CARE HOME ADULTS 18-65
Kings House 1 Earle Road Westbourne Bournemouth Dorset BH4 8JQ Lead Inspector
Sally Wernick Unannounced Inspection 05 October 2005 10:00 Kings House DS0000003951.V254507.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 Kings House DS0000003951.V254507.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. Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Kings House Address 1 Earle Road Westbourne Bournemouth Dorset BH4 8JQ 01202 764455 01202 764455 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) Kingshouse@together-uk.org Together Working for Wellbeing Mrs Sheila June Shutler Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19) of places Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Five named adults (names known to CSCI) over the age of 65 years may be accommodated until such time as their assessed needs cannot be met by the home 22nd March 2005 Date of last inspection Brief Description of the Service: Kings House is situated in a quiet residential area of Westbourne and is easily accessible to shops, local amenities and beaches. It is a red brick detached property with a conservatory, pleasant rear garden and summerhouse. It is registered under the category mental disorder (MD excluding learning disability or dementia) for up to 19 male and female service users. The majority of rooms are shared some with en-suite and there is a self-contained flat within the building, which can accommodate two service users assessed, as suitable for more independent living. Kings House is operated by Together a mental healthcare association and accommodates individuals with enduring mentalhealth problems. Those living at Kings house receive 24-hour emotional and practical support from a team of experienced residential care workers. The day to day running of the home is undertaken by the project manager Mrs Shutler and the deputy project manager Sini Lehtinen. The service aims to provide ongoing support to ensure service users stability and help those who are able to progress to more independent living. To facilitate this, service users are encouraged to carry out a range of domestic tasks including laundry, meal preparation and cleaning. A number of service users use day care services all have a range of activities, which they pursue independently. Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection visit carried out by two inspectors was unannounced and started at 10.00am on Wednesday 5 October and was completed at 2:00pm. It was conducted as part of the normal routine of inspecting twice during a twelve-month period. 12 standards were considered. The Deputy Manager Ms S Lehtinen assisted the inspectors in their work. Methodology used included a tour of the premises, review of records and discussions with service users and staff. No complaints have been received during this inspection period. What the service does well:
Kings House is a specialist service for men and women with mental health problems. There are currently 18 residents and of those spoken to one had lived in the home for 18 years, “because she was very happy there” and another was nearing the end of a 6 week assessment period. Both described being pleased with the care they received identifying competent, caring staff who had a good awareness of their needs. Accommodation mainly comprises of shared rooms however there is the opportunity for independent living in selfcontained accommodation. Premises are comfortable and well equipped with two communal rooms, conservatory, summerhouse and attractive rear garden. Records and discussion with service users demonstrated that they are encouraged to make decisions about their lives. A service user informed the inspector that she made long distance trips to see her children; another had been supported on a holiday to Spain. One service user described the range of mental health day services he used. Residents are assisted to maintain as much independence as possible and are encouraged to maintain contact with their families and local community. Support at the home is offered in a way that promotes service users’ privacy dignity and independence. One service user retains their own medication which promotes a feeling of trust and responsibility. Whilst others, the deputy manager stated, were strongly encouraged to pursue individual activities. For example swimming, which one resident particularly enjoyed and which created a feeling of well-being. Posters and notices around the home demonstrated that residents were encouraged to join in appropriate activities and social events. A Halloween party was one such forthcoming event. Generally the quality of life presents as very good with a variety of recreational and social activities and home cooked meals.
Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 6 The home is well run by experienced staff and the atmosphere is a positive one. Comprehensive systems are in place to offer quality care to service users and this is reflected in the wide-ranging policies and practice. 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. Kings House DS0000003951.V254507.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 Kings House DS0000003951.V254507.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): 2 The service user fully participates in his/her assessment plan. The care programme approach ensures that new service users are fully assessed by mental health practitioners. EVIDENCE: At the time of the inspection one new service user had joined Kings House. His portfolio revealed that he had visited the home prior to his admission and his needs had been fully assessed in line with the Care Programme Approach. There was a comprehensive risk assessment undertaken by Kings House although recent key work information and more recent relevant information on risk had not been incorporated. The individual service user plan was in place although not signed and there was a good understanding from staff on how the home could meet his individual needs. The emphasis at Kings House is on promoting, identifying and meeting individual aspirations and during his 6week assessment process there was evidence that in collaboration with the service user the home was working towards achieving that. Kings House DS0000003951.V254507.R01.S.doc Version 5.0 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): 6,7,9 Care plans were up to date and indicated that service users were involved in their formulation. Service users are encouraged to make choices and independent decisionmaking is promoted. Risk assessments are not regularly reviewed and do not always monitor any deterioration in physical and mental health. EVIDENCE: The Inspectors spent some time looking at the individual plans of 4 service users and were able to discuss with 2 of them the contents of their plans. Each service user has a portfolio containing up to date information including a comprehensive care plan. Recording was of a good standard with each section of the plan detailing aspects of care for each individual. The service user is involved in completing the plan with his/her key worker and this involves setting goals and how to achieve them. The plan is evaluated monthly in key worker sessions and reviewed six monthly. Plans were signed by two service users and their key workers and dated. One new service user was reluctant to
Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 10 sign documentation but having spoken to him felt consulted and involved in the assessment process. Both service users asked were happy with their personal development plans one sought advice on where he might continue to learn French as a foreign language. This information was passed on to his key worker who agreed to explore that. Risk assessments were not updated specifically in relation to activities or actions, which might trigger anxiety in a new resident. Similarly for one long established service user who was prone to falls there was no up to date risk assessment on how the threat of harm might be minimised. The deputy manager was taking immediate steps to resolve that. Good working relationships were observed between staff and service users and key worker notes demonstrated that staff promoted independent decisionmaking. New development plans are under way for all service users and the emphasis is on independent choice. The deputy manager spoke enthusiastically about adopting a more person centred approach. One member of relief staff who was spoken to had a good awareness of a new resident’s needs and all residential staff are encourage to refer to service users portfolios where appropriate. Residents engaged with the key worker process and staff were supportive and understanding of their needs and aspirations. Service users are encouraged to manage and be accountable for their own finances. One service user spoken to makes regular visits by train to her disabled children who live a significant distance away. Another was supported on a trip to Spain. Each resident is encouraged to identify skills and activities, which they enjoy and steps are taken to enable them to pursue those. Where service users have been absent from the home appropriate documentation has been forwarded to the relevant agencies and police informed. Experienced staff cover a 24-hour rota and all staff members including relief staff have knowledge of and are well known to service users. Kings House DS0000003951.V254507.R01.S.doc Version 5.0 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): 12,13,15,16,17 Activities, social interests and relaxation within the home and community are wide-ranging and appropriate for the service users. Service users spoken to are encouraged to make links with the local community through attendance at local day centres. Friends and relatives are made welcome throughout the day. Service users are encouraged to make independent decisions. Meals offer variety and menu choice and service users spoken with enjoyed the food on offer EVIDENCE: Service users are encouraged to make their own choices and decisions regarding social and recreational activities. Some take part in social activities organised by day centres and drop in centres. Other activities are impromptu. Service users are encouraged to go out with their key workers for coffee and if
Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 12 they wish may be accompanied on an activity by a member of staff for example to go swimming. There is also a range of weekly-organised activities such as bingo, DVD and occasional parties such as a forthcoming Halloween party, which was well advertised. Where appropriate service users are encouraged to pursue hobbies. There is a craft room for art and “fun cookery” classes and any other suitable activities, which residents may wish to engage in. Whilst there is a computer for the use of staff service users are advised that they may access this facility if they wish to. The inspector felt that it would be more appropriate for a resident’s computer to be placed in a communal area and greater access be facilitated. The deputy manager stated that a bid for monies had been made for an additional computer. Service users choose the level of involvement they want from their family and friends all are made welcome and may visit at any time during the day. Each service user has their own key and those who are able are encouraged to progress to more independent living. To facilitate this service users are assisted to carry out a range of domestic tasks including their own laundry, light meal preparation, and cleaning of their rooms. Key workers will go out with service users as and when needed. Service users are offered a choice of two midday meals including a vegetarian option. Service users help plan menus at the residents meetings, which are changed every 4 weeks. Service users spoken to say they received a good varied diet with individual preferences and dietary needs catered for. Breakfast time is flexible with service users helping themselves to a choice of cereals, fruit toast etc; a light evening meal is served at 5.30pm and drinks and snacks are available all day. Kings House DS0000003951.V254507.R01.S.doc Version 5.0 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): 19,20 Service user’s physical and emotional needs are comprehensively met. The home’s policy and procedure relating to medication is satisfactory. EVIDENCE: Care plans in place demonstrated a good understanding of service users’ emotional and practical needs. General interaction between staff and residents indicated a heightened awareness of individual’s mental and physical state and a log was in place to share information on a daily basis. The inspectors observed residents attending at the office to collect their medication at various times during the day. Risk assessments did initially indicate where there might be greater physical and/or mental need but again these had not been updated. Staff spoken to have a good understanding of residents needs as evidenced in discussion with the key worker but these were not always specifically recorded. At the current time only one resident is self-medicating. Medication and stock records were up to do date there were secure systems for controlled medication. Diabetic medication is kept in a refrigerator which is temperature controlled although staff were not sure of the correct temperature required. Information is to be sought from the CSCI pharmacy inspector.
Kings House DS0000003951.V254507.R01.S.doc Version 5.0 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): Not assessed on this occasion. EVIDENCE: Kings House DS0000003951.V254507.R01.S.doc Version 5.0 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): Not assessed on this occasion. EVIDENCE: Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 16 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): Not assessed on this occasion. EVIDENCE: Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 17 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): 42 The home normally follows practices that promote and safeguard the health, safety and welfare of service users. However, not all risk assessments are up do date. EVIDENCE: Risk assessments on chemical hazards in communal areas must be updated within the COSHH manual and there should be regular new product checks to ensure these are also incorporated. It is recommended that an Occupational Therapy assessment be undertaken of the premises to ensure safety and suitability for older residents. A new boiler has resulted in erratic radiator temperatures some of which are very high. This needs to be assessed for potential risk of harm. The accident and incident book whilst very well maintained was not translated into up-to-date risk assessments for residents. Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 18 Fire records were examined and were satisfactorily maintained. New staff received two fire-training sessions within the first week of employment. Records indicated that fire training involved a quiz. Staff signatures had been obtained to evidence that they had taken part. In all aspects of care, the home needs to identify any potential risk of harm and demonstrate action taken to reduce that harm. Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 19 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 X 3 X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Kings House Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000003951.V254507.R01.S.doc Version 5.0 Page 20 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. Standard Regulation Requirement Risk Assessments must be regularly reviewed for residents (previous timescale of 31/07/05 not met) The registered manager must ensure that all hazardous chemicals are subject to a full risk assessment. Radiators must be adjusted to maintain correct and safe temperatures Timescale for action 05/01/06 1 YA9 13(4)a 2 YA42 13(4)a 05/01/06 3 YA42 13(4)a 05/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA2 YA12 YA42 Good Practice Recommendations Risk assessments should be reviewed at each key work session and weekly for those undertaking the 6 week assessment process. Action should be taken to develop individual activity based programmes for each service user An occupational therapy assessment should be undertaken of the premises to ensure safety of older residents. Kings House DS0000003951.V254507.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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