Inspection on 13/06/05 for Keswick

This inspection was carried out on 13th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Keswick 13/08/07

Keswick 25/04/06

Keswick 25/07/05

Keswick 27/01/05

Keswick 30/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Keswick Eastwick Park Road Great Bookham Surrey KT23 3ND Lead Inspector Sandra Holland Announced 13 June 2005 10:00am 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 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. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Keswick Address Eastwick Park Road, Great Bookham, Surrey, KT23 3ND 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) 01737 242188 Anchor Trust 1st Floor, 408 Strand, London, WC2R ONE Ms Shona Bradbury Care home only (PC) 51 Category(ies) of Old age, not falling within any other category registration, with number (OP), 51 of places Dementia - over 65 years of age (DE(E)), 15 Physical disability over 65 years of age (PD(E)), 10 Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 Of the 51 Residents accommodated, up to 15 may fall within the category 2 Of the 51 service users accomodated, up to 10 may fall within the category Date of last inspection 27th January 2005 Brief Description of the Service: Keswick is a care home which is owned and operated by Anchor Trust. It is situated in the Surrey village of Great Bookham, a short distance from the high street, which has a range of shops and serivces. The home is adjacent to a health centre and a junior school. The home is arranged into seven units, each with six to eight bedrooms, a communal lounge/dining room with open plan kitchenette and bathroom and toilet facilities. The building is of two storeys with a passenger lift providing access to all areas. A wheelchair lift enables access to one residential unit. There is a large lounge/dining room on the ground floor which is used for activities. This room is also used as a day centre for non-residents. A spacious conservatory overlooks the rear garden which has a patio area, lawn and flower beds. The main entrance lobby is light and airy with a reception desk and a seating area for residents. Car parking spaces are provided to the front of the property. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was the first to be carried out in the Commission for Social Care Inspection year April 2005 to March 2006. The inspection was carried out by Mrs. Sandra Holland, Regulation Inspector and took place over seven hours. Ms. Shona Bradbury, Registered Manager was present, representing the service. A tour of the premises took place and a number of records and documents were examined, including care plans, staff files, medication administration records (MAR’s) and accident and complaints records. The inspector spoke with seventeen residents, two visitors and ten members of staff. The people living at Keswick prefer to be known as residents and that is the term that will be used throughout this report. What the service does well: What has improved since the last inspection? What they could do better: It is of serious concern that a previous requirement that staff are not employed until all the required recruitment documents and checks have been completed, has still not been met. One member of staff has been employed at the home and has worked unsupervised without having a Criminal Records Bureau (CRB) check in place. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 6 All records in respect of Controlled Drugs must be maintained, be accurate and kept up to date. The receipt of all medication received into the home must be recorded at the time of delivery and medication no longer required must be returned to the pharmacy. A fire risk assessment for the premises is maintained but must be reviewed and updated. The record of fire alarm testing must be kept up to date. Members of staff need to sign to indicate that they have read and understood the fire policy and procedures. All residents must be supplied with a contract or statements of terms and conditions of residence. Staff at the home must be appropriately supervised. 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. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 8 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 standard(s) 2, 3 and 5. Statements of terms and conditions of residence in this home are called Licence Agreements. Pre admission assessments are carried out. EVIDENCE: From the individual plans for each resident it was evident that Licence Agreements are drawn up, which detail the terms and conditions for living at Keswick. These include the services to be provided, room to be occupied, the fees to be charged and notice periods that either the home or the resident must give. It was noted however that Licence Agreements are in place for some, but not all residents. The manager advised that the home invites prospective residents and their family or friends to visit the home to assess its suitability. Prospective residents who decide they would like to move into the home, are then invited for an assessment day. This enables the prospective resident to see the home more fully, to meet other residents and enables the home to assess the prospective resident, to ensure that their needs can be met. The written assessment of a recently admitted resident was seen. This was linked with a general practitioner’s (G.P.) letter, providing medical information, both of Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 9 which enable the home to understand the support and care the resident may need. A requirement has been made – please see page 22. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10. Individual plans are held which record the needs of each resident and how these are being met. Resident’s health care needs are well met. EVIDENCE: The manager advised that individual plans of care are in the progress of being changed to make them easier to use. The new style of plan will ensure that all records of residents needs are included in the one document. Some of the plans seen were in the new style. Wherever possible, the plans have been signed by the resident concerned to show their involvement. It was clear from the care plans, that a number of health care professionals support the residents, including general practitioners (G.P.’s), district nurses, chiropodist and community psychiatric nurses (CPN’s). Residents also go out to appointments with health care professionals, including the dentist and hospital specialists. The policy and procedure for the administration of medication must be improved. The following shortfalls in medication administration were noted: • The receipt of Controlled Drug (C.D.) medication was not recorded on the day it arrived in the home Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 11 • • The record of C. D. medication receipt and storage was not clear enough to allow an audit trail to be followed C.D. medication was still held in the home for residents who had left the home. Staff were observed to treat residents in a manner that promoted their privacy and dignity. A number of residents made positive and appreciative comments about the assistance and care that the staff provide. A requirement has been made – please see page 22. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 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 standard(s) 12 and 13. The residents benefit from a flexible daily routine and a variety of activities are available. EVIDENCE: Residents were seen to be well occupied doing crosswords, knitting, reading, walking in the garden and chatting in small groups. A word-based activity was taking place in the main lounge/day centre and residents are welcomed to join in. During the afternoon a number of residents were entertained in the main lounge by, a visiting singer/guitar player. Those residents spoken to confirmed that they are free to decide on the times of going to bed and getting up, for example. Visitors to the home were spoken to and advised that they are always made welcome in the home and that they appreciated the care provided. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16. An effective complaints procedure is available. EVIDENCE: The complaints record book was seen. The manager signs this to show that she has noted the complaint and she advised that she responds accordingly. Letters and documents kept in the complaints file showed how the manager had responded or what actions were taken. Residents stated that they felt able to approach the manager or other members of staff to raise any complaints. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 20, 21, 23, 24, 25 and 26. The overall décor and furnishings in this home provide a well-cared for and homely environment for residents. EVIDENCE: Keswick is a purpose built home, which is divided into seven smaller, family sized units. It is well maintained with colourful decoration. It is appropriately furnished and equipped to meet the needs of residents. Resident’s bedrooms are for single occupancy and are fitted with wash hand basins. Staff advised that residents are encouraged to bring items of furniture and other belongings into the home to make their bedroom more individual. Resident bedrooms seen, had been personalised with photographs, ornaments, plants and pictures. Toilets and bathrooms, with specialist, easy access baths, are situated nearby and were seen to be hygienic. The home was clean, tidy and freshly aired throughout. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 15 The garden was planted with pots of seasonal flowers and tables and chairs were arranged on the patio. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29. A team of staff are employed to meet the needs of residents. There is concern about the standard of the home’s recruitment procedures. EVIDENCE: In addition to the members of care staff, a maintenance worker, housekeepers, an administrator, a day centre manager/activities co-ordinator and kitchen staff, are also employed to carry out the roles required to meet residents’ needs. A number of these staff were spoken to during the inspection. They confirmed that they were clear about their role within the home. The manager advised that the number of care staff trained to National Vocational Qualification (NVQ) Level 2 in care, or the equivalent, meets the 50 ratio required. It was stated that three staff are qualified as NVQ assessors and the manager is training to be an Internal Verifier for NVQ. Staff files were examined and it is of serious concern that a member of care staff has been permitted to work, sometimes unsupervised, without a Criminal Record Bureau (CRB) clearance being obtained. This must not occur. No member of staff must be employed until all the required recruitment records and checks have been completed. The manager stated that the member of staff would not be permitted to work until the CRB clearance had been obtained. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 17 It is required that a risk assessment be carried out regarding a member of staff, as a caution was identified on that person’s CRB clearance. Requirements have been made – please see page 22. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 and 38. The home is managed in an open and inclusive way and residents and staff made positive comments about the manager and accessibility to her. EVIDENCE: The manager has worked at the home for a number of years and has developed a stable staff team, the majority of whom have been employed for at least two years, and some for many more. Informal, but positive and professional, interaction was observed between the manager and residents and staff. The manager advised that resident and staff meetings are held, to discuss developments in the home, and minutes of these were seen. Diversity amongst the resident and staff groups was apparent. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 19 A resident’s questionnaire about the standards of service at Keswick, was distributed in April 2005. Many of these were returned very promptly and raised three main issues – the lack of information about complaints, inspections and inspection reports. The manager wrote to residents and their representatives within a week to provide the answers to the points raised. At present the system to assess the quality of the service at Keswick does not seek the views of people in the community, such as local doctors, chiropodists or district nurses. It is recommended that this is introduced. The records regarding fire prevention at the home were seen. It was noted that there is a risk assessment for the premises in relation to fire, but that it has not been updated since June 2002. This is unacceptable. The fire risk assessment must be updated to reflect the current needs of residents and any changes in other assessed factors. During the course of the inspection, the laundry door providing access to the rear car parking area was observed to be open on more than one occasion. The car park is open to the road. This is a hazard to the health and safety of residents, some of whom have dementia, and may wander out. It also allows entry to the home by unauthorised persons and it must not be allowed to continue. A requirement and a recommendation have been made – please see page 22. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 3 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 3 2 x x x x 2 Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 17 Schedule 4 Requirement The registered person shallmaintain in respect of each service user, the rcords specified in Schedule 4 of The Care Homes Regulations 2001 (As Amended). Specifically, a record of the care homes charges (contract) to service users must be held, including any extra amounts payable for additional services. These must be available in the home for inspection at all times. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Specifically, the receipt of Controlled Drugs must be recorded on arrival in the care home, Controlled Drug records must be accurately maintained and Controlled Drugs no longer required must be returned to the pharmacy. The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home and the information and documents specified in Schedule 2 of The Timescale for action 29th July 2005 2. 9 13 (2) 27th June 2005. 3. 29 19 Schedule 2 13th June 2005 Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 22 4. 38 13 (4) (c) Care Homes Regulations 2001 (As Amended) have been obtained. Specifically, no person must be permitted to work unsupervised without a Criminal Record Bureau (CRB) clearance being obtained and a risk assessment must be carried out regarding any member of staff who has a caution identified on their CRB clearance. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. Specifically, the risk assessment regarding fire at the premises, must be reviewed and updated and the security of the premises must be reviewed in relation to the external door in the laundry. 29th July 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 33 Good Practice Recommendations It is good practice to seek the views of external stakeholders on how the service is meeting the service users needs. Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Keswick H58-H09 S13691 Keswick V219134 130605 Stage 4.doc Version 1.30 Page 24 - 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. 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