Inspection on 09/08/06 for Kingston Farmhouse

This inspection was carried out on 9th August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingston Farmhouse 22/03/07

Kingston Farmhouse 03/10/05

Kingston Farmhouse 25/04/05

Kingston Farmhouse 24/11/04

Kingston Farmhouse 02/04/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Kingston Farmhouse Beatrice Avenue Whippingham East Cowes Isle Of Wight PO32 6LL Lead Inspector Mark Sims Unannounced Inspection 9th August 2006 09:30 Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 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 Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 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. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingston Farmhouse Address Beatrice Avenue Whippingham East Cowes Isle Of Wight PO32 6LL 01983 294145 01983 289667 kingstonoffice@yahoo.co.uk 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) Mrs Jennifer Ann Bacon Mrs Trudie Manton Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd October 2005 Brief Description of the Service: Kingston Farmhouse is a registered care home that provides care for up to nine adults of both sexes with learning disabilities. The home is situated in a semirural position in a quiet cul-de-sac on the outskirts of East Cowes. The property is a detached house with some historic interest, having connections with the nearby Osborne House Estate. It sits in its own grounds and offers some fine views of the Medina Valley from its secluded rear garden. The home is within walking distance of a main bus route and is convenient to ferry services to the mainland. Members of the present resident group were found to be living full and active lives and all are engaged in a variety of educational, social and recreational activities. Staff within the home strive to promote independence amongst the residents and support them in developing a range of social and life skills. All the residents are accommodated in single rooms that have been decorated to their taste. One resident with mobility difficulties is accommodated in a ground floor room that has had major alterations, including the installation of an ensuite bathroom. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first ‘Key Inspection’ for Kingston Farmhouse, a ‘Key Inspection’ being part of the new inspection programme, which measures the service against the core and/or key national minimum standards. The fieldwork visit, the actual visit to the site of the home, was conducted over two day, where in addition to any paperwork that required reviewing the inspectors met with service users, staff and undertook a tour of the premises to gauge its fitness for purpose. The inspection process also involves far more pre fieldwork visit activity, with the inspector gathering information from a variety of professional sources, the Commission’s database, pre-inspection information provided by the service and linking with previous inspectors who had visited the home. The new process is intended to reflect the service delivered at Kingston Farmhouse over a period of time as apposed to a snapshot in time. What the service does well: What has improved since the last inspection? The last inspection report identifies that no requirements or recommendations were made following the last regulatory visit and therefore it could be argued that nothing, from a regulation perspective, has needed improving. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 6 However, a serious issue or concern was identified by the Local Authority, Social Services Department, during a routine placement review, when it was discovered that one-to-one hours paid for by the Local Authority could not be accounted for by the service. This has led to a situation whereby the service has been contractually required to better evidence how, when and where one-to-one support is provided to the clients. At this inspection this issue was broached with the manager, as it was brought to the Commission’s attention via professional comment cards returned prior to the fieldwork visit, the manager discussing the measures taken following the Local Authority review and demonstrating the improved documentation now in place to support where one-to-one hours are being used. The records consisting of ‘care dairies’, ‘activities logging forms’ and ‘running record’ (the above terms being the inspector’s labels for records and not necessarily those used by the service). 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. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 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 Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 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): St 2 Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The individual aims and desires of the service users are known to the home and/or staff, documented within the person’s care plans and kept under review. EVIDENCE: The care planning files for three residents were reviewed during the visit and at times discussed with the client, if they were present. The files are informative documents that as indicated within the summary have been amended or revamped following the concerns identified by the Local Authority Social Services Department. In discussion with service users it was evident that they have had an input into the development of their care plans and that they have been appropriately supported by their keyworkers in creating plans that reflect their needs and wishes. It was also evident from the five service user comment cards returned prior to the fieldwork visit occurring, that the service users feel able to make decisions about what they wish to do both within the home and externally, be that socially or occupationally related. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 9 Despite the concerns that existed over the provision or accounting for one-toone hours, etc. all four care managers who returned comment cards to the Commission indicate that: ‘There is a service user plan for the person(s) that I have placed in the home’ With three of the four also acknowledging that: ‘The service user plan is being followed and reviewed regularly within the home’. The four preferring to comment separately that: ‘My client is well cared for and his needs met’. However, it is also worth recalling that the initial enquiry into the one-to-one concerns commenced following a routine placement review and a complaint made by a service user that they were not receiving the one-to-one support they required. This in itself could be considered evidence of the fact that the management and/or staff are not establishing or properly assessing the needs of clients and therefore unable to provide a service based on their individual aspirations and desires. However, given the information above and the fact that the clients are able to discuss issues such as being supported to access suitable work placements: ‘one service user employed by a local supermarket chain and another in a café in the nearby town of West Cowes’, or their leisure pursuits two clients returning during the fieldwork visit and chatting about their visit to a pub lunchtime and the shopping they had completed prior to this, evidencing that people’s needs and more specifically their wishes and desires are being appropriately catered for at Kingston Farmhouse. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 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): St 6, 7 & 9 Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. The service users have a clear understanding of their care plans and their individual goals and aspirations. The service users are a fairly autonomous group, who make their own individual and group decisions. Service users are supported to take risks in pursuit of independence and personal development. EVIDENCE: Whilst reading through the care plans the inspector had the opportunity to chat to the service users about the content of their individual files and to ascertain that people clearly understood what was recorded about them and the reasons why these records were being maintained. The service users were also very knowledgeable about their keyworkers and the support and guidance they could expect from their keyworker should they Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 11 require it, several of the service users were not only able to recount the names of their current keyworkers but also the names of previous keyworkers, the manager on occasions rotating the keyworker positions. In addition to establishing at this visit that the service users understand and appreciate the care planning process, information gathered from the previous inspection reports also indicates that: ‘Since the last inspection staff have further developed the care planning system. The new system is, according to the manager, ‘more user friendly’ and brings together in one document all the important information needed by staff for the delivery of care’. In conversation with the staff this statement still appears to hold true, with staff apparently comfortable with the care planning system, involved in case reviews as keyworkers and more actively documenting one-to-one events and activities. The professional feedback and/or comment cards also establishing: ‘There is a service user plan for the person(s) that I have placed in the home’ ‘The service user plan is being followed and reviewed regularly within the home’. ‘My client is well cared for and his needs met’. During the visit it was established that generally each of the service users’ needs are being met in an individualised way and that much of their day-today activity is self directed and/or determined. Two clients returning to the home after a shopping trip, which included a visit to a pub for lunch, this clearly being their preference and facilitated by the accompanying staff member. Another client was keen to show off his video and DVD collection, which is extensive and is obviously both his hobby and his passion, the presence of additional ornaments and posters, etc. establishing that the person had a very keen interest in science fiction movies and memorabilia. The comment cards returned by the service users also help substantiate the fact that service users generally make decisions about their own daily activities, etc: Four of the five comment cards returned ticked ‘always in confirmation to the question: ‘do you make decisions about what you do each day?’ the remaining comment card ticked in the ‘usually’ box. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 12 Three of the four relative comment cards returned also indicate that where and/or when the service users are unable to make decisions, they are consulted about the most suitable way forward and that overall they are satisfied with the care provided. The service users are also well support by the local authority social services department, with it evident that reviews of their care placements, etc. are used to address both positive and negative aspects of the care they receive, as highlighted by the one-to-one accountancy issue. What the identifying of this particular issue illustrates is that the service users are both able to determine what they require from the service and that when things are not being delivered in accordance with their wishes they are able to raise this with the appropriate agency/body. It was also evident from conversations with the service users, that in addition to understanding and exercising their rights to question and/or challenge the service delivered with external agencies, they are also afforded the opportunity internally, via the residents’ meetings, to raise concerns about the service and/or personality conflicts affecting them. The meetings occur on a weekly basis and are designed to manage conflict, develop the service and ensure that the service users are integral parts of the home’s decision-making process. The ability of the residents to make decisions and influence the delivery of their personal care packages are important facets of any care service and are inextricably linked to a person’s right to take risks. Again four of the five service user comment cards returned indicate that people are able to do what they like throughout the day and weekends, which differ slightly due to the closure of day services, etc. The fifth comment card indicates that during weekdays the person is unable to do what they wish, although at weekends this changes and they are able to do what they want. In conversation with service users it was established that two of the home’s residents are working, as mentioned earlier in the report, both of the residents clearly making their own way to and from work and both benefiting from the social stimulation and distraction work provides. Another resident discussed how he enjoys cooking and is supported by the staff when preparing his signature dish, which according to the other service users is very tasty and well cooked. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 13 Whilst a further two residents smoke they are fully aware of the home’s designated smoking area and that smoking in communal areas and/or their bedrooms is not permitted on safety and hygiene grounds accordingly. All or each of these activities, according to information taken from the dataset, provided by the service prior to the fieldwork visit, are subject to a risk assessment process and are therefore available to staff in house. This testimony is further supported by statements within previous inspection reports, which record and/or reflect: ‘all residents are subject to risk assessments that aim to highlight any potential difficulties that could be encountered by individuals during their daily lives’. In addition to this evidence the comment cards of both the service users’ relatives and the visiting professionals also acknowledge that they are satisfied with the overall standards of care delivered, which can be taken to include any element of risk associated to the activities undertaken. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 14 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): St 12, 13, 15, 16 & 17. Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. Service users are well supported when accessing appropriate age, peer and culturally based activities. The service users are active members of the local community. The service users are supported in the development of personal relationships/friendships and maintaining family contacts. The rights of service users are respected and their daily responsibilities acknowledged. All meals are freshly prepared, individually portioned and enjoyed by the service users. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 15 EVIDENCE: As already highlighted within the report five service users, via the comment card system, have indicated that generally life at Kingston Farmhouse is agreeable and meets their specific needs: ‘Four of the five comment cards returned ticked ‘always in confirmation to the question: ‘do you make decisions about what you do each day?’ the remaining comment card ticked in the ‘usually’ box’. ‘Again four of the five service user comment cards returned indicate that people are able to do what they like throughout the day and weekends, which differ slightly due to the closure of day services, etc. The fifth comment card indicates that during weekdays the person is unable to do what they wish, although at weekends this changes and they are able to do what they want’. Individual remarks were also added to the comment cards and included: ‘I like helping in the house. I like listening to music, going for walks and shopping – visiting mum’. ‘I enjoy being taken out and supported by staff and going out with the other residents down the beach and park’. During the fieldwork visit the inspector spent a lot of time in general conversation with the service users and staff, gathering from those discussions that people access a variety of different day services and centres, that people are also involved with the local college and attend both skills development courses, and specific evening courses, on subjects of personal interest, and that two clients work in and around the local area. It was also established that the fieldwork visit had occurred on an evening when the clients would normally attend a local club - referred to as the ‘Wednesday Club’, although the presence of the inspector appeared to cause some residents to question whether they wished to attend. However, it was apparent that generally people opted to attend the club, as it was a good opportunity to socialise and catch-up with friends from other services and centres. At a previous inspection it was also noted that: Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 16 ‘The home has two vehicles which are leased by two of the residents and used to transport residents to various social and recreational activities around the Island. The running costs of the vehicles are shared between all the residents. An independent advocate was involved in the drawing up of the contract which residents entered into. The contract ensures that those who use the cars the most assume most of the cost’. At this visit it was established that this arrangement is presently still in place, although the manager is considering reviewing the contracts and arrangements for the two cars, as the leasing agreements are due for renewal. Access to motor vehicles is useful for the home given its location, although several of the service users are familiar with public transportation, whilst other clients are known to prefer walking to and from the town, etc. The dataset information provided by the home lacks detail on the activities and/or recreational pursuits of the residents, although it does list: • • • • • • • • Computer Games Televisions Music Swimming Eating out Pub visits Bowling Cinema as popular activities, etc. entered into by the clientele. In conversation with the service users it was established that they do enjoy social outings, two service users having been out shopping and to the pub, whilst the fieldwork visit was in progress and that as a group they indulge in communal activities, karaoke being a particular favourite, according to several clients spoken to. Another activity, which appeared popular with the majority of the service users is contacts or visits to family members, one comment card openly reflecting that ‘visiting mum’ is a welcomed social opportunity, which later in conversation the person confirmed is a regular event and that their bedroom at home is nicely arranged. Other clients, whilst opting not to stay in contact with their relatives as often, are still in regular communication with their families, etc., the comment cards of five relatives indicate that they are made to feel welcome in the home and that they can see their next of kin in private should they wish. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 17 The staff also confirmed that as keyworkers they are often the first port of call or contact for any relation, etc. visiting or contacting the home, as they are often the person most aware of how the person/client has been recently. Previous inspection reports indicate that problems in maintaining contact with families/relatives, etc. have been few and far between, with staff acknowledged as supportive and helpful: ‘From discussions with residents it was apparent that staff were available to support them maintain contact with their friends and family. This support takes many forms from helping residents with reading and writing letters, receiving phone calls and even accompanying them to the mainland for visits’. As discussed earlier within the report the service users are well supported by the home’s philosophies and practices in making or reaching their own decisions on how the service is performing, etc. One aspect of this decision-making, again mentioned earlier in the report, affects the menus and food consumed within the home. The service users are encouraged and/or supported in generating their own weekly menus, copies of which have been supplied as part of the dataset. In conversation with service users it was apparent that the meals provided at the home are enjoyed and that snacks and drinks are available throughout the day, service users on a couple of occasions making drinks for the inspector. Observations indicate that mealtimes are social occasions, with service users and staff eating together in the home’s dining room. Whilst meals are largely prepared by the staff the service users do help with both the preparation and clearing away after dinner, one client adamant that he enjoys helping the staff with the washing up and packing away of used utensils. Another client discussed his love of cooking and described how he is supported on his home days in the preparation of his favourite dishes, his signature dish being enjoyed by his peers. The manager did discuss concerns that had been raised by the environmental health officers, in respect to clients cooking and/or using the kitchen. However, as these activities have been risk assessed, are largely supervised and are taking place in the client’s own home, the Commission does not share the environmental health officers’ concerns and considers this a fundamental right of any person living within their own home. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 18 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): St 18, 19 & 20 Quality in this outcome area is good. This Judgement has been made using the available evidence, including a visit to this service. Personal care and support is provided in accordance with the needs and wishes of the service users. Service users have access to both physical and emotional health care support. The home’s medication policies and procedures are adequate for the purpose of supporting the service users. EVIDENCE: The service users’ care planning records indicate that their personal care is delivered in accordance with their own needs, which mainly involves support and encouragement from the staff, as the service users are essentially able to manage the physical aspects of their own personal care. One client discussed how the staff help her to access her en-suite facility and then leave her to attend to those aspects of her personal care that she can, before returning to assist with those facets of her care she could not manage. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 19 The same service user also described how staff assist her in choosing her own clothing and was quick to point out that this is again only in a supportive role, as she knows what she likes. All five of the comment cards returned by the service users are ticked in the ‘always’ box, in response to the question ‘do the carers listen and act on what you say’, which supports the service user statements, recorded above, that staff are largely responsive and supportive of clients’ requests. The home has two shower rooms and a bathroom, which are accessible to clients, although generally baths are supervised. During the tour of the premises it was noticed that the toiletries of a client had been left in the bathroom following their bath, whilst this evidences that people have access to their own personal toiletries and that these items are brought to the bathroom to be used by the clients when bathing and/or showering, it also establishes that staff on occasions forget to return items to the person’s bedroom, which could lead to situations where another client might access and use them by mistake. The nine comment cards returned by relatives and professional visitors also establish that they are: ‘satisfied with the overall standard of care provided’, with the four professional comment cards returned by the care managers also documenting that: ‘There is a service user plan for the person(s) that I have placed in the home’ ‘The service user plan is being followed and reviewed regularly within the home’. ‘My client is well cared for and his needs met’. The comment card returned by the general practitioner most involved with the service users not only establishes that he is: ‘satisfied with the overall care provided to service users at the home’ but also identifies that he feels the: ‘The staff demonstrate a clear understanding of the care needs of the service users’ ‘That specialist advice is incorporated into service users’ plans’ and; ‘That service users’ medications are appropriately managed’ It is also clear given his individual comment ‘the staff are looking after clients/patients with complicated problems’, that he feels the staff are managing people’s general health needs well. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 20 The opinions of other health professionals, namely community learning disability nurses were also sought, although those professionals approached elected not to respond to the comment cards dispatched. The home would appear, given the doctors’ comments, to have a good handle on the health care needs of the service users, a statement supported by the inclusion on the individual clients files of the ‘Health Assessment Plans’ (HAP), plans devised by the local authorities and designed to ascertain the client’s own perspective of health care and health care services, i.e. likes and dislikes, phobias, etc. At previous inspections the health care needs of the service users have always been found to be well handled / managed with inspectors reporting: ‘From an examination of residents’ care plans it was apparent that the healthcare needs of residents are monitored closely. All residents are subject to a risk assessment process that is designed to highlight any particular concerns associated with medical conditions’. ‘Records demonstrated that staff monitor the health care needs of residents and regular referrals are made with, among others, GPs, chiropodists and dentists. All the residents are registered with local general practitioners who, according to staff, offer each resident a yearly health check. Staff will attend outpatient and other appointments with residents as and when required. A record is kept of all health care visits’. A comment made by one of the service users, via his comment card, probably best sums up the home’s approach to supporting clients in accessing health care services: ‘If I am poorly and ask for a doctor’s appointment – staff would act on it straight away’. As indicated above the general practitioner most heavily involved with the service users at Kingston Farmhouse, feels the residents are appropriately supported with their medication. In discussion with the manager it was ascertained that no-one is currently selfmedicating and that the staff of the home are involved in supporting service users with their medicines. On checking the records associated with the home’s medication procedure it was noted that all medications were being properly accounted for and that ‘medication administration records’ (mar) sheets were being appropriately maintained. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 21 The home’s medications are securely stored and four of the home’s nine staff, according to information provided within the dataset, had completed ‘medication administration’ training. In addition to containing information about the training courses completed by the staff the dataset also makes a clear declaration that the home has a medications procedure, which is accessible to staff. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 22 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): St 22 & 23. Quality in this outcome area is poor. This Judgement has been made using the available evidence, including a visit to this service. The service users feel they are listened to and can approach the staff and management with concerns. Recent events raise questions about the management’s ability to safeguard the wellbeing of the service users. EVIDENCE: The dataset establishes that the service has a complaints process and whilst the residents may not appreciate the intricate or finer details of this policy / procedure their response to the question ‘do you know how to make complaints’, all five returned comment cards ticked ‘yes’, indicating that generally they feel both able and sufficiently informed enough to raise concerns. This particular assumption is perhaps best evidenced by the fact that the service users were able and willing to broach the subject of their one-to-one hours with their care managers and to raise concerns or objections at not receiving the support they felt they required. Whilst technically this approach did not follow precisely the guidance set out in the home’s complaints policy, it does establish that the service users feel sufficiently empowered and autonomous within the Kingston Farmhouse environment. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 23 It was also recorded on the service user comment cards that: ‘problems are brought up in house meetings, with staff or care managers’, supporting the assumptions above. The house meetings, as already highlighted within the body of this report, are used to discuss both service specific issues and issues of a personal nature, mainly clashes between parties. The meetings are all minuted and are attended by all of the service users, one person discussing how there are opportunities to address issues of conflict or concern. The relatives of service users would appear less certain or aware of the home’s complaints process, with three of the four comment cards returned indicating that people have no knowledge of how their complaint would or should be handled by the home, which is a matter the management might like to consider. The dataset, in addition to establishing that the home has a complaints process, also records that the home, in the last twelve months, has received no complaints. However, professional feedback, via the comment cards, indicate that three of the five people to respond had received complaints about the service, although predominantly this focused on the one-to-one accountancy issue mentioned throughout the report. This issue in itself is sufficiently serious enough for this section of the report to be rated as poor, although work has been undertaken to address the problem, as identified earlier within the report. However, in addition to this concern the inspector also established that two recently recruited staff had commenced work without appropriate ‘Criminal Records Bureau’ (CRB) or ‘Protection Of Vulnerable Adults’ checks having been taken up, the manager has since confirmed the return of one clear CRB, the second remained outstanding at the time of writing the report. The dataset, whilst establishing the existence of an adult protection policy / procedure also indicates, via the training records provided, that none of the staff currently employed have attended any specific adult protection training, although this would have been touched upon when they completed their National Vocational Qualifications’ (NVQs). Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 24 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): St 24 & 30. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The premises is in need of redecoration and refurbishment, as communal areas appear tired and shabby. The hygiene or cleanliness of the property was in need of attention, with large deposits of dust, debris, cobwebs and grime visible. EVIDENCE: Whilst it has to be acknowledged that the service users find the home to be ‘fresh and clean’, all five respondents indicating via the comment cards that this is the case, the experience and observations of the inspector were different. The tour of the premises, enabling a significant build up of dust and debris, etc. to be brought to the attention of the manager, as were cobwebs and grime in the shower room, bathroom and communal corridors. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 25 Whilst the dataset established that the home employs a person to undertake the role of domestic/cleaner the hours are divided, with the person’s job title being cleaner/support worker. The dataset also establishes that this person is only employed for 22 hours per week, which as her time is divided between roles could explain why attention to such areas as the high dusting and removal of cobwebs, etc. is not being addressed. The manager also stated during the tour that due to staffing issues, the person designated the responsibility of cleaning the home has had to focus or devote more hours to care and support work, which again could account for some of the build up of dust and grime observed. However, she is confident, following the recruitment of additional care staff that the demands placed on the cleaner/support worker should ease and that more time should be dedicated to cleaning. It is the opinion of the Commission, given the current situation, that a dedicated domestic/cleaner would be a more reasonable option and that the management should consider establishing a permanent domestic/cleaner position. Whilst the above issues of concern were highlighted, the inspector feels it is important to recognise the efforts made by the service users to involve themselves in keeping the home tidy, with people observed involving themselves in washing up and cleaning away utensils, etc. following their tea, etc. The service users also discussed how they are supported, during their home days, to maintain the cleanliness of their bedrooms and to change bedding, etc. During the tour of the premises the inspector visited a number of bedrooms, either in the company of the manager or the residents. These visits enabled the inspector to establish that each bedroom was individually decorated and furnished and to ascertain from the occupant that the choice of décor and/or furnishing had been their own decision and choice. Generally the bedrooms visited were found to be in a reasonable state of decoration and the furnishings appropriate to the needs of the clients. A fact supported by the findings at previous inspections when inspectors recorded: ‘All residents’ rooms were visited during the inspection and found to be furnished appropriately to meet their needs. The manager confirmed that Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 26 residents’ rooms are subject to a rolling programme of redecoration and refurbishment and that residents are consulted over the choice of wallpaper etc. The majority of rooms had been personalised by the introduction of personal pictures and photographs and most contained personal televisions, videos and music centres. All residents’ rooms were observed to contain double electric sockets, beds, wash hand basins and comfortable chairs. The furniture and fittings in residents’ rooms was observed to be of good quality and well maintained’. However, the same cannot be said for the communal areas of the home, although it is understood, form information contained within the dataset, that two new showers have been fitted and a new toilet system. The manager also stated, during the fieldwork visit, that the front lounge had been refurbished and that new sofas had been installed, although this was identified at the last inspection, as was the manager’s commitment to upgrading or replacing the home’s central heating system and an acknowledgement of the fact that the kitchen required renewal and/or updating. However, to date neither of these issues has been addressed, with the need for the central heating to be addressed potentially becoming more urgent given the ever approaching onset of winter. Generally the communal areas of the home, lounge, corridors, dining room, kitchen, bathrooms, etc. require attention, be that with regards to their cleanliness or state of decoration. The manager will need to prioritise the work required, heating, kitchen, lounge/diner, corridors, etc., ensuring the most pressing jobs are addressed first, although this should not impede the managing of the cleanliness issues bathrooms, shower rooms, corridors, etc., should be manageable in a much shorter time period. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 27 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): St 32, 34 & 35 Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The information provided/obtained is confusing, however, it tends to indicate that the home is currently meeting the 50 ratio of staff trained to National Vocational Qualification level 2. The recruitment and selection process is not robust or thorough and cannot be considered to afford the service users’ safety, security or protection. Training records are poorly maintained and would appear to indicate that staff have insufficient access to training and development opportunities. EVIDENCE: The dataset indicates that six of the home’s seven staff currently posses a National Vocational Qualification (NVQ) at level 2 or above, giving them a ratio of 85 . However, the training record, included with the dataset, documents that eight support workers are employed by the home and that presently only two hold an NVQ, with a further two results/awards pending, giving a much reduced ratio of 25 . Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 28 In discussions with the manager it was established that five staff presently hold an NVQ level 2 or above, with two of the five currently undertaking an NVQ at level 3, leading to a ratio of 62.5 of staff trained to the appropriate level. The latter information would seem to fit with the data gathered at previous inspections, as the last inspection report indicates: ‘at the time of the inspection all but two of the staff had obtained an NVQ qualification’. From the perspective of the service users it is felt that the staff treat them well, with all five of the residents confirming this via the comment cards. In discussion with staff it was stated that access to training is good and that people generally have the opportunity to access the courses that they wish, although again the training record included with the dataset would appear to contradict this claim. However, given the discussions with the staff and the information contained within previous reports, which record: ‘The training needs of individual staff are determined through supervision. All staff are provided with a staff development file in which to record qualifications obtained and training courses attended. All staff are expected to obtain qualifications in First Aid and Food Hygiene. The home also organises training in specialised areas and has for example over the last year organised training sessions on managing challenging behaviour, bereavement counselling, epilepsy and visual impairment’. ‘Over the last year staff have completed training in, amongst other things, health and safety, first aid and the administration of medication. Specialised training is also accessed in response to the needs of residents’. The dataset also establishes that training planned for the remainder of the year is to include: infection control, manual handling, first aid and further access to NVQ level 2 courses. However, given the confusion caused by the training information supplied and the difference between the manager’s recollection of staff qualifications, etc. and the information documented it is the opinion of the inspector that the manager must review how staff training information is stored, maintained and retrieved. An issue of great concern for the inspector was highlighted when reviewing the home’s recruitment and selection policy/procedure, as both of the most recently employed staff had not been subject to checking against the ‘Criminal Records Bureau’s’ (CRB) file or the ‘Protection Of Vulnerable Adults’ (POVA) register. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 29 In discussion with the manager it was established that she would process both of these applications immediately and has since the inspection visit confirmed the submission of both applications and the return of the support worker/driver’s CRB and POVA checks, although to date the support worker has only received her POVA clearance and is continuing to work under supervision. Previous inspections would tend to indicate that the home’s recruitment and selection process has been adequately managed and that: ‘the home follows a set procedure when recruiting and employing staff. All prospective employees have to complete an application form and attend for an interview. They also have to provide the names of two referees, one of which must be their most recent employer and successfully complete a Criminal Records Bureau check. All new employees are subject to a three monthly probationary period. The files of the home’s two most recent employees were examined and indicated that good recruitment procedures had been followed’. In conversation with the support worker it was determined that she has commenced her induction programme, which the manager stated was based on the ‘common induction standards’. The manager also stated that ‘Learning Disabilities Award Framework’ (LDAF) training has been difficult to access and that presently none of the staff have undertaken this training, although it is hoped that one staff member will shortly be able to undertake the course. The professional opinions of the staff teams would appear to differ currently with comment including: ‘not all staff are aware of the needs of the clients’ to ‘ a well run home’, however all professional comment cards returned do document that ‘overall people are satisfied with the care provided’. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 30 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): St 37, 39 & 42. Quality in this outcome area is adequate. This Judgement has been made using the available evidence, including a visit to this service. The manager is both appropriately qualified and experienced to operate the home, although recent issues/concerns could raise questions about her management style. The service users feel they are able to comment on the future direction of the service and that staff listen to their concerns and/or observations. The health, safety and welfare of the service users are not being appropriately promoted of protected. EVIDENCE: The dataset records that the manager possesses both an NVQ 4 in care and management and that she works 35 hours a week within the home. At previous inspections the management of the home had been considered: Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 31 ‘The home was found to be well managed and staff were clear about both their roles and responsibilities. The home has developed a comprehensive range of records and documents relating to the effective operation of the home’. However, given the Local Authority’s (social service) concern over the provision of one-to-one hours and the failure of the management to appropriately submit the CRB and POVA applications for new staff, the style employed by the manager could be questioned. However, as the manager has only recently returned to work following a period of maternity leave and as steps have been taken to address the concerns of the Local Authority, it is perhaps worth considering that some of the issues might have occurred as a result of the manager finding her feet on her return to work. In conversation with the service users it was ascertained that the manager and staff team are considered approachable and supportive, with people actually describing staff as: ‘nice’ and ‘friendly’. The comment cards returned also establish that service users know whom to speak to if they are unhappy with any element of the service, all five comment cards returned substantiating this view. The professional opinions of the home’s management however, seem to differ with only three of the five comment cards returned indicating that ‘a senior member of the staff team is always available to meet with visiting professionals’, one professional adding: ‘not all staff are aware of the clients’ needs’. However, all five professionals, returning comment cards, agree that ‘the overall care service provided is good and meeting the clients’ needs’ a sentiment also reflected in four of the five relatives comment cards. The involvement of the service users in regularly organised residents’ meetings further support the view that overall the home is reasonably well run and that the provision of care is good. The service users, in discussions, described how the residents’ meetings are useful tools for exploring issues affecting the dynamics of the home, including the day-to-day running of the establishment, personality clashes and general wants, needs or wishes. The service users, as reported earlier within the report, find the staff and management approachable and supportive and have both verbalised this and made statements commenting to this effect. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 32 Previous inspection reports provide further evidence of how service users and/or their relatives are involved in the monitoring of the service, describing how: ‘The home has achieved an Investors in People award and the manager has developed a range of internal quality assurance procedures. The views of family, friends and advocates and other stakeholders in the service are sought on how the home is meeting residents’ needs’. Generally the health, safety and welfare of the service users is well managed, as evidenced via previous inspection reports, which record: ‘The home has a Health and Safety policy which aims to provide a safe environment for both residents and staff. This policy was drawn up by reference to the relevant legislation and guidance’. The manager confirmed that regular checks are carried out by the relevant authorities to ensure that the home’s equipment and facilities are safe’ The dataset also confirms that the home has a range of health and safety materials, policies and procedures available and the training records and training plan indicate that staff are accessing health and safety training events, although these are often divided into their specific areas, fire safety, moving and handling, etc. However, despite the good work being undertaken by the management the recent failure to recruit staff using an appropriate and robust recruitment and selection process has undermined this and has left service users open to maltreatment and exploitation, etc. Whilst this may be an isolated incident, which is in the process of being rectified, it is a serious incident and one that cannot be ignored, as it opened the resident group up to the potential of being abused, clearly not in their best interest and not compatible with the home’s duty of care or general principles of good care. Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 33 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 3 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 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 X Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 34 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 2 Standard YA23 YA24 Regulation Requirement Timescale for action 11/10/06 11/10/06 3 YA30 4 YA34 YA23 5 YA35 Regulation The manager must ensure that 12 staff have access to adult protection training. Regulation The manager must provide to 23 the Commission a schedule detailing how and when those areas of the home requiring attention are to be addressed, including the heating system. Regulation The manager must review the 13 home’s current domestic staffing cover, ensuring that sufficient time is available to address all necessary cleaning, etc. Regulation The manager must take steps to 12 & 19 ensure all staff are appropriately vetted prior to employment commencing at the home. Regulation The manager must review how 18 she currently documents and tracks the training needs and achievements of staff, ensuring an auditable and measurable system is introduced. 11/10/06 11/10/06 11/10/06 Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 35 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 YA37 Good Practice Recommendations The manager should take time away from other duties to familiarise herself with the procedures of the home, current issues that require attention and the need for ongoing auditing of the service being provided. The manager should, once she has addressed requirements 1 & 4 be in a position to meet the health, safety and welfare needs of the clients. 2 YA42 Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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. Extracts may not be used or reproduced without the express permission of CSCI Kingston Farmhouse DS0000012503.V300087.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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