Inspection on 29/09/05 for Keswick House

This inspection was carried out on 29th September 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 no outstanding requirements from the previous inspection report, but made 8 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 22/02/06

Keswick House 05/03/05

Keswick House 22/06/04

Keswick House 10/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

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 29th September 2005 01:00 Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 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.V254076.R01.S.doc Version 5.0 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.V254076.R01.S.doc Version 5.0 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.V254076.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 05/03/05 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.V254076.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven hours from early afternoon into the evening. The methodologies used were: individual and group discussions with the residents, a meeting with one visiting professional, and two further conversations with relatives over the telephone. Two residents spoke with the inspector in private and four residents allowed the inspector to see their bedrooms. Observations of the staff relating to the residents and informal dialogue also took place. Discussions were held with the manager and an examination of care and staff records was carried out. A guided tour of the environment was also undertaken. What the service does well: All of the residents spoken to said that they were happy at the home. “All the staff are nice.” No, I don’t get bored” and “ I like living here”, were comments made that well reflected the relaxed atmosphere in the home. Relatives too were full of praise: “My relative is very happy, they have changed a lot.” “They will always talk and inform me of things” “It’s open visiting, there are no restrictions.” Staff support and encourage residents in their relationships with family members. Each resident’s health care needs were met that addresses both physical and mental needs, and any professional appointments required are followed up and acted upon. The plans held in the office hold all of the necessary information. Files are stored appropriately. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 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.V254076.R01.S.doc Version 5.0 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): 1,2 and 4 Residents have their needs assessed prior to admission but full information about the home is not available within the Statement of Purpose and Service User Guide. Without this, prospective residents and their families are not fully aware about the home to confirm that Keswick can meet their needs. EVIDENCE: The homes Statement of Purpose is incomplete and therefore does not offer current and prospective residents and significant others the opportunity to make an informed choice about the services provided and whether the home can meet their needs. It was noted that all three homes owned by the proprietor were in receipt of the same Statement of Purpose. It is strongly recommended that these be separated to reflect the differences. The home does not offer a Service User Guide as required. This must include details of the homes main policies, complaints procedure, fees charged, a summary of the statement of purpose, description of the homes accommodation, residents views of the home and key contract terms covering admission, occupancy and termination. It was noted that a number of these documents were in place but they must be combined as a Service User Guide and in a format appropriate for those residing at Keswick. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 9 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 residents may be expected to finance themselves. It is strongly advised that this be incorporated into individual contracts between the home and the resident. The Inspector spoke with a relative, who confirmed that a structured admission process had taken place, a settling in period had been offered and the social worker, family and the manager for the home had met to discuss the residents needs. They confirmed everything had been “fine” and that they were “very happy with the way things had been handled, there was never a problem with communication.” Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 The manager and staff work well with each resident to find out what they want from life. Residents are encouraged to be independent however care planning must be strengthened to evidence this. EVIDENCE: Three service user files were seen at this visit and each held the original assessment undertaken before each service user moved into the home. Care plans were in place as were daily records, risk assessments and reviews. Discussion with the manager took place and although residents and their families were able to inform the inspector that their assessed and changing needs were met, and that they were able to make decisions about the ways in which they led their lives, written records did not fully reflect this. The registered manager must strengthen the systems in place to monitor and review the quality of care, in particular residents’ goals and aspirations. The home does not operate a key worker system and it is therefore imperative that written records are up to date, thorough, succinct and informative. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 11 The residents were very busy on the day of inspection and the comings and going were just as they would be in any household. On arrival residents were seen unpacking the weekly shop and assisting with food preparation, some were at college, some were in their rooms listening to music , one resident was in the day care facility, some were at the library using the internet facilities and 2 ladies were getting ready to go to the theatre. All other residents went off to the pub in the early evening. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 12 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): 12, 13, 14, 15 and 16 Residents enjoy a varied lifestyle and take part in activities linked to their interests and abilities. They enjoy good relationships both within and outside the home. This lifestyle enables them to become full members of the local community. EVIDENCE: Five of the service users and two of their family members chatted about their lifestyles comments like: “There are no difficulties, I can call or telephone anytime, I receive a clear picture of what is going on within the home.” and “I am very happy, since moving in my relative has changed a lot, they are more confident and interact much more.” were made. Residents also stated they could come and go as they please, friendships were evident both in and out of the home and opportunities to partake in various activities were offered. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 13 Some residents independently access the local community and suitable documentation was in place, which had been planed and agreed with the individual. In discussion with the residents it also became evident that they all maintain varying forms of contact with their families. Notes of family and friends involvement was recorded in each individual plan under the daily records section, residents said that they enjoyed their lives. “I feel independent.” “I like living here”, were typical comments made. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 14 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, 19, 20 and 21 Personal care and health care needs are closely monitored and the results well recorded, medication procedures require strengthening to fully protect self medicating residents. EVIDENCE: The plans examined and discussion with residents showed that requirements for support were individualised. There was evidence that health care professionals are involved where necessary with information relating to health care issues within residents files. There were letters indicating that appointments were made with the relevant bodies to address health issues. Some residents at the home self medicate, suitable storage facilities were available. It is imperative that individual assessments are undertaken, agreed and signed by the resident to confirm their understanding of all the risks. Medication administration, recording and storage were checked during this inspection and all were in order. The inspector had the opportunity to speak with the pharmacist who was able to confirm that professional relationships were “very good” and that the home would “always ask advice where necessary.” Regular written audits from the pharmacist were in place. It was recommended that a signature sheet, with the persons name recorded next to Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 15 it should be in place. This will offer accountability as to who had administered which medicines should there ever be an area of concern if a signature could not be deciphered. It was pleasing to note that there weren’t any gaps being left on the medication administration records, controlled drugs were not being administered at the time of inspection. The manager confirmed that a Homely Remedies Policy was not available within this establishment; it is strongly recommended that this be implemented. 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. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 16 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): 22 and 23 The home has an appropriate complaints procedure in place. Staff have a good understanding and are aware of their responsibilities in protecting service users from any form of abuse. EVIDENCE: The home has an appropriate complaints procedure on display in the hallway, this must also be made available to every resident within the Service User Guide. Two residents were asked what they would do if he wished to make a complaint and they were clear about his rights to complain and who to complain to. One staff member was spoken to about her understanding of signs of abusive practice. She confirmed that she had received training about abuse and that she had a good understanding of her responsibilities. Training records showed that the majority of staff had had training in this area. Residents were asked about how staff treated them and in every case they confirmed that they had a good relationship with all of the staff. Discreet observation of staff and service users interaction throughout the day gave an impression of mutual respect between them and that residents were relaxed in the home. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 17 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, 25, 26, 27 and 28. The standard of the internal environment within this home is satisfactory providing residents with a homely place to live. Maintenance planning and the upkeep of the external and internal environment need to be addressed to maintain and aid the presentation of this home. EVIDENCE: The home is a large Victorian detached house and is in keeping with other properties in this area. A tour of the accommodation was made by the inspector with the support of two of the residents. The home has a satisfactory standard of decoration and fitments, the manager is fully aware that redecoration is required in some areas. It was noted that radiators were not risk assessed, these must be individually assessed and guarded if necessary. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 18 Four residents rooms were visited during this inspection. The residents had personalised their rooms and were happy with them. The communal areas had a ‘homely’ feel and were generally comfortably furnished. A requirement to provide a new three-piece suite in the front lounge was made on this visit as it was broken, worn and considered very uncomfortable to sit on. The laundry was not seen on this occasion, the kitchen was not inspected. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 19 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): 31, 32, 33, 34, 35 and 36 Future recruitment practices will need to be tightened thus ensuring suitable staff are employed. The majority of staff have received the mandatory training required to ensure that the individual and joint needs of the service users are appropriately met. EVIDENCE: There is a stable staff team within this home which gives residents confidence and ensures that everyone is aware of individuals needs. Residents confirmed that they knew everybody and were aware of who was, and who would be coming on duty. Relatives confirmed that staff were very well informed and that they “always know what is happening”. Staff too felt the home ran well and stated, “the atmosphere is good, it’s relaxed”. Three staff files were seen on this visit, one did not contain a criminal record disclosure as required, future recruitment procedures must therefore be improved upon. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 20 There was evidence to confirm that supervision and training were offered to staff but it was not easy to follow, the manager should seriously think about using a training and supervision matrix to strengthen her evidence. Mandatory training has not been offered to all staff and is a requirement of the inspection; specialist training for staff to meet individuals needs should be considered. The manager confirmed that at least 50 of care staff had completed the National Vocational qualification (NVQ 2) and some staff were undertaking, or had, the level 3 also. Staff were discreetly observed throughout the visit talking to residents, they had a good understanding of each residents’ needs, and they showed the utmost respect to the residents both in their actions, i.e. knocking on doors, respecting their privacy and dignity, and in the various interactions with them. It was clear from observations that there was a good rapport between everyone. Staffing levels were suitable and residents and their relatives confirmed that they felt there were always enough staff on duty. Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 21 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): These standards were not inspected on this occasion. EVIDENCE: Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 X 4 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 1 2 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Keswick House Score 3 3 2 2 Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000008241.V254076.R01.S.doc Version 5.0 Page 23 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. 1 Standard YA1 Regulation 4 Requirement Timescale for action 10/11/05 2 YA1 3 YA6 4 YA20 5 YA21 6 7 YA24 YA34 The Statement of Purpose must be a current reflection of the service and include all items listed under schedule 1. 5 A Service User Guide must be produced and offered to all residents and /or their significant other. 24(1)(a)(b) The registered manager must strengthen the system in place to monitor and review the quality of care, in particular residents goals and aspirations 12(1)(a) There must be an assessment of residents who self medicate, which takes account of competence and risk. 12(2) The registered manager must 12(3) 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. 23(2)(a) The registered manager must replace the three piece suite in the front lounge. 19(1)(b)(i) The registered person shall not employ a person to work at the DS0000008241.V254076.R01.S.doc 10/11/05 10/11/05 06/10/05 31/12/05 31/10/05 03/10/05 Keswick House Version 5.0 Page 24 8 YA35 18(1)(c)(i) care home unless they have obtained all the documents and information specified in Schedule 2. In this instance a Criminal Records Enhanced Disclosure (CRB) Mandatory training must be offered to all staff. 10/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA1 Good Practice Recommendations The registered person should consider providing three separate Statement of Purpose for each individual home owned by the proprietors, to avoid confusion. 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 residents may be expected to finance themselves The registered person should consider a signature from residents or their significant other to confirm a Service User Guide has been provided. The registered person should consider introducing a signature sheet, with the persons name recorded next to it. This will offer accountability as to who had administered which medicines should there ever be an area of concern if a signature could not be deciphered. The registered person should consider introducing a training matrix and supervision matrix for all staff. Specialist training for staff to meet individual needs should be considered. 3 4 YA1 YA20 5 6 YA35 YA35 Keswick House DS0000008241.V254076.R01.S.doc Version 5.0 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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