Inspection on 12/02/09 for Keys Hill Care

This inspection was carried out on 12th February 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Coopers Mill Ltd

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Keys Hill Care Keys Hill Park Park Road Wroxham Norwich Norfolk NR12 8SB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Don Traylen     Date: 1 2 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Keys Hill Care Park Road Keys Hill Park Wroxham Norwich Norfolk NR12 8SB 01603679740 01603679741 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Keys Hill Park Limited care home 36 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 36 36 The maximum number of service users who can be accommodated is 36 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Learning Disability - Code LD Date of last inspection Brief description of the care home Keys Hill Park was registered as a care home in July 2008 to accommodate up to 36 people with Learning Disabilities, or who have a Mental Disorder. The service was puroposely developed in 2008. Keys Hill Park consists of eleven separate domestic properties. It is made up of a converted Edwardian Mansion surrounded by six newly developed townhouses and a cottage. Each property has a garden area and are e set within three acres of landscaped grounds with a private roadway and parking areas. The service has two main functions:to provide support to people with learning Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home disabilites and to people who have eating disorders. The part of the service intended to provide support to people with eating disorders is called Beechlands, whilst the learning disability service is referred to as Keys Hill Park. The service is only ten minutes walk from the centre of Wroxham in Norfolk and is nearby to a regular bus service. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection started at 10:45 and ended at 7pm. this was the first inspection since the service became registered with the commision. The registerd manager and the deputy manager were present throughout the inspection. A tour of the different buildings was carried out. The policies and intentions of the service were read. Three people living at the home and one person who was visiting the service to decide if he wanted to move there were spoken to. Five support staff were spoken to. The service completed an Annual Quality Assurance Assessment prior to this inspection. prior to the inspection. Care Homes for Adults (18-65 years) Page 6 of 29 Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Peoples aspirational needs should be determined so these can be planned. People should be consulted for their views about whether staff treat them with respect. People should be consulted about the arangement for staff to eat with them. The rate of progress towards recovery and rehabilitation should be monitored and be Care Homes for Adults (18-65 years) Page 8 of 29 recorded as an aspect of care planning. The acccommodation provided should include a telephone. People should not be expected to use a pay phone that is outside of their home. The television services provided should be in working order.The home should ensure that TV signals can be received in rooms where they have been provided with an ariel connection point. The home should ensure all of these services are in working order. The policy for safeguarding people should make reference to the guidelines issued by the Local Authority. Staff must be facilitated to report any issue of abuse. Staff and people living at the home must be provided with the contact details to do this. Safeguarding should be better promoted, so that all staff and all persons living at the home and any visitors are informed of how to and where they can independently report an allegation of abuse to the Local Authoroity or to the Police. A record of the initial induction should be established to show how it is structured and more detals of the competance of staff should be shown in the record of the Skills for Care Common Induction Standards. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured their needs are carefully assessed prior to any agreement that is reached about living at the home. Evidence: The Statement of Purpose was an informative document with the appropriate information about the serviceOther brochures about the service were available to inform people of the style of support offered by the service. At the time of this inspection there were six people living at Keys Hill Park. The admission records for one person was read. His assessment documents included a comprehensive assessment by a multi-disciplinary team. He had been discharged from hospital and his admission was carried out by a Learning Disability Partnership team and a Health Service Senior House Officer. The home had worked in partnership with the assessing team to determine if they could provide the supporttghis person needed. He informed us that he had visited the service before moving in and was pleased to be living there. He stated that he had met staff and told us that he had time and the Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: opportunity to decide if he wanted to move there. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured their care is carefully planned and recorded, although further planning to meet aspirational goals would further assure people they are consistently consulted and can regularly participate in their own care planning . Evidence: The care plan for one person was read and the care arrangements for two people were discussed individually with them. The plan was extensive and included risk assessments and evaluation records. This plan had been reviewed on 19/01/2009 and the person participated in the process. There was an activity plan. He informed us about his understanding of the support he wanted and the aims he wanted to acheive. He explained in detail his aspirations about living independently and moving-on from the service, that were not fully recorded within his plan. This matter was discussed with the two service managers and that the overall intention of the placement and this persons aims and aspirations were not clear in his plan. One of the service managers spoke to him and agreed to record and measure his progress towards his aspirations. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: One element of the care plan is that the service are supporting people to access their Department of Work and Pensions (DWP) Benefits entiltlements. Two people told us how they had made decisions about their medication and about their finances. Care plans were kept locked within each of the individual homes. The location of these records was known by two people who showed us where their plans were and knew this was for security and Data Protection reasons. They each said they agreed with this arrangement and did not want to have the plan in their rooms. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured their care is well planned and carefull provide to support their health needs. Evidence: All people living at Keys Hill Park were actively being supported to claim any DWP Benefit entitlements. This is an element of care that is likely to be needed by most people receiving support from this service. Support to access and enjoy the local community was seen to be taking place. One person went shopping on his own during the inspection. Another person was accompanied outside of the home and when she returned she spoke to us about her day. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: The immediate neighbours and the local commuity were invited to the home for an open day when the service was being planned and preparing to open. One person has regular trips home to see his parents. He is supported to travel independently to do this. He manages to keep contact by telephone. He told us that the use of a telephone is a problem for him to access. There is no landline telephone available in his house and he uses a payphone at the main office whenever he wants to use a telephone. This lack of facility was discussed with the registered manager and the other service manager who said they would review the provision of a telephone link to the houses, so that somebody can independtly access a telephone whenever they wish. It was stated that the person would have to pay towards the cost of a telephone service. This may be a contractual agreement that the home should resolve prior to any person moving into the home. On person commented that staff sometime talk to him in a manner that is not appropriate when his input into the daily domestic routines had been discussed. This was also reported to the registred manager and the other service manager during the inspection and they spoke to this person about this matter and agreed to take action to monitor by consutling people to see if they have similar or other issues. The response shown by the service was accepted by the person. Meals were not observed, although the arrangement for choosing food and shopping are made by people receiving the service. It is part of each persons care plan to become responsible for their domestic arangements including cooking their own meals at times and choosing and purchasing their own food. Three people stated the food was ok and alright and informed us there was plenty to eat and drink. There was an issue raised by one person that he was not keen for staff to eat with him as part of a support technique, or as a general arrangemenst. The manager said he would review this arrangemenst and consult people for their views. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured they are given support for their health related needs and are given opportunities to make decisions about their health and welfare. Evidence: People had clear choices about when they wanted to go to bed or get up. There was some necessary encouragement about awareness of domestic routines and personal hygeine habits that were part of the support needed and had been written into care plans. People had been assessed for whether there were risks associated with administering their own medication. In one,case one person said he did not want to administer his medication yet, but wanted staff to support him until he felt ready to do this. Another person adminsitered some of his own medication and this was locked in his room. Medication that was administered was checked and verified as being accurately stored and recorded. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has suitable policies to inform people they can complain and are protected from harm, but further assurances could be acheived. Evidence: The service has policies for complaints and for protecting people. The policy for protecting/safeguarding vulnerable adults was brief and to the point about elements of abuse and that any abuse would be reported to the local authority or Police. The policy did not refer to the Local Authority guidelines, or to other ways people would be protected from harm. Three staff who worked in two of the houses were asked about their knowledge and ability to report abuse. They each stated they would report to the manager. There were no instructions, or contacts, in the houses for them to report abuse to, although they were aware the Local Authority (or Police) take the lead role when investigating these matters. Staff agreed it would be helpful to have useful contact telephone numbers in each house. From a conversation with one person, people receiving the service had not been informed or given details about reporting abuse, although one person said he would inform the manager. From the issues raised in this report about people not having landline telephones, the lack of functioning TV ariels, or TV signals plus the mealtime arrangements for sharing food these are issues that are potential complaints. The log book for complaints did not include these issues. The service did not have a quality assurance process to Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: monitor if there were any complaints or issues people wanted to raise. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured their accommodation is spacious, comfortable, modern clean and well maintained. Evidence: Three people living at the service told us they were pleased to be living there. One person said, it is the best place I have lived at. The accommodation provided is excellent. The service has stated in one of their brochures that they have attempted to raise the bar, which they have acheievd in terms of the accommodation. It is recognised the accommodation is part of their stated committment to offer modern support services and to set a new standard. The service accommodation is a renovated Edwardian Mansion and six townhouses and a bungalow in a small complex. The service consists of a individual houses that accommodate two, or four people. The size of the accommodation and the quality of the furnishings and fittings and the proportion of space offered to each person are very comfortable and generous. All rooms are genorously proportioned, well decorated and all bar one house has bedrooms that have full ensuite facilities, the other house has a dedicated bathroom. Computer connections and TV connections and telephone terminals are located throughout all of the houses. Each house has a garden and most of these gardens are Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: surrounded by trees and small wooded areas. A handyman ensures minor repairs are addressed. The managers office is located in the main buidling that also has a training and meeting room and an administrators office. The service is intended to provide support for people with learning disabilities and Mental Disorders as well as for people who have an eating disorder. The different functions of the service have been planned so that people needing support because of an eating disorder, will reside in the part of the service called Beechlands. This part of the service is not yet operational. The service has stated in their AQAA that they are aware of the separated environments and the potential need for people to integrate and meet as a community. The service has adeqate and alternative meeting rooms to facilitate this plan. One person told us that he was expected to use a pay phone that is located outside of his home, when he wants to phone home. He also told us that the television signal could not be received from the connection provided in his room. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured that staff are generally competant. Evidence: Staff are given a contract and job descriptions and a staff handbook plus the General Social Care Council codes. The staff team is effective. Staff rosters are planned and there were adequate levels of staff in each house. Staff training and their qualifications were appropriate to their responsibilities. Staff demonstrated a professional approach and an understanding of peoples needs and were respectful in their communication with people living at the home. Staff are working toward achieving NVQ and LDQ awards in care. More than 50 of staff have NVQ awards, although it was discussed with the manager that Learning Disability Qualification awards are expected to be acheived because of the specific needs people using this service have. The service is promoting LDQ awards and the possibility of having a qualified LDQ award assessor working for the organisation. Recruitment records showed the service has safely recruited staff, although a work history in the case of one of the two staff records we saw was not complete. The AQAA Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: completed by the service stated staff receive an initial induction during their first week and then commence the Skills for Care Common Induction Standards. The records for the induction were brief and did not clearly support the contents of the initial inducation. The records for the Skills for Care Based Common Induction Standards were not clearly related to these Standards and if how staff had been assessed for their competancy. This was discussed with the manager who was asked to improve the recording of the two induction programmes. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assured the service is well managed and run in their best interests. Evidence: The manager is a registered nurse who has acheievd the Registered Managers Award. Discussions with the manager and one person using the service showed the person wanted the service to listen and record these views. The manager agreed this was a quality asurance process that could be improved. The service is aware of the quality aspect of monitoring and have made clear references to this in the AQAA they submitted. It is anticipated that this aspect of their operation will become more active. The service has stated in their AQAA that they will focus on quality assurance processes and develop their NVQ and LDQ awards training. They had a comprehensive range of policies clearly indexed, well presented and easy to read. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: Health and saftey is promoted through the records seen for weekly fire alarm tests and an evacuation plan for the buildings. Hot water is safely delivered through thermoststic control valves. Each house has washing and drying facilities for personal laundry. All hazardous chemicals, medication and money was kept locked in the three house that were visited during the inspection. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 18 The Induction process must show clear details of the content and assessement process so that people are assured that staff are competant and they are in safe hands. 10/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans shoul include and record a persons aspirations the reality of acheivement so that these become an established part of the support they need. The home should reconsider how people can access a telephone within their own home, so that personal relationships can be maintained and promoted. The home should review aand consult about their mealtime policy to reconsider if it is always appropriate for staff to eat with people at their mealtimes. The service should promote more vigorously their methods to safeguard people. The service should ensure that TV signals can be received 2 15 3 17 4 5 23 26 Care Homes for Adults (18-65 years) Page 27 of 29 in their room where connections have been installed. 6 7 26 34 A telephone connection should be provided in peoples rooms where they have requested this facility. The recruitment process should show the full details of a person previous work or an explantion of their history prior to their application. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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