were in a reasonable state of repair, some newly decorated, but some window frames still need attention. The manager said this has started and ‘they need to get on with it’. The laundry has a satisfactory standard of equipment to meet the needs of people and staff have hand washing equipment and safety clothing for use to prevent the spread of infection. The manager said previously she would be improving the method for moving soiled linen from one part of the home to another through the introduction of a non-touch system. This has now been done, but we saw that staff still hand sluice some soiled linen. This is a practice not recommended as it increases the risk of cross infection. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and are generally in sufficient numbers to support people who use the service. Recruitment practice protects vulnerable adults from those unsuitable to work with them. EVIDENCE: Comments about staff were all very positve. People who use the service like staff and consider them kind and helpful. We spoke with four care staff. As we found at the previous inspection, three felt their numbers should be increased with comments including: “I want to be able to spend more time with the residents rather than being rushed”. No person who used the service mentioned staffing numbers as a problem and needs appeared to be fully met. Since the recruitment of some additional, local care staff it is now possible for additional staff to be available at short notice should there be a problem, such as sickness or the need to escort somebody to hospital. The home does not
Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 20 employ agency staff to cover any staff shortage. The recruitment record of two recently employed care staff were examined. Each had all the necessary checks complete so as to ensure they are suitable to work with vulnerable adults. Staff knowledge continues to improve. Where a training need is identified, such as diabetes, this has been arranged. People felt staff knew what they were doing and were competent in their work. We looked at the training provided when staff are new to the home. It followed the nationally recognised and expected information from which staff should gain enough knowledge to work safely. One staff member said about her induction training: “Everything was quite clear”. We established that new staff are ‘extra to numbers’ on the rota until they are able to work alone safely. Staff confirmed that they are encouraged to undertake National Vocational Qualification (NVQ) in care. This qualification is a measure of staff competence. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems in place and is managed in the best interests of people who use the service. EVIDENCE: Mrs. Julie Smith, the registered manager, has achieved qualifications in managing a care home (The Registered Manager’s Award) and is currently working towards the National Vocational Qualification (NVQ) level 4 in care. She continues to achieve much at the home. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 22 The home is known for its friendliness. People who use the service said they like Kent House and feel safe and well cared for. Health care professionals speak of improved standards of health care provided. Staff spoke of the good relationship between people at the home and the good management. Asked what the home does best they said: “Friendly place”, “Nice atmosphere”, “Friendly staff” and “Food’s pretty good”. The organisation and manager have several ways in which they monitor the standards at the home: • Weekly, monthly, quarterly and yearly audit. • Checking records, such as medication, fire safety and maintenance. • Meetings for people who use the service. • Meetings for people’s family and representatives. • Staff meetings. • Anonymous questionnaires to residents, family, GP’s and District Nurses. • Regular staff supervision meetings and staff appraisal. • Unannounced visits by member of the organisation to speak with residents and check standards are being maintained. The home are particular good at keeping us informed of events which affect people’s welfare, as they are required to do. The manager continues to run the home in the best interests of the people there. She takes on board and acts upon advice. Some people choose to look after their own financial affairs and have lockable space within their room to store valuables. Some prefer the home to keep an allowance for them. This is kept securely with accurate records of transactions. Receipts are now provided when valuables or money are returned. This provides additional protection for people and the home. Staff are receiving one to one supervision of their work although this has fallen behind somewhat following staff changes and Christmas. The providers have invested much time and money in the home, with many improvements since the previous key inspection. We saw no health and safety concerns during the visit. Staff were able to describe clearly what they should do in the event of a fire and discussion about health and safety are part of their one to one supervision. Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 23 Kent House DS0000032744.V361229.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 Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Kent House DS0000032744.V361229.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. Standard Regulation Requirement Timescale for action 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 Kent House DS0000032744.V361229.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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
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