CARE HOMES FOR OLDER PEOPLE
Kenwyn Western Road Ashburton Devon TQ13 7ED Lead Inspector
Judy Cooper Unannounced Inspection 30th December 2005 2:00 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 Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 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. Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kenwyn Address Western Road Ashburton Devon TQ13 7ED 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) 01364 652243 01364 652245 alisonlyon@devon.gov.uk Devon County Council Sarah Reilly Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th October 2005 Brief Description of the Service: Kenwyn is a large detached building, situated within walking distance of Ashburton. The home is approached via a steep driveway and there is adequate parking. The home benefits from a large level garden that, thanks to the provision of a ramp and the raising of a patio area at the side of the home, is accessible to all residents. Currently the home provides accommodation for up to 18 residents who are 65 years of age and over (OP category). The home does not admit residents with any severe mental of physical frailty. At present the home is only utilising accommodation within the purpose built wing. This is because the passenger lift accessing the first floor of the original house has been decommissioned and, therefore, the four rooms (two of which were registered as doubles) on the first floor of this part of the home, are now not accessible to residents. The situation will be ongoing until the lift is replaced. A meals on wheels service operates from the premises (currently supplying approximately five meals per day).The home provides a day care service for up to two service users per day. The premises also currentlyincludes a completely separate suite of training rooms for Local Authority staff (however these are shortly to be decommisionned and the accomodation given back to the home for residential use). A further room designated for an employee counsellor is sited completely separately from the residential areas of the home.The home is both well established and well known within the local community. There has been a recent announcement, made by Devon County Coucil, that kenwyn will be the subject, along with some other residential premises, of a review under the Devon County Council Modernisation Programme. This is to determine the future of the service. Currently there is a consutation process underway to allow all information to be gathered, which will then be taken into account in making any final decisions. The announcement regarding the future of the home is expected at the end of March 2006. Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on a Friday afternoon commencing at 2.00p.m. A discussion took place with the manager who was present for the inspection, regarding the recent announcement from the Local Authority that Kenwyn will be the subject, along with some other residential premises, of a review under the Devon County Council Modernisation programme which will determine the future of the service. Residents and staff were spoken with and the staff also observed, whilst in the course of undertaking their daily duties. The majority of the required core standards were inspected at the last inspection in October 2005. A further two outstanding core standards were also inspected on this occasion. Other standards, inspected on this occasion, concentrated on resident welfare on a day to day basis. What the service does well:
There continues to be a very relaxed, family atmosphere within the home which the manager and staff should be commended on for maintaining as this helps create a comfortable, pleasant environment for the residents to live in. The staff continue to maintain residents’ dignity and rights to make personal choices and ensure that residents are treated with respect and their individual needs known and met. The staff group remains stable and are well trained. They work and communicate well together as a team, which helps ensure that residents’ needs are known and well met, whilst residents have a sense of continuity and security due to most staff remaining in post for long periods of time. Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 6 The manager and staff are maintaining a very positive attitude in respect of the recent announcement that Kenwyn is currently to be the subject of a review under the Devon County Council Modernisation programme, which will ultimately determine the future of the service. This is helping residents remain calm and settled with any feelings of anxiety being kept to a minimum. The residents and their families/carers have been made fully aware, by Devon County Council senior management, as well as by the manager of the home, that the future of the home is being reviewed. Having this awareness and being included in the consultation process has aided residents by ensuring they are aware and have an understanding of possible changes that may take place. What has improved since the last inspection? What they could do better:
Further upgrading within the home needs to be undertaken to ensure all areas are presented and maintained to good and acceptable standard for the residents to live in. This includes continuing to address the recommendations contained within the Occupational Therapist’s report of the home undertaken in September 2004; the provision of new bedroom furniture for residents as needed/desired, and the alteration of the radiators heating controls, within residents’ bedrooms, to allow residents to regulate the temperature within the room individually.
Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 7 The re-siting of the home’s laundry also needs to be considered to ensure that infection control measures are maintained. (Currently soiled linen has to pass the door entrance to the kitchen, on the way to the laundry). The current passenger lift will need replacing if the registered provider intends to utilise the bedrooms on the first floor of the original building. 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. Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 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 Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The admission process continues to be well managed. EVIDENCE: The home is not currently admitting further permanent residents (having already got fifteen permanent residents within the home) but continues to offer placements for up to three respite residents, bringing the total resident numbers up to eighteen. By looking at the records for a resident, who was being admitted for a respite stay, during the inspection, under a planned emergency admission, it was noted that a full and detailed admission procedure had been undertaken, even when time was of the essence. This had ensured that Kenwyn was an appropriate respite placement for the resident. Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 10 Residents are treated with dignity and respect and their individuality, independence and privacy is maintained as much as is possible. EVIDENCE: It was noted during the inspection that residents were always treated with respect and that their dignity was upheld. Such evidence that supported this was noting the gentle, personal way that staff spoke to residents, taking into account their individual levels of ability and all residents were nicely dressed, clean and well presented. Residents spoke highly regarding the care they received and of the kindness of the staff. One respite resident was very open in their praise of the home, stating that the respite stay they were currently having had helped them very much. During the inspection a local District Nurse visited to see several residents and it was clear from observing the verbal communications that took place that there are good relationships between the manager and the District Nurse service.
Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 11 Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 Residents continue to enjoy a pleasant and supported lifestyle at the home, which helps them maintain a good quality of life, with visitors welcomed and encouraged. Various informal activities are made available and good meals continue to be provided. EVIDENCE: Residents were noted as choosing how they spent their time with a few spending time in their own rooms whilst the majority had chosen to be in the welcoming communal areas of the home. It was also noted that during the time of the inspection several visitors came and went freely. Residents again confirmed that the meals continued to be provided to a very high standard with residents stating that they enjoyed all meals. Several residents said that they had enjoyed a very happy and busy Christmas at the home. During the inspection it was evident that residents, as well as other stakeholders have been, and continue to be, consulted about the future of the
Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 13 home, and are involved in the current consultation process. A further residents’ meeting is planned for the 23rd January to allow, and facilitate, further discussion. This ensures that all concerned are kept up to date with any plans, thoughts, decisions etc. Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not inspected on this occasion. EVIDENCE: Although none of these standards were inspected, it should be noted that the home has not received any complaints, by the CSCI, within the past twelve months. Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Kenwyn remains comfortable, clean and, in some areas, well maintained, however general upgrading of the environment and the upgrading of some worn and dated furniture and fittings in residents’ bedrooms would further improve the residents’ environment. The part of the home being used continues to provide a safe place for residents to live in. EVIDENCE: Overall the home presented as very comfortable, clean and welcoming. The home is currently suitable for its purpose, in so far that the registered provider is only utilising the purpose built rooms for resident occupancy, whilst communal facilities are sited on the ground floor of both the original building and the purpose built wing. The tour of the building evidenced that the upgrading programme, including redecoration of the homes’ corridors and some refurbishment of the home’s furniture an fittings, continues which is aimed at maintaining a good standard of accommodation throughout.
Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 16 Bedrooms have been personalised as desired and residents can bring in personal items with them if they wish to. The lounge and dining areas provide adequate space and are well appointed. The management stated she continues to maintain the day to day home’s fire precautions in line with the requirements of the local fire department. With the provision of a new ramp and, the raising of an adjoining walkway, residents have easy access from this area to the home’s very attractive gardens. The registered provider has provided window restrictors on all windows considered to be a risk and that are accessible to residents. A new assisted bathing facility has been provided in the first floor bathroom, which aids those residents with mobility problems. The Registered Provider does not yet have definite plans to address the physical shortcomings of the building as identified within the summary of this report, including replacing the passenger lift that is currently out of action which therefore continues to prevent access to the first floor of the original building. The radiators within the residents’ bedrooms have not yet been provided with individual thermostats to allow residents to monitor the heating within their own rooms to a temperature that they are individually happy with. An alternative access to the home’s laundry room, which will prevent the risk of cross infection, has not yet been identified. It is understood that these environmental shortcomings will be taken into account within the consultation process currently taking place. The home was clean, and there were day to day infection control measures in place, to protect residents from the spread of infections. Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 Residents’ needs are well met by an experienced and well trained staff group. EVIDENCE: Training continues to be very well planned, including providing NVQ 2,3 in care as well as other work related areas. Currently twelve members of staff have NVQ level 2 and three have NVQ level 3. An additional staff member is to commence their NVQ level 2 in the near future. The numbers of trained staff ensure that there is far in excess of the required 50 of trained staff working at the home. This therefore ensures that all current residents are cared for by staff, who are aware of their needs and have the knowledge and skills to meet them. Residents again confirmed that they felt confident with, and well looked after by, the staff and that staff were always available if needed. Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31. The home continues to be managed efficiently and well. The Registered Provider must recommence monthly visits to the home to confirm that resident welfare is being met and that the day to day management of the home remains in order. EVIDENCE: The manager has been in post for approximately nine months. She has many years experience of working with this resident group and completed the Registered Manager’s Award and the NVQ level 4 in care in December 2004 having already achieved a Diploma in Management studies in 1998. She has also recently, successfully, undergone the registration process with this Commission to allow her to become the registered manager of Kenwyn (November 2005).
Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 19 (It was noted at this inspection that the required Regulation 26 monthly visits from the registered provider, or a representative of the provider, have not taken place within the home since August, due to senior management sickness. These should be commenced again as soon as possible). Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 20 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 4 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x x x x 3 STAFFING Standard No Score 27 x 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 x x x x x x Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP26 Regulation 23 Requirement The responsible person must explore ways of upgrading and re-siting the home’s laundry room to ensure that soiled linen does not pass through the home and, in particular, past the kitchen entrance (previous timescales given of the 05/08/05 and subsequently 14/04/06 not yet met). The registered provider should arrange for monthly visits to be undertaken, by the provider or a representative of the provider, and and a written report of the visit forwarded to this Commission. Timescale for action 14/04/06 2 OP32 26 30/01/06 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
Kenwyn Refer to Standard OP22 Good Practice Recommendations The registered provider should continue to ensure that the
DS0000032506.V264082.R01.S.doc Version 5.1 Page 22 2 3 OP24 OP25 recommendations contained within the Occupational Therapist’s Environmental Assessment of September 2004 continue to be acted upon. If the first floor of the home’s original building is to be utilised again, adequate repairs to the existing lift, or a replacement lift must be provided to ensure safe and easy access for residents. Consideration should continue to be given to replacing/upgrading residents’ bedroom furniture as necessary/desired. Temperature controls should be in place within service users’ bedrooms to allow them to individually control the temperature setting within their rooms. Kenwyn DS0000032506.V264082.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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