Inspection on 18/07/05 for Kingston Residential Care Home

This inspection was carried out on 18th July 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kingston Residential Care Home 01/06/07

Kingston Residential Care Home 19/09/06

Kingston Residential Care Home 08/11/05

Kingston Residential Care Home 25/09/04

Kingston Residential Care Home 19/04/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

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 Residential Care Home 27-31 Westbrook Road Margate Kent CT9 5AU Lead Inspector Patrick Gough Announced 18/07/2005 at 9:00hrs 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 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 Stationary 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 Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Kingston Residential Care Home, Address 27-31 Westbrook Road, Margate, CT9 5AU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01843 292412 Craegmoor House Mrs Joanne Jeavons Care Home 21 Category(ies) of Learning Disability (21) Physical Disability (7) registration, with number of places Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25/08/2004 Brief Description of the Service: Kingston provides residential accommodation and care for adults with differing degrees of learning disability. The service users may have an additional physical disability. The Home, owned by a large Company, is a Victorian terraced property on three floors. It is situated in a residential area of the seaside town of Margate and is within walking distance of all local amenities, including the seafront and local shops. There is on road parking to the front of the property. The Home provides 24-hour staff cover, including staff on wake-duty at night. There is always a senior member of staff on duty or on call, to deal with any queries or emergencies. The health care needs of the residents are met by the local primary health care team. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted over two days. A pre-inspection questionnaire was completed by the Manager and issues from this, as well as a review of the requirements and recommendations made at the previous inspection, were addressed. Evidence was gathered from conversations with some residents and a number of staff participated in interviews. Mealtimes were observed and practice was evidenced on several occasions throughout both days. A tour of the premises was conducted, which enabled the inspector to view residents’ rooms and communal facilities. A sample of residents’ files as well as some personnel records were examined. Various other records were seen, including health and safety, staff meetings, staff supervision and documentation relating to the care of the residents. Correspondence received from associated professionals relating to the service was also considered and reflected in the findings. The inspectors found that the management and staff were cooperative, open and confident in their responses and engaged fully in the inspection process when required. What the service does well: The Home facilitates meaningful contact between the residents and their families. The recruitment of staff follows a rigorous process and good practice guidance. The staff, which were interviewed, commented on the effectiveness of the process. The quality of the food is good and it is presented in appropriate quantities. The residents were observed to be enjoying the meals. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: The Home must improve the care planning process to ensure that assessed needs are incorporated in the plan. The methods of intervention, that is, how the resident will be supported to achieve the set objectives, must be included in the plan and it should be reviewed regularly with achievements noted and any changes or amendments documented. A greater range of activities must be provided to reflect residents’ interests and stimulation given to encourage them to participate. The residents should be enabled to access the local community facilities more often and be supported in this by the Manager and staff. Within the Home, the residents should have more support and assistance to engage in personal and life skills tasks to promote and stimulate their abilities. The staffing levels should be increased, given that all the residents have a high level of need, to provide an acceptable level of supervision and to support, encourage and participate with the residents. Where, at times, the Home requires assistance, particularly with behaviour management, physical and social development, and the whole range of learning disability, it should be sought more quickly so that staff have the necessary guidance to implement relevant strategies and programmes. Considerable attention must be given to the décor within the house, the general fabric of the building and cleanliness, in particular. It is recommended that the Company review its policy on the provision of maintenance to the Home. Serious consideration must be given to improving the management of the staff team, through better monitoring of practice, a more structured approach to care practice, better planning, considered implementation and improved case file management. The planned performance management system, incorporating regular formal supervision and appraisal must be implemented Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 7 without delay so that the staff receive the necessary support and guidance to improve practice. The quality of the provision must be monitored more keenly by the Company and the Manager. Poor quality within the living environment, poor care practice, and inadequate service must be highlighted, challenged and then addressed through subsequent action plans. 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 Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,5 The assessed needs for each resident are either not included or are not reflected accurately in their care plan and therefore do not formally feature in the key working practice resulting in many needs not being met. The staffing levels are not sufficient to adequately meet the needs of the residents and so some residents are under stimulated and not usefully engaged. The generic contract currently in place does not include the specific details of the provision for each individual resident thereby making it difficult to gauge successful delivery. EVIDENCE: The statement of purpose contains all the relevant information pertaining to the Home except for details of staff skills and qualifications. This information is useful for care managers and relatives in determining if the Home has appropriately skilled staff to work effectively with the prospective resident. The residents’ needs are assessed on an ‘Outcome Based Evaluation’ format, which is used throughout the Company. Many of the assessments have recently been completed and cover, though in no great detail, the personal, health and social needs of the resident. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 10 The information gleaned from the assessment, however, is not adequately incorporated in the care plan. One resident had a number of needs identified, none of which featured in the resulting care plan. Similarly, indicators, which should have informed a risk assessment, were not addressed. The staff were observed to be communicating effectively with the residents, mostly through signs and body language although a small number of residents have effective use of language. Whilst the Home engages the assistance of healthcare professionals, it needs to be more proactive in recognising when the staff are no longer able to adequately meet the needs of residents and the appropriate time to seek guidance. All the residents, due to their complex needs, have been identified as needing a high level of input, on a daily basis from staff. The current staffing level, however, does not allow for this and a number of residents are under stimulated. Six staff, including one member of staff engaged in a 1:1 role with a resident, were on duty on the morning shift during the inspection, however duty rosters supplied to the Commission indicated that three to four staff are normally on duty. This is an inadequate number to interact productively with the residents. Each resident has a contract in the form of a ‘terms and conditions of residency’, which is a generic document and which does not include the specific information relative to individual residents. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 6,8,9 There is little correlation between the resident’s needs assessment and their care plan and therefore the resident’s needs are not adequately met. There is no clear or consistent method of measuring the resident’s participation in the running of the Home and consequently resident’s views and opinions may not be noted and acted upon. Whilst risk assessments are completed they are not sufficiently effective to ensure the safety of residents or staff. EVIDENCE: The residents’ care plans have been completed, with each resident having approximately twelve targets to achieve. The targets are too generic and many are common to the majority of residents and as already indicated, not reflecting the true needs of each individual. In one resident’s file a care plan target referred to their prescribed medication and was inappropriately tabled as a target. Road safety was chosen as another Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 12 target, however there was no reference to it in any update or review of implementation and no evidence of involvement in off-site activities necessitating the application of road safety awareness. The evaluation of the care plan is scheduled to occur each month and this generally takes place as indicated by the key worker’s signature and date. There is, however, no written evidence indicating what progress has been made with the targets and no reference to the value or effectiveness of the staff interventions. There is a section titled ‘record of achievement’, which is designed to record target achievements, however two brief entries on one resident’s plan on 6/03/2003 and 6/07/2005 did not relate to any of the set targets. Many of the residents display little interest in how the Home is managed and its impact on their lives. The Manager stated that those residents with the level of ability and understanding do make a contribution and are encouraged to do so. The Manager was advised to document such instances and to involve the resident’s advocates such as care managers and relatives. The Home has a generic risk assessment manual, which is compiled by the Company. This has not been fully completed and although an annual review of the assessments is required according to the Company Strategy 1.8.7, nothing has been added or amended since 1999 and in some instances, 2000. There was evidence that individual risk assessments had been completed. Whilst the risk was identified and adequately described, there was a lack of definitive detail in the recommended preventative measures. Some issues identified in the needs assessment, which should have featured in the risk assessments were not addressed. One resident’s assessment referred to a tendency to abscond from a previous placement but this was not identified as a risk. No risk assessment was completed for a resident who displays aggressive behaviour. The staff had no training on the process of assessing risk, however the Manager stated that it is included in the health and safety training. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 11,13,14,15,16,17 Although the residents are encouraged to perform domestic tasks there is no planned approach, as in the care plan, to life skills learning thereby denying the residents the opportunity to maintain their skills. Limited involvement in the community decreases the opportunity for the residents to maintain and develop their interests and to mix with their peers. The selection of activities on offer is very limited resulting in residents receiving little stimulation. The Home facilitates good contact opportunities between the residents and their relatives thereby maintaining good family links. Life Skills opportunities do not feature in the residents’ care plans and therefore it is difficult to measure the residents’ response and their achievements. There is a selection of good quality food available which meets the residents’ dietary and nutritional needs. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 14 EVIDENCE: The Manager confirmed that some residents participate in practical life skills such as bed making and hoovering. There was reference to these activities on the daily activity records and some staff suggested that it was generally unplanned and an alternative to more useful opportunities such as taking the residents out for off-site experiences. Life skills practice does not feature in the resident’s care plans that were examined. One of the residents attends a local club one afternoon each week. There is limited community involvement for the remainder of the residents and staff commented on the lack of necessary resources such as financial and personnel. Given that the Home is located close to shops cafes and other amenities there was little evidence in the daily logs that residents were given opportunities to be involved in the local community. During the inspection three residents were taken out for a walk. During the early part of the day there is limited planned interaction between the staff and the residents and a sample of daily logs record residents as being ‘asleep on the sofa’, ‘sitting in the lounge’, ‘in the lounge colouring’, and’ listening to music looking at magazines’. For two hours each afternoon there are eight staff on duty in order to assist the residents participate in planned activities. In practice, however, it is a resource, which is under utilised and there is normally only one activity available to the residents. The Deputy Manager has created an activities folder with a wider range of onsite activities, which has not yet been introduced to practice. Some staff have commented on the lack of opportunity to broaden the experiences of the residents, particularly the opportunity to take them out into the local and wider community. Staff also indicate that when suggestions are made relating to a wider choice of activities, the lack of financial resources is cited as a obstacle. This was discussed with the Manager, who refuted this suggestion. The inspector advised that the staff are informed that money is available to fund activities for the residents. It was noted in one of the staff meeting minutes, that some of the staff were resistant to involvement in activities because they were ‘boring’. Alternative activities were suggested however little change has occurred. The Home facilitates contact between the residents and their family and friends and the Manager gave examples of the regular contact that occurs. The staff were observed to be respecting the resident’s privacy and those residents who have the ability to use a bedroom door key have the opportunity Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 15 to do so. Residents can choose how they use their time, however at times some staff were not proactive in stimulating their interests. The residents are offered a choice of suitable menus on a two weekly cycle. There is a range of meat and fish as well as fresh vegetables and fruit for the lunchtime meal. Breakfast consists of cereal and toast. The residents appeared to enjoy the evening meal, corned beef hash and beans, served during the inspection, although one member of staff suggested that a ‘lighter’ alternative may be healthier. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 16 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 standard(s) 18,19,20 Personal support is offered to the residents in a sensitive and appropriate way thereby ensuring that residents are treated in a respectful manner. Resources to purchase personal items are not readily available and occasionally residents are not able to personally acquire items as quickly as they should. The health needs of the residents are generally well met but a more proactive and prompt response to experienced difficulties in providing a better service would hasten progress for the resident. The systems for medication storage and administration are poor and potentially place residents at risk. EVIDENCE: The staff were relating to the residents in a sensitive manner and personal support was provided appropriately. Although there are designated times for getting up and going to bed and for mealtimes, the Manager confirmed that there is a flexible and relaxed approach, with consideration given to residents’ wishes. Some staff were concerned that the residents’ money is not always easily accessible to purchase items of clothing and that residents do not always have the opportunity to shop for their own personal items. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 17 There has been some delays in accessing additional guidance and support from specialist services for some of the residents. Care managers have expressed concern about the lack of initiative and delayed response to review decisions. The inadequate care plans and poor reviewing system allows ineffective interventions to proceed unchallenged and delays the prospect of accessing sound advice from external professionals. The residents’ health is monitored and records indicate that support is given to access various routine medical appointments. The Manager was advised to construct a definitive healthcare plan as, currently, information on health issues can be found in different sections of the resident’s file. The medicines are stored in a locked cabinet within a locked room. On inspection, however, the key was in the cabinet lock and it was observed that staff other than care staff had access to the room. The cabinet is located close to a double glazed window and can be easily viewed from the exterior of the building. Each resident’s medication, some in blister packs, was stored separately on shelves within the cabinet and homely remedies in a different location. Medication administration record charts were generally dated and initialed appropriately although some were crudely done, with deletions subject to challenge. Designated staff have received medication administration training. The method of administering the medication, in that medication is taken from the storage area to various parts of the building in containers, could lead to errors being made. The medication charts are signed on return to the storage area. This issue was discussed with the Manager and other staff and it was recommended that advice be sought on safe administration, recording and storage of medication. It was noted that there was a discrepancy in the information relating to one resident in that, the staff offered conflicting information on the frequency of seizures within a defined period, to that recorded and stated by the medical consultant. The inspector was unable to clarify the information due to the absence of the administration records for part of that defined period. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 18 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 standard(s) 22,23 The Home recognises the difficulty residents may have in using the complaints procedure and utilise staff experience and knowledge of the residents to register complaints on their behalf so that residents’ issues are addressed. Whilst the residents are adequately protected through the adult protection procedures and the staff’s awareness, the current staffing complement does not provide the required level of supervision and support to promote their safety. EVIDENCE: The Home has a complaints procedure, which is used for internal and external complaints, however the majority of the residents are unable to understand the format that has been produced for their use. The Manager indicated that the staff, through their knowledge of the individual residents, are enabled to assess their discontent or anxiety and register their complaint on their behalf. The procedure, which refers to NCSC, needs to be amended. It was suggested that a record of those complaints registered in that way be kept. Two complaints received since the previous inspection, were not recorded in the complaints book. They were, however, responded to within a reasonable timescale. Adult protection training has been provided and most staff have accessed it; those who have not already received it are due to do so within the forthcoming months. Some staff, which were interviewed confirmed that they knew how to respond appropriately to observed abuse or suspicions of abuse. The staffing ratio, however, does not provide for sufficient supervision, given the extent of the premises and complexity of the residents’ needs. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 19 Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 20 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 standard(s) 24,26,30 There has been no improvement in the décor or furnishings in the last twelve months and although this does not pose a risk to the residents, it does not create a pleasant and pleasing environment to live in. Infection control procedures, supported by staff training, are in place, however the practice of role interchange increases the risk of the spread of infection, affecting the residents, within the Home. EVIDENCE: The Home, located within a residential area close to the town centre, offers access to local amenities. Some areas of the premises, particularly corridors and landings do not have natural light due to the configuration of the house. Some areas of the Home were not acceptably clean and there was evidence of offensive odour. Many of the rooms and corridors are in need of redecoration as the paintwork is chipped and marked and the wallpaper is torn in places. Some of the carpeted area is stained and dirty, particularly the stairs. Generally the décor is Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 21 shabby. Recommendations made as a result of an environmental health inspection, relaying to the kitchen, have been addressed. There is no planned maintenance and renewal programme for the fabric and decoration of the premises and currently the member of staff responsible for daily maintenance issues is required to manage the maintenance in another of the Company’s Homes. During the inspection, the maintenance engineer was required to abort work within the Home to address an issue at the other Home. The inspector noted that a number of maintenance jobs were only partially completed. The Manager stated that maintenance and replacement requests are agreed or refused at the discretion of the Company. Each resident has a single room, most with vanity units included. Some of the bedding is worn and in need of replacement and some radiators need covers. One resident’s easy chair had no seat cushion. Some bedrooms were nicely personalised. The laundry facility is located towards the rear of the premises and there is a designated laundry room operator. The Home is awaiting delivery of a washing machine with a sluicing facility. There are policies and procedures for the control of infection and training is provided. It was noted that a variety of staff have access to the kitchen and at times come into contact with food and cooking utensils and in discussion with the Manager the need for the implementation of proper infection control procedures was emphasised. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 22 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34,35,36 The residents’ quality of living is debilitated through the lack of clearly defined roles and unstructured approach to meeting individual needs. Although core training has been delivered, the Home has not enabled staff to engage in, and achieve accredited training, which would equip them with a wider range of knowledge and skills in order to more efficiently meet the needs of the residents. Recruitment policies have been consistently followed resulting in residents receiving care from staff that have been appropriately vetted. Irregular formal supervision and assessment of staff performance has contributed to an unfocussed approach to care planning and therefore many of the residents’ assessed needs are not adequately addressed. EVIDENCE: The staff, including the Manager, do not have an up-to-date job description and given that there are various strata of management within the Home, there is a lack of clarity of roles. The staff team lack direction and cohesion and would benefit from a more structured style of management to engender a more resident focussed approach. Some of the staff indicated that they would Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 23 like to involve the residents to a greater degree in activity during the day and take them out into the community. Management support for these initiatives would enhance the residents’ lives. There are a number of staff, who have the necessary skills, experience and qualities to work effectively with the residents. Staff were observed to be comfortable with the residents and were able to communicate effectively through verbal prompts, gestures or signs. The Home has experienced difficulty accessing an effective NVQ training provider and as a result none of the current care staff team have achieved NVQ Level 2 qualification. Currently there are eight staff participating on the NVQ 2 course and six on NVQ level 3. Three staff files were sampled and were found to contain all the relevant material information required. The files were untidy and were difficult to negotiate. They would benefit from reorganisation to ensure that the recruitment and post appointment procedures are followed consistently. There is a training matrix, which tabulates the courses provided and those who have attended. Whilst there is a format for attendees to comment on the value of the training, there is no training needs assessment conducted for the staff team as a whole and no post training assessment of the impact the training may have had on the practice with the residents. There is no individual training needs assessment conducted for each member of staff. Formal supervision has been given to staff but on a less than satisfactory level. One member of staff had supervision in June 2003 and on January 2005; another had a session in June 2003 and November 2004. The Manager stated that the Company had recently introduced a performance review system, which would incorporate six formal supervision sessions annually as well as an annual appraisal. This has not yet been implemented. The supervision process needs to be focussed on the supervisee’s role particularly relating to the National Minimum Standards and the resident’s care plan. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 24 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,41,42 Inadequate monitoring of the quality of the provision has contributed to an unacceptable delay in addressing residents’ needs and in improving the quality of the living environment. The residents’ files are not sufficiently updated to effectively record and assess their level of progress and achievement. The staff receive the necessary knowledge and guidance on safe working practices to safeguard the residents. EVIDENCE: Regular unannounced visits are conducted by the service provider in accordance with Regulations. The level of detail, however, in the subsequent reports does not appear to inform future practice and planning. The monitoring visits, with the exception of the most recent one, indicate a level of satisfaction with the environment, which is unacceptable. The monitoring visits need to Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 25 reflect the true outcomes and be more challenging in its assessment of performance. The Manager has not yet implemented a quality assurance monitoring system. Resident’s files, containing confidential information, were not securely stored, in that they could be accessed by staff other than care staff. Some files were not up to date and care plans had not been reviewed as scheduled. Some, which had been reviewed, were not supported by evidence of achievement or reasons for plan remaining the same. Examination of training records confirmed that staff had received training on safe working practices, such as, fire safety, manual handling, basic food hygiene, health and safety and infection control. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 2 x 2 Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 2 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 2 x x x 2 Standard No 11 12 13 14 15 16 17 2 x 2 2 3 3 3 Standard No 31 32 33 34 35 36 Score 2 2 x 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Kingston Residential Care Home Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x 2 3 x H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 27 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 6 Regulation 15 Requirement The Home shall create a care plan for each resident, which adequately reflects assessed needs and is implemented and reviewed at appropriate intervals. The Home shall conduct risk assessments, as appropriate, for each resident to ensure that they can engage in activities that are free from avoidable risks. The Manager shall access, in a timely fashion, additional professional support to meet the residents health needs. The Manager shall seek advice and implement resulting recommendations on the safe administration of medicines in the Home. The Manager shall provide sufficient staff within the Home to ensure that residents have appropriate supervision commensurate with their needs. The Manager shall ensure that the premises are maintained, decorated and furninished to an acceptable standard, providing a pleasant living environment for the residents. H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Timescale for action 19/9/2005 2. 9 13 19/9/2005 3. 19 12 19/9/2005 4. 20 13 19/9/2005 5. 23 12 19/9/2005 6. 24 23 1/1/2006 Kingston Residential Care Home Version 1.40 Page 28 7. 24 16 8. 32 18 9. 10. 36 39 18 24 11. 39 26 12. 41 17 The Company shall provide the necessary resources to ensure that the Home is kept clean and free from offensive odours. The Company shall facilitate the required training in order that they acquire the qualification and skills to perform their role. The Company shall ensure that all staff receive regular formal supervision and annual appraisal The Manager shall establish a system for monitoring, on a monthly timescale, the quality of provision within the Home and provide the Commission with a summary report on a three monthly basis. The Company shall prepare a report, supplied to the Commission, following monthly unannounced visits, which accurately reflects the quality of provision within the Home. The Manager shall ensure that all records within the Home are kept up to date. 19/9/2005 19/9/2005 19/9/2005 19/9/2005 19/9/2005 19/9/2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 2 3 5 8 11 Good Practice Recommendations The assessed needs of residents should be incorporated in their care plan. The Home should be more proactive in engaging professional assistance to support staff in meeting the needs of the residents. The Company should provide an individualised contract for each resident. The Manager should establish a system for measuring the residents contribution to the running of the Home and should keep a record of such. The Home should plan to enable the residents to engage in H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 29 Kingston Residential Care Home 6. 7. 8. 9. 10. 11. 13 14 18 30 31 41 meaningful life skills activities. The Home should provide opportunities for the residents to participate in the local community. The Home should provide a wider range of activities for the residents and promote and encourage their involvement. The Manager should ensure that financial resources are readily available to allow residents the opportunity for personal requisites. The Manager should review staff roles and practice to support infection control. The Company should provide a job description for each member of staff to ensure that each individuals role is clearly defined. The Company should provide specific training for the relevant staff on case file management. Kingston Residential Care Home H05 H56 S23485 Kingston Rest Home V227361 180705 Stage 4.doc Version 1.40 Page 30 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU 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. 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