Inspection on 08/10/07 for Kingston House

This inspection was carried out on 8th October 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingston House 25/10/06

Kingston House 23/01/06

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Kingston House 10 The Street Kingston Canterbury Kent CT4 6HZ Lead Inspector Lois Tozer Key Unannounced Inspection 8th October 2007 09:30 Kingston House DS0000065348.V346102.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 House DS0000065348.V346102.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 House DS0000065348.V346102.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingston House Address 10 The Street Kingston Canterbury Kent CT4 6HZ 01227 832981 01227 832981 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) CareTech Community Services (No.2) Ltd Post Vacant Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Eighteen years of age and over. Date of last inspection 25th October 2006 Brief Description of the Service: Kingston House is registered to provide care and support for nine adults who have a learning disability. The home is a detached, two-storey property, set in its own grounds and within the quiet, rural village of Kingston. All bedrooms are single and two have en-suite facilities. There is no lift so wheelchair access is restricted to the ground floor. There is parking for several vehicles to the front of the premises and the rear garden is accessible for residents from the lounge and has far reaching views over the countryside. There is a pub and a shop in the village. Canterbury and Dover are approximately half an hour drive away. A bus stop is within walking distance of the house. The home has a wheelchair accessible mini-bus. Staff cover is provided 24 hours a day, to meet people living at the homes assessed needs. The fee range for the service at the time of the visit was £1189.29 to £1484.19 per week. Information on the home’s services and the CSCI reports for prospective service users should be detailed in the Statement of Purpose and Service User Guide, available from the home. Any enquires about improvement plans should sought from the home. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key visit took place on 8th October 2007 between 09.30am and 4.30pm. A range of service user comment cards were sent out, but those returned had staff comments that the people they were sent to were ‘non-verbal’. No alternative information from the home’s own quality assurance system was sent to demonstrate views are collected in any other way. Because of this feedback and comments from relatives, the Short Observational Framework for Inspection (SOFI) was used. This involved us being in a communal area and observing the lifestyles, engagement and staff interaction people were experiencing. A formal way of collecting information was used, and the observations lasted for 1½ hours. The views and experiences of people who live at the home are included throughout this report. The Manager and staff gave both verbal and observation (through SOFI) feedback. The inspection process consisted of information collected before, during and after the visit to the home. We saw information such as assessment and care plans, duty rota, risk assessments, incident report forms, communication plans, photographic activity books and medication records. The manager had completed a CSCI Annual Quality Assurance Assessment (AQAA), which was received before the visit. This showed that the manager had considered some areas of improvement, and that there was action taking place to get people more involved and have a say than the comment cards returned by staff. What the service does well: This home has many positive things happening that directly affect people living there. There is a lot of activities, and many of these take place away from the home. People who seldom, if ever, leave the home, have activities they like, and people come to visit them. There is a happy atmosphere, and people look quite comfortable and confident around the staff team. Medication is managed for people living at the home, and is done very well. The type of support people need and want is in the care plan. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 6 Menu’s are quite varied. What has improved since the last inspection? What they could do better: First assessments, before people come to live at the home, need to give much better, whole person, information, not just say what they cannot do. Although lots of things are happening, some people are a little overlooked around ‘in-house’ activities. The manager or senior need to sit and observe what is going on and who needs more attention. Some of the good work on communication and preferences is not being followed. People are being served food in a way that has been clearly expressed a dislike to. The type of activities that go on in the home could be more varied, so people could dip in and out and choose between noisy or quiet. The session observed using SOFI seemed to get a bit wearing after two hours. Staff need to remember to sit down when they help people to eat, and also use meal times as a way of engaging people, since they have captured their attention. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 7 The environment – bathrooms, toilets, laundry and kitchen. All of these areas need a really big improvement, as they are at an unacceptably poor, unhygienic standard. The dining room is not big enough for people to use together and leave when they want to. This could cause problems in the future. Some people need more help to keep their furniture clean and smelling nice. The system of quality assurance that is called ‘Visits by the registered provider’ needs to improve so big issues, like the environment, are sorted out before they get to a hazardous state. 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. The summary of this inspection report can be made available in other formats on request. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 8 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 House DS0000065348.V346102.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. Service users support needs are assessed, but this is not thorough, and does not always involve family. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individual care plans showed that an assessment had taken place by the home prior to admission, and had involved the previous care provider. Some assessments were better than others. One sampled showed that the information did not reflect a whole person, mainly describing deficits and problems. The communication assessment was scant, stating ‘non-verbal’ and that facial expressions were used, but did not put these into any useful context. There was an overwhelming lack of understanding around non-verbal communications at this stage. There was no indication that the service user had been consulted, or tried out the home beforehand, or the potential impact of moving out the area they had lived for most of their life. Family input was not documented, and arrangements on continuing contact were not clear. This is especially important, as there are considerable miles between the family and the person receiving care. Further, more valuable information had been obtained through staff support giving direct care within the home, and this had helped produce a support plan. Kingston House DS0000065348.V346102.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. Service users individual plans are lengthy and not user-friendly, which limits their daily use, so known decision and preferences are not supported as well as they could be. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Key staff have completed care and support plans, and these are written in simple, plain language, clearly noting people’s preferred support, likes and dislikes. Observations, using SOFI showed that some of these highlighted support needs were not being followed, such as food preferences. Communication profiles had been developed by the home, but this valuable information was within the care plan, rather than be out in day-to-day use. Using SOFI observations we saw some excellent support work from kind and motivated staff. Their impact on people may be of even greater benefit if they are clear about individual’s personal space and the impact of staff body Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 11 language. Two approaches were observed; only one successfully helped a person communicate without becoming anxious. There has been a move towards using person centred plan templates, but staff have not had training to carry these out from the service users perspective (rather than simply write them in the first person). This has replicated paperwork, and made the support plans even bigger, not had the desired effect of better, more personalised support. Daily notes are written up on a series of forms, so it was hard to get an impression of how a person felt about particular activities or events in their life. There were goals in place, and these were things people enjoy, but outcomes were not clear. Staff supported people to make decisions that were meaningful to them, and showed a great deal of respect towards all people. This excellent work is not reflected in daily notes, where only occasional entries recognised the perspective of the individual, such as ‘looking up and holding her head up a lot more today, smiling’ but most simply stated the person’s perceived mood. Risk assessments have mainly been created from a company wide generic form that has most environmental information filled in, giving a ‘one size fits all’ approach. This put people, regardless of ability, with the same risk factors for general things, such as being in the kitchen, travelling in a vehicle or having a bath. Although space was available to tailor these to individual support requirements, this was at the back, and not accessible without wading through many forms. What had been added did try to widen opportunities for people, but the overall emphasis was more on restricting, rather than enabling participation. Risks to people who wear loose slippers and have a shuffling gait had not been considered, and was discussed. Reviewing this may improve ability to take steps on the carpet, safety and independent mobility. Reviews of all documents were poor, and often only offered a date and signature, with a statement ‘no change’. There is a company-wide review of paperwork taking place. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. Most of the time people have dignified and enabling support, but some aspects need to improve so staff can help people to get the best out of every day. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A variety of activities take place both in and away from the home. We observed an ‘in-house’ music activity during this visit, using the SOFI observational tool. Some really positive and often excellent staff interactions were taking place with people, and most people had just the right level of support to dip in and out of involvement. Positive observations were the way staff treated people, respectful, listening, looking for signs of well-being or distress, trying to motivate movement, enabling short bursts of engagement. Some areas that need work were the overpowering nature of the music session – which ran for about 2 hours, and started again after lunch. It was unclear if being in a session like this was everyone’s choice or just what was put on. The way one person responded to communication with staff showed that, for them, Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 13 there was clearly a right and wrong way, and both ways were observed. Most people had an object to hold, and were asked to dance, but a particular person was not offered contact like this. There was clear evidence in photos of people out and about in the community doing things and taking part in enjoyable activities, but these excellent photo journals are seldom used with service users for discussion, as they are stored in a locked room. More thought to in house activities would improve service user experience, for example, if they were able to dip in and out of contrasting activities, like housework, art and music, dotted around the home. Most people have very good support to see and keep in contact with their families, but a particular individual needs greater assistance, which was discussed, the manager having a clear idea as how to improve contact. These arrangements are essential elements of the pre-admission assessment process, which has not been completed well. Observations and records showed that people are respected and treated with dignity, and are included in the daily routines of the home. Some of the jobs could involve people more, for example, using the kitchen – but the actual environment is a hurdle for this. Support during mealtimes could improve, as staff were seen supporting people to eat from a standing position, without level eye contact. Other staff supported from a sitting position, and were gentle in their approach, but seldom spoke to the person. Other specific support around meals was not being followed, such as the social support and the type and presentation of foodstuff. There is a good variety of food, and people are involved in choosing what goes onto the menu using pictures or discussing at the time if they like or dislike what they are eating. A smoothie maker has recently been purchased to increase the level of fruit consumption. People were observed to be very thirsty during their meal, indicating that more drinks might be needed throughout the day, possibly because there is a plumbing problem, and the heating was on throughout the day, creating a very warm atmosphere. The physical design of the dining room prevented some people on one table from being able to leave when they wanted to. Although the service users were understanding and patient, this has the potential to limit dignity and safety should someone which to leave in a hurry. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. People have their personal and health needs supported in a dignified manner, and with small improvements, could demonstrate excellence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person has a ‘Health Action Plan’ completed, on file, but the other documentations that are a company standard have remained, making it difficult to see what support, or what form is the right one to follow. Medical and physical health needs from appointments are clearly documented and followed up. Better communication support (putting into use the aids that already exist and improving on them) would involve people and increase emotional support. Other documentation details specific personal support needs. Observations showed staff to be considerate and move at the right pace for people when getting ready for personal support. We did observe that staff did not shut and lock the loo door when supporting a person, which resulted in a person walking in. Also, when people are left to relax on the loo, and the door cannot be locked, it would be beneficial and preserve dignity if a visual sign saying the room was occupied were put in place. Wherever possible, same gender care is provided, the home employing equal numbers of Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 15 both genders. Staff showed considerable competence when using a hoist, and the service user looked comfortable and relaxed throughout. Medication is managed centrally, and this arrangement appears appropriate at the moment for the people living at the home. Staff have had training and competency is assessed on a semi-regular basis. All records about medication were in excellent order, and staff consistently follow the policy and procedure to maintain a safe situation for service users. Preferred forms of medication are obtained, such as liquid or soluble types. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. People are protected from abuse, but they could be better supported to indicate if they had an issue of complaint. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a simpler service user complaints procedure available now, which some people have in their rooms. It is mainly in text, and few people are able to read. We discussed making it more simple, using clear pictures, or fabric; whatever the assessed needs indicated would make it more accessible, since this remains an outstanding requirement. Over half of the core staff have received safeguarding adults training, and this is provided on a rolling basis. New staff will have this formal training within 6 months, but it is covered at induction too. The manager discusses service user issues with the team through meetings, decisions and an open door policy. Finances are supported centrally, and a safe, accountable system is in place. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is poor. People need more support to make sure all parts of the home are clean and do not put anyone at risk. Environmental improvement is desperately needed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We had a good look around the home and saw several service users personal bedrooms, which were personalised and generally pleasant. Some people would benefit from greater support cleaning their bedrooms and their furnishings to reduce odours and improve dignity. The communal living areas of the home were quite homely, although lacked an area for people to go to get away from the ‘noise’ of the home. The lounge and dining room are adjoining, leading into the garden, so people do have a lot of freedom, in good weather, to come and go. All carpets were in the process of being professionally cleaned. The dining room is too small for the service users to eat together and be able to have freedom of movement. Potential for more people to use wheelchairs Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 18 within the home is high, and this will need to be assessed and development or changes to routine considered before the situation arises. The bathrooms, toilets, laundry and kitchen were not in good repair, and presented an environment, where infection control measures would be hard to manage. Skirting and flooring in bathrooms and toilets had come away from the walls; some areas were musty and smelly. Toilet roll holders had not been refitted (or alternative dispensers where these were not successful), and some areas were marked with dried faeces. The home was very hot, and radiators were on full, with access to some of the controls boarded in. We were told that the heating had to be on to get hot water, and that the plumbing had been a problem for a considerable time. Hot water was inconsistent, some hand basins did not have running water, and others needed both hot and cold taps turned on to get the warm water out. The indicator ‘hot’ and ‘cold’ on some taps was the wrong way round. The kitchen was in a poor state of repair. This also contained the cleaning cupboard, which staff were returning cleaning products and sponges that had just been used in the toilets via this food preparation area. The oven had been out of action since mid September, although a new one had been put on order. Service users have used the kitchen for some activities, but there are no lowered work-surfaces, and most people living at the home would need to sit throughout the activity. A service user was observing staff cook, but were sat on the work surface to do so. The last inspection had environmental concerns and an action plan was required, which was raised, but not carried out. There was sufficient concern about the environment that we asked the manager to contact the environmental health officer from the local council to assess the situation. The manager did so, confirming a visit had taken place the following day, specific to food hygiene, and a health and safety / infection control officer would visit in respect of the other matters. This agency left an action point list with the home. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is adequate. Despite being heavily reliant on agency staff, people are supported in positive way that supports and maintains a good quality of life, but are not sufficiently familiar with the specific support requirements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a core team of 12 full time & 6 part time staff. Three have NVQ 2 or higher, a further 4 are working towards this. There are considerable vacancies, and recruitment and retention has been difficult. In the last three months, agency staff has covered 424 shifts (of around 7 hours a shift). Around 4 to 5 new faces from the agency support service users each month, when regular staff cannot be booked. The manager has made efforts to book up in advance the same agency staff, and SOFI observations showed that despite 4 out of the 5 staff on duty during the visit were from the agency, people were supported in a way that maintained their dignity and personhood. Some improvements in support around communication and help with meals Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 20 would be of benefit, and the manager and senior staff must make sure they give good role modelling. The manager has used the British Institute of Learning Disabilities (BILD) work pack to support staff help people who have developed dementia, and this has clearly had a positive effect. There is always a senior staff member from the core team available. Training has been given to meet peoples physical health needs, and the area quality assurance manager advised communication training was to be rolled out to managers soon. A bigger focus on training around assessed needs would be beneficial, especially in person centred support and active support for activities (creating and enabling opportunities). There is a thorough induction for regular agency and core staff, and a slimmer one for others. To compensate for such high agency staff use, some effort has been made to put support requirements for mealtimes on placements, but these are not being followed. Recruitment checks are taking place centrally. The manager has tried hard to use the local job centre and has placed adverts in the local press, but has had poor uptake. Staff who have moved on have often moved within the organisation. Service users have not been very involved in this aspect, but do get to meet new staff in advance before employment. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. The manager is competent and makes sure social aspects of running the home meet service users needs, but the quality monitoring and safety of the environment needs rapid improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has run the home for over 1 year, and has recently submitted an application for registration (having been registered elsewhere in the organisation). He has shaped the service to be responsive to peoples needs, and clearly supports an ethos of empowerment. Having reported and requested environmental improvements over the last 12 months, the organisation have been slow to respond. The manager has no financial control, so improvement is out of his power. Recruitment has also been difficult, and potentially more help and support in Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 22 this department could come from the organisation. Self-monitoring is quite good, and people do have a say, despite there not being formalised communication systems in place. Pictures are used to seek views and these are recorded and acted upon. The manager would benefit from conducting observations to get a good feel of life experienced by people from their point of view. Sadly, bigger things like environmental issues have not been adequately supported. The manager said a recent visit from Care Tech quality assurance (QA) had also identified many of the issues reported here. This is a new QA team, with highly focused plans to change the emphasis on support away from burdensome forms to information collection that measures, maintains and improves people’s quality of life. Health and safety checks do take place, but it is questionable how effective they are when so many environmental issues identified around hygiene have been noted. The home has monthly visits from a representative of the registered provider, so these issues have been well known to the organisation month after month. The organisation must really improve the quality and speed of maintenance issues. A ‘competent’ person in an external organisation has signed of the fire risk assessment, but actual night escape procedures has overlooked service users needing support and education about their nearest fire escape route. The manager said that this aspect would be reassessed, and would be added to the risk assessment. A range of staff have had health and safety training, including food hygiene, infection control and first aid – sufficient to put cover in place for each shift, but the knowledge is not being applied to the environment. Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 23 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 2 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 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X X 2 X Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 24 YES 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. 1 Standard YA2 Regulation 14 Requirement Timescale for action 01/12/07 2 YA6 14 15 3 YA22 22 (2, 6) 4 YA24 23 To promote service user wellbeing the detail and depth of information collected through the pre-admission assessment must be thorough enough to support people in a clear way, which includes ways of communicating with them. The system used needs to be reviewed and improved for use with future service users. To improve and increase service 01/01/08 user involvement in their own lives, an approach, which seeks their views and opinions, must be put in place. This must be reflected in the service user plan and be kept under review through detailed daily notes that draw on a person’s experience. Outstanding requirement, 01/01/08 previous timescale of 31/12/06 unmet. To make sure service users views are listened to, respected and acted upon, a clear, accessible and effective complaints procedure must be in place. 15/11/07 Outstanding requirement, previous timescale of DS0000065348.V346102.R01.S.doc Version 5.2 Kingston House Page 25 31/12/06 unmet. An action plan, which states clear timescales for initial and final action is required to address all the matters around the environment, raised during this and the EHO inspection visit. 5 YA30 13 (3) 23 (2, a) To protect staff and service users 01/12/07 environmental risk assessments and relevant policies (including infection control, food hygiene, fire precautions) must be kept under review and action taken to make sure these are followed. This is also applicable to standard 42 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 YA17 Good Practice Recommendations So service users get the food they like, presented in the way they like, review how staff are furnished with this information. To improve the type of social contact and dignity, review the way and manner in which people are supported during mealtimes. So people can enter and leave the dining room freely during mealtimes, assess and make changes that enable this to happen. To give service users the smallest possible consistent team, review recruitment methods to attempt to improve permanent staff levels and retention. 2 3 4 YA17 YA24 YA34 Kingston House DS0000065348.V346102.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 House DS0000065348.V346102.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!