Inspection on 22/02/06 for Keswick House

This inspection was carried out on 22nd February 2006.

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 no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Keswick House 15/05/08

Keswick House 16/05/06

Keswick House 29/09/05

Keswick House 05/03/05

Keswick House 22/06/04

Keswick House 10/01/04

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

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Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Keswick House 212 Lightwood Road Longton Stoke-on-Trent Staffordshire ST3 4JZ Lead Inspector Rachel Davis Unannounced Inspection 22 February 2006 12:00 Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 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 Keswick House DS0000008241.V284719.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Keswick House Address 212 Lightwood Road Longton Stoke-on-Trent Staffordshire ST3 4JZ 01782 336656 01782 318281 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) Mr Alan John Bradshaw Mrs Joy Bradshaw Mrs Joy Bradshaw Care Home 12 Category(ies) of Learning disability (12), Physical disability (2) registration, with number of places Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2005 Brief Description of the Service: Keswick House is a care home for adults accommodating 12 people with learning disabilities, two of whom may have a physical disability. The level of need amongst the residents varies but generally they are relatively independent and able to access local facilities with minimum support. The home is privately run by the registered providers Mr and Mrs Bradshaw, Joy Bradshaw is also the registered manager. Mr and Mrs Bradshaw also operate two further homes, Derwent, next door and Rydal in nearby Dresden. Joy is also the registered manager next door at Derwent but Rydal has a separate registered manager, Mrs Gaynor Rowley. To the rear of Keswich House is a small day care facility which is used by up to five people each day. There were no vacancies at the time of inspection. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours on 22nd February 2006. The inspector used the National Minimum Standards for Younger Adults and Adult Placements as the basis for the inspection. This visit only covered a small number of the national minimum standards, to ascertain a full picture this report should be read alongside the unannounced inspection held on 29th September 2005. There were 6 service users at Keswick on arrival, by 4pm everyone had returned home. Two staff were on duty on each shift of the day. The inspector spoke with everybody to varying degrees. What the service does well: What has improved since the last inspection? The Statement of Purpose has been individualised to the service offered, only minor additions are now required. Generally care planning has continued to improve; information regarding goals and aspirations has been addressed. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 6 Assessments for service users who self medicate are now in place. A new three-piece suite has been purchased as required. Infection control training and appropriate equipment relating to this is being implemented throughout the home. Liquid soap and paper towels and dispensers are being added to minimise the risk of the spread of infection. All the staff within the home have a Criminal Record Bureau check (CRB) as necessary. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 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 the following standard(s): 1 The Statement of Purpose and Service User Guide were not as comprehensive as is required. This means that permanent and prospective users of the service may not be aware about how the home deals with important issues that may affect their day-to-day life. EVIDENCE: Both a Statement of Purpose and Service User Guide were available. The Statement of Purpose has been individualised to the home since the last inspection. However, whilst most of the required information was available such as the number of people the home caters for, links with the community, staff training, arrangements around consultation, it was not quite to the level required. Other important information required within the Service User Guide, such as the complaints procedure, terms and conditions, the address of the Commission were not included at all, this document requires further work. The registered person should consider dating the Statement of Purpose and Service User Guide to assist with the timing of the required annual review. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 6, 9 and 10 The general standard of care planning was satisfactory, with individual plans in place for each service user. There were some good responses to looking at the risks that they may individually encounter however; environmental risk assessments must be improved upon. EVIDENCE: A random selection of care plans were examined during the inspection, the overall standard of these care plans was suitable. Plans had been regularly updated and evaluations were in place and quite detailed. It was recommended that the home tries to get further evidence of service user participation and considering the Person Centred Planning (PCP) approach may facilitate this. The assessment of general healthcare needs was good and services were brought in as required whether that be behavioural specialists, the doctor or a chiropodist to name a few. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 10 There was evidence of the risk assessments being completed and that the staff enabled service users to take responsible risk. Missing person policies and procedures were in place as required. Service users records were stored securely and confidentially. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 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 the following standard(s): 16 and 17. The lifestyle for the service users varies according to their wishes and capabilities, with greater support offered from staff where needed. The home must continue to evidence and ensure that all of the service users are able to undertake the activities they wish. EVIDENCE: The service users enjoy a varied and active life, everybody has an activity plan, which shows events they attend. These include college courses, sports activities and work placements. Alongside this the service users spend time with their families. On the day of the inspection six of the residents were at home, some spent time in their rooms others were involved in doing domestic tasks. The service users are encouraged to be as independent as possible and many access the local community alone. They use public transport and local facilities. Two of the residents have been supported to do voluntary work. Many service users maintain close contact with their families, spending regular weekends with their parents. Families are welcomed into the home. Four Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 12 service users have keys to their bedrooms but do not have a front door key, this should be discussed within a residents meeting. There was reliable evidence of regular minuted meetings taking place. The service users were involved in planning their own meals and during this visit two prepared their own lunch with minimal support, it was confirmed that fresh fruit and snacks were readily available. Further documentation would help to evidence that alternative meals were offered and that “ we go with the majority” as one service user revealed, was not always the case. There were foods in the fridge and freezers which were not labelled with the type of food or the date. This will need to be addressed without delay and foodstuffs must be kept in accordance with environmental health requirements. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 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 the following standard(s): 18 and 19. Service users are enabled and supported to engage in local community activities. Daily routines are dependent on individual choice, age and ability and staffing is provided accordingly. The home is mindful of the healthcare needs of the service users and responds well to ensuring that these needs are met. EVIDENCE: Personal support needs are recorded in the care plans, each service user has their own individual style and staff were aware of this uniqueness and dealt with people dependant upon that individuality. The health of the service users were well monitored and all medical appointments were recorded, appropriate attendance at dentists, opticians and general practitioners was noted. The medication systems were not examined at this visit. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 14 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 the following standard(s): These standards were not inspected on this occasion; please refer to the last inspection report. EVIDENCE: Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 24, 27 and 30. The home is in need of attention, adaptation and further improvement. Attention is currently being spent on infection control procedures. EVIDENCE: A tour of the environment was conducted. Some painting and redecoration had been carried out to the environment since the last inspection, although, in some areas it was unfinished. Externally the property appears somewhat worn and tired, and the home requires redecoration, grouting, flooring, and new fixtures and fittings in a number of instances. The Commission are aware of a major variation to the property and therefore appreciate that some work will not be undertaken until building work is completed. The provider must however provide an environmental plan of what work will be considered priority during 2006/2007. It was noted that products falling under Control Of Substances Hazardous to Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 16 Health (COSHH) regulations were appropriately stored; data sheets or relevant risk assessments were in place. In the laundry, systems were in keeping with infection control guidelines. It was recommended that the COSHH data sheets were in the same vicinity as the products to support staff if necessary. The shower room flooring requires sealant to eliminate the ingress of water. There was not a toilet roll holder in the toilet located next to the dining room. Generic risk assessments need to be developed for the working environment and this was discussed with the provider/manager at the time. The lighting in the home must be assessed to ensure that the halls, landings and stairwells are suitably lit. The second floor was cold on the day of inspection further discussions with service users revealed that they too felt it was not always warm enough to stay in their rooms. This was discussed with the manager during feedback and assurance was given that this would be rectified immediately. Staff and service users work together to maintain the cleanliness of the home, infection control issues are being addressed, the proprietor has purchased liquid soap, towel dispensers, waste bins and storage receptacles. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35. The service users are adequately supported. The home needs to ensure all information required is obtained in future recruitment. Further mandatory training is still required, individual staff skills will need to be assessed and further developed in order to ensure that all the needs of the service users are fully met. EVIDENCE: Two staff files were chosen on a random basis to be inspected, evidence of POVA First and a CRB enhanced disclosure were available in each case, However some elements were missing in staff files mainly identification, photographs and a medical declaration, the manager must ensure that all elements of Schedule 2 of the national minimum standards are in place. Staff had now been supplied with the General Social Care Council Code of Conduct leaflet, as is required. There is a stable staff team within this home which gives service users confidence; there are no vacancies presently. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 18 All the service users were very positive about the staff team and the manager. Although mandatory training has improved some areas still require attention, moving and handling, equal opportunities and disability equality training are required. Specialist training is being considered, especially training in epilepsy and diabetes. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. There is an experienced manager in place but they must mindful of the time made available for managerial duties. A number of standards are not met and this could impact on the running of the home. EVIDENCE: Fire safety records were examined; the fire risk assessment was out of date, this should be completed annually. Fire drills are offered to staff and service users as necessary, the last one being on 16th January 2006. It was ascertained at this inspection that the manager has contacted the fire department with regard to alterations to the property. The fire alarm and emergency lighting were suitably checked and recorded. Gas and electrical tests were in date. Water temperatures were recorded monthly. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 20 It was confirmed that Joy the manager is usually one of the staff on shift and only has minimal super numerary hours per month, this should be regularly monitored as Joy also manages Derwent next door and any requirements made must be met in a timely manner. Service users confirmed Joy was “ very nice” and “ helpful.” People spoken to were confident in going to her if they were worried, upset or cross about something. Service users views are sought in achieving the aims and objectives noted in the homes Statement of Purpose, the manager must further demonstrate this by evidencing service users involvement in recruitment, interviewing of staff development of policy and procedure and the general management of the home. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 3 X 3 X X 3 X Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 22 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. 2. Standard YA1 YA1 Regulation 4 5 Requirement The Statement of Purpose needs minor amendments to meet the regulations. A Service User Guide must be produced and offered to all residents and /or their significant other. Previous requirement not met. The registered manager must ensure the storage of foodstuffs complies with legislation. The registered manager must ensure the residents know whether they will be able to remain in the home as they grow older and sensitively discuss their wishes and views relating to ageing, illness and death. Previous requirement not met. The registered manager must ensure appropriate and assessed lighting is available within the home. The registered manager must ensure the second floor of the home is warm enough at all times. DS0000008241.V284719.R01.S.doc Timescale for action 22/03/06 22/03/06 3. 4. YA17 YA21 13(4)(c) 16(2)(j) 12(2)12(3) 28/02/06 30/04/06 5. YA24 23(2)(p) 31/03/06 6. YA24 23(2)(p) 28/02/06 Keswick House Version 5.1 Page 23 7. YA24 8. 9. YA24 YA27 10. 11. YA27 YA34 12. YA35 13. YA42 23(2)(b)(d) The registered manager must provide the Commission with an environmental maintenance plan for 06/07. 13(4)(a) Radiators must be individually risk assessed. 13(3) The registered manager must ensure the shower room floor is sealed to prevent the ingress of liquid. 23(2)(c) The registered manager must provide a toilet roll holder in the downstairs toilet. 19(1)(b)(i) The registered person shall obtain all the documents and information specified in Schedule 2. 18(1)(c)(i) Mandatory training must be offered to all staff. Previous requirement part met. 23(4)(a) The registered person must complete a fire risk assessment. 30/04/06 31/03/06 22/03/06 28/02/06 03/10/05 10/11/05 10/03/06 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. Refer to Standard YA1 Good Practice Recommendations It is advised that the management team streamline some of their information to ensure that it is absolutely clear about what the home does and does not provide and what the service users may be expected to finance themselves. The registered person should consider dating the Statement of Purpose and Service User Guide to assist with the timing of the required annual review. The registered person should consider exploring the Person Centred Planning approach PCP, to see if it appropriate for this service. The most appropriate file layout should also be considered. The registered person should further expand the recorded information regarding meals and how choices are made. The registered person should further evidence service DS0000008241.V284719.R01.S.doc Version 5.1 Page 24 2. 3. YA1 YA6 4. 5. YA17 YA39 Keswick House 6. YA42 users involvement in recruitment, interviewing of staff, development of policy and procedure and the general management of the home. The registered person should consider providing the Control of Substances Hazardous to Health (COSHH) data sheets with the product as well as in the office. Keswick House DS0000008241.V284719.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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. 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