CARE HOME ADULTS 18-65
Kings House 1 Earle Road Westbourne Bournemouth Dorset BH4 8JQ Lead Inspector
Sally Wernick Unannounced Inspection 7 March 2006 11:00
th DS0000003951.V285086.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 DS0000003951.V285086.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. DS0000003951.V285086.R01.S.doc Version 5.1 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) www.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 DS0000003951.V285086.R01.S.doc Version 5.1 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 5th October 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. DS0000003951.V285086.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and started at 11am on Tuesday 7 March. It was conducted as part of the normal routine of inspecting twice during a twelve-month period. The Manager Mrs Shutler assisted the inspector in her; work, as did other members of the staff team. Methodology used included a tour of the downstairs premises, review of records and discussions with service users and staff. No complaints have been received during this inspection period. Not all of the minimum standards were assessed on this visit. Please note where a National Minimum Standard was not assessed the score is shown as x. What the service does well:
Kings House continues to provide good standards of care for service users. Residents describe being happy with the care they receive identifying competent, caring staff, who have a good awareness of there overall needs. Accommodation mainly comprises of shared rooms however there is the opportunity for independent living in self-contained accommodation. Premises are comfortable and well equipped with two communal rooms, conservatory, summerhouse and attractive rear garden. Records and discussion with service users evidence that they receive personal support in a way that they prefer. There is a choice of healthcare, providers such as G.P’s and staff, demonstrate a good awareness of residents needs. There is a clear, up to date complaints procedure and, staff has clear knowledge of the adult protection policy and action to take if they or residents have any concerns. Kings House is well maintained and the range of Health and Safety policies in place offer protection to both staff and service users. Recruitment, induction and staff training are all of a high standard and residents are included in the appointment of new staff members. The registered manager is fully qualified and experienced in working with the current client group The homes quality assurance system continues to monitor standards of care canvassing the views of service users and providing regular feedback to both them and other stakeholders. DS0000003951.V285086.R01.S.doc Version 5.1 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. DS0000003951.V285086.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 DS0000003951.V285086.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): Not assessed on this occasion EVIDENCE: DS0000003951.V285086.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): 9 Risk assessments are regularly reviewed and monitor the physical and mental health of service users. EVIDENCE: In line with a requirement made at the last inspection all risk assessments are regularly reviewed and include up to date information on the physical and mental health of service users. Staff, continue to have a good awareness of residents needs, assessments are detailed and there is evidence that residents are included in their formulation. DS0000003951.V285086.R01.S.doc Version 5.1 Page 10 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): Not assessed on this occasion. EVIDENCE: DS0000003951.V285086.R01.S.doc Version 5.1 Page 11 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 Service users receive support and guidance from staff in a way, which promotes good practice and ensures physical and emotional needs are met. EVIDENCE: The inspector looked at the individual plans of three service users and was able to discuss with one of them the contents of his plan. Each care plan contained detailed information about the level of personal guidance and support required by each resident and how that should be given. Of the eight residents spoken to all acknowledged the wide degree of choice available to them both in their everyday living and in their choice of healthcare provision. Service users have some choice of staff who, work with them and all have a designated key worker. Residents engage with the key worker process and staff, are seen as supportive and understanding of their needs and aspirations. Care plans set out the preferred routine of some residents, their likes and dislikes as well as contact with family and friends. Information about independent advocates was clearly available in the communal dining room and there are good working relationships with other relevant healthcare professionals. DS0000003951.V285086.R01.S.doc Version 5.1 Page 12 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 & 23 A system is in place to deal with any complaints that might be made about the home to ensure that concerns will be listened to and investigated. There are systems in place to protect service users from harm or abuse. EVIDENCE: The home has a complaints policy/procedure that is included in the service guide for residents. Of the eight residents spoken to all felt confident that there complaints would be listened to and acted on. One verbal complaint arising between residents was recorded during this inspection period and was dealt with to the satisfaction of the resident and appropriately by the home. The home has and Adult protection policy and procedure and staff spoken to were confident of the action to be taken in the event of an allegation of abuse. Staff records indicate that training is undertaken and there are clear policies for managing physical and verbal aggression by service users. Service users are encouraged to manage and be accountable for their own finances but where financial records and monies are kept by the home these are securely and correctly maintained. DS0000003951.V285086.R01.S.doc Version 5.1 Page 13 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 & 30 Kings House provides a safe, homely and comfortable environment well suited to the needs of current service users. The home is clean and hygienic and promotes safe working practices. EVIDENCE: Kings House is a well-maintained property with airy communal areas, which are clean and free from offensive odours. The building and garden is well maintained and there is an ongoing programme of works in place. There is a dedicated cleaner who helps to maintain good levels of cleanliness and furnishings are of a good quality. Residents were happy with their bedrooms most of which are shared although there is the provision for semi-independent living as well as single rooms. There is an attractive summerhouse and an activities room, which can be used by residents for individual cooking as well as a range of craft activities. Laundry facilities are sited separately and staff encourage service users to follow hygienic practices. Hand washing facilities are available and all staff has been trained in Infection control. DS0000003951.V285086.R01.S.doc Version 5.1 Page 14 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): 32, 34 & 35 Service users are supported by sufficient number of key workers who are suitably trained and qualified offering consistency of care within the home. However the target of 50 staff with NVQ qualification by 2005 has not yet been met. The home has a comprehensive recruitment policy that ensures service users are not at risk. The home has a good training and development plan, which is linked to the home’s aims and service users needs. EVIDENCE: Staff at Kings House has a range of relevant background experience and a variety of qualifications that make them well placed to work with the current client group. This is further enhanced by good training provision within the organisation and a thorough induction. There are ongoing programmes of individual development for each staff member the aim of which is to provide specialist skills so that they are better able to support service users. Whilst some staff are trained at NVQ level 3 however and others are studying for that qualification it remains the case that 50 of staff must be qualified to at least NVQ level 2 by 2006. Service users spoken to said that staff was respectful, approachable, kind and caring. There was clear evidence that staff was well motivated and committed and good working relationships between service
DS0000003951.V285086.R01.S.doc Version 5.1 Page 15 users and staff were evident. Since the inspection the registered manager has submitted information on the variety of qualifications the staff team hold which the manager says she has been told equate to a variety of different NVQ levels. This will be reviewed at the next inspection. Four staff files were examined on this occasion. All relevant information relating to recruitment was evidenced. Files were very comprehensive and well maintained and a thorough recruitment procedure is adhered to. Residents take an active role in the recruitment of new staff and are involved in the interviewing process. All staff receives a structured induction programme which includes equal opportunities training as well as the full range of health and safety practices. There is an emphasis on staff development, which is strongly related to service users needs. Staff; confirm that training days are available and time allotted during the working week for study. DS0000003951.V285086.R01.S.doc Version 5.1 Page 16 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 & 42 A well-qualified experienced manager runs Kings House. Service users are encouraged to make their views known and to have regular input into the homes policies and practice. The health safety and welfare of service users and staff are protected by the home’s policies, procedures and practice. EVIDENCE: The registered manager at Kings House is fully qualified and experienced in working with the current service user group. The home is well run and is able to meet its stated purpose, aims and objectives. There is clear evidence that the manager undertakes regular training to further her own development and to maintain and enhance her skills and competencies. The organisation has formal systems in place for reviewing the home’s aims, objectives and services provided. DS0000003951.V285086.R01.S.doc Version 5.1 Page 17 The area manager monitors quality assurance monthly and a written report is provided to residents, staff and the Commission for Social Care. Residents confirm that their views are sought and that they are provided with a written response. There are regular residents meetings at which views are canvassed and the home distributes annual questionnaires to service users and staff. Information is then collated and included in the homes annual review report. Standard 42 was considered in full at the last inspection and as a result there were two requirements and one recommendation relating to health and safety two of which have been fully implemented. All hazardous chemicals are subject to a full risk assessment details of which are clearly recorded in the home’s COSHH manual. Following the last inspection Kings House had installed a new central heating boiler and radiator temperatures within the home were erratic. A new pump has resolved that and radiators are now maintained at safe temperatures. Following the last inspection it was recommended that an Occupational Therapy assessment be undertaken of the premises to ensure safety and suitability for older residents. Externally this has occurred and plans are underway in 2006 to make the home easily accessible for wheelchair users. The inspector is not aware of any internal assessment by an Occupational Health Advisor. This would be a prudent course of action given the increasing frailty of some of the older residents. DS0000003951.V285086.R01.S.doc Version 5.1 Page 18 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 X 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X x 3 X 3 X X 3 X DS0000003951.V285086.R01.S.doc Version 5.1 Page 19 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. Standard Regulation Requirement 50 of care staff must be qualified to at least NVQ level 2 and qualifications gained by the extended date of 2006. Timescale for action 31/12/06 1 YA32 18 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 YA42 Good Practice Recommendations An occupational therapy assessment should be undertaken of the premises to ensure safety of older residents. DS0000003951.V285086.R01.S.doc Version 5.1 Page 20 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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