CARE HOME ADULTS 18-65
KingsWalden Villas 40 The Baulk Biggleswade Bedfordshire SG18 0XS Lead Inspector
Andrea James Unannounced 22 of August 2005 1:00
nd 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. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Kingswalden Villas Address 40 The Baulk Biggleswade Bedforshire SG18 0XS 01767 318674 01767 318674 hftbedfordshire@hft.org.uk Home Farm Trust 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) Mr Ian Chambers Care Home Only 8 Category(ies) of Learning Disability (LD) 8 registration, with number of places KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13.01.05 Brief Description of the Service: Kings Walden Villas is one of five registered care homes within Bedfordshire that are managed by Home Farm Trust. HFT is a nationwide provider for people with learning disabilities. Kings Walden Villas is situated in a residential area of the market town of Biggleswade, and is a short distance from the local HFT headquarters and day care facility in Shefford. The home is within walking distance of the town’s shops, public houses, cafes, bus and rail links. A leisure facility with swimming pool is a short car journey away. The home does not have off road parking.The building was originally used as a private domestic dwelling. It has been sympathetically converted to retain its homely environment, and provides single accommodation to eight adults with learning disabilities organised on two levels. Communal space consists of toilet and bathing facilities, a lounge, dining room and kitchen. In addition, at the rear of the property is an all weather conservatory that leads to a small-enclosed garden. Within the garden, is an outbuilding that is used for combined storage and laundry purposes. The home is not currently adapted to accommodate people with physical disabilities. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out on the 22nd of August 2005 and lasted for a period of 4 hours. The home was registered to meet the needs of 8 service users with learning disabilities. The registered manager was present for the inspection and 3 service users were home on the day of the inspection, the other service users were on holiday. A case tracking methodology was used to gather the information used in this report. The service users present on the day of the inspection were used as a sample and as a result their care plans and documents were inspected in detail. The views of the service users care staff and the manager are also reflected in the report. What the service does well:
The home provided satisfactory standards of care to the service users and had enabled them to maximise their independence. Service users spoken to said they were able to attend college, have part- time employment and maintain relationships with families and close friends. Service user said they were happy with the service provided by the home and described the home and the care as “ nice”. A house rota was implemented to ensure all service users were empowered to develop domestic skills within the home. The care staff spoken to appeared to be experienced and knowledgeable about the needs of the service users. She spoke positively about the dedication of the current staff team and felt it was a lovely home in which to work. Satisfactory training was provided to the care staff to ensure they were aware of the changing needs of the service users. 50 of the care staff had achieved their qualifications in NVQ level 2 in care. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better:
The home should ensure that new service users are assessed on admission in order to identify their needs and to implement accurate care interventions. The care plans inspected were unsatisfactory and as a result the home failed to clearly identify the needs of the service users. This was also identified in the last inspection as needing to be addressed. The service users are still having to launder and iron their clothing in the outhouse provided, which is cold and unwelcoming in winter months. The home had not addressed this area of concern despite several requirements being made. The numbers of staffing provided to meet the needs of the service users were insufficient and as a result the needs of the service users were not always met. The rota showed that some service users were regularly left on their own for an average of 2 hours, between shift changes. A requirement was also made from the last inspection to the home to address this area of concern but remained unmet on the day of the inspection. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 7 The home had quality monitoring policies but no formal recording of quality monitoring was implemented for the home. As a result the views of the service users and staff were not identified. The inspector would like to thank the service users, care staff and the manager for their co-operation in the inspection process. 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. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 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 KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 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) 1,2,3,4 and 5. Satisfactory procedures were in place to ensure service users were provided with enough information to decide if they wanted to move into the home. Satisfactory procedures for assessing potential service users, offering trial visits and contractual agreements were in place which resulted in positive outcomes for new and potential service users. EVIDENCE: All service users spoken to said they were given a service user’s guide and were informed of the resources available in the home. A record of this was seen on file. The records of a potential service user were inspected which had a full preadmission assessment of need. Care staff and service users spoke of the new service user who had visited the home on several occasions and had tea stays and overnight stays. The service user was due to move into the home in the near future. All service users had contractual agreements that were signed and dated satisfactorily. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 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 standard(s) 6,7,8 and 9. The home was good at encouraging service users to develop, make choices and take risks in order to maximise their independence through daily living skills. The home was poor at identifying the needs of the service users and implementing satisfactory care interventions where needed, as a result some service users health care needs were not addressed. EVIDENCE: The service users spoken to said they were encouraged to develop their daily living skills and they spoke at length about their day jobs, college placements and how the staff enabled them to take risks. One example was of a service user who was enabled to take up part- time employment in Sainsbury’s and had developed the skills to take public transport independently of staff support. Service users said they were able to make decisions in their day-to-day lives and commented that they had regular residents meetings and yearly reviews. The home failed to implement satisfactory assessment of needs and as a result the needs of the service users were not identified. This resulted in the care
KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 11 planning documentations failing to meet the requirements because they could not demonstrate how the care interventions were to be implemented for individual service users. The care plans also failed to demonstrate evidence of being review on a regular basis. Some documentation seen suggested that satisfactory risk assessments were in place and they had been reviewed in recent months. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15 and 17. The home ensured service users were enabled to live a fulfilling lifestyle which encompassed, personal development, cultural awareness, community involvement, leisure activities, social and family contact and healthy eating. EVIDENCE: Service users were enabled to develop and maximise their independence in various ways. Two of the service users had recently moved into supported living and others were being assessed for the same purpose. Service users spoken to said they were encouraged to self medicate, help with food shopping and preparation. Two service users were observed to have made themselves their own sandwiches for lunch and proceeded to wash and put away dishes used. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 13 A service user said he attended the gym on a regular basis, which he enjoyed. One service user was enabled to have a girlfriend who he visited on a regular basis. This he said had enabled him to feel independent and mature. Service users were also encouraged to visit their families on a regular basis, and the home ensured opportunities were given for relatives and families to visit. The home had various in-house and communal activities that all service users were encouraged to partake in. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 20. The home offered good personal support to service users, which enabled them to maximise their independence. The ability to maintain good health care practices were in place and as a result service users wellbeing in regards to health issues were satisfactorily met. EVIDENCE: Service users spoken to said they were encouraged to maximise their independence through the personal and health care support received from the care staff. The service users health was addressed by the input of various external professionals for example dieticians, physiologists, gp’s and district nurses. The home needed to ensure that the needs are identified in the care plans. The medication procedures had improved minor development was required to ensure all administration of medications are signed for. One service users was enabled to self-medicate, she also kept accurate records of administration and storage. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 15 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 and 23 Satisfactory processes for complaining and reporting abuse were available in the home which resulted in service users being able to voice their views or report suspected abuse should they occur. EVIDENCE: Service users spoken to said they had regular residents meetings and felt confident in expressing their views. The care staff and manager were observed communicating effectively with the service users. The service users said they felt able to complain should they have concerns. Records seen suggested service users did complain and knew how to complain. The home ensured care staff were trained in abuse awareness and this was also covered in their induction process. Care staff said they knew how to report abuse should they occur. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 16 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) 24,25,26,27,28 and 30 Processes were available in the home to ensure the service users were able to live in a comfortable environment that suited their life styles, promoted their independence and privacy and were clean and hygienic. The furniture’s in some bedrooms did not meet the needs of some service users. EVIDENCE: The environmental standards of the home were satisfactorily maintained for most of the home. The decorations were of a moderate standard and the communal furnishings appeared suited to meet the needs of the service users. The furniture in some bedrooms needed to be replaced in order to meet the needs of the service users. A service user said he was not happy with his bed and his chest of drawers which on inspection appeared to have been broken and needed to be replaced. All bedrooms were individually decorated to meet the needs of the service users.
KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 17 The home had separate dining and lounging facilities that ensured sufficient communal space was available for the service users. The home was clean and no offensive odours were identified. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 18 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) 32,33,34,35 and 36. Satisfactory processes were in place for staff training, supervision, and recruitment and to ensure competent and qualified staff were available to meet the needs of the service users, however the numbers of staff available to meet the needs of the service users were insufficient. EVIDENCE: The home had a steady core of staff that had worked in the home for a number of years. They spoke knowledgeably about the service users and demonstrated a good understanding of the service users care needs. The staffing levels in the home were inconsistent, as a result service users were often left in the home on their own and the staffing ratios consistently fell below the recommended ratio of 6: 1. The manager said it would not be financially viable to have two staff on with service users at all times. The rotas showed that one staff was always on their own on weekends. Care staff said they felt unsafe during these periods. The care staff spoken to said she received regular supervision and felt that she understood her roles and responsibilities. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 19 Regular training was offered for various areas of service users needs for example one care staff said she was due to embark on diabetic and epileptic awareness in the near future. 50 of the staff team had obtained their NVQ level 2 qualification care. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 20 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) 37,38,40,42 and 43. The conducts of the manager created an environment where both service users and care staff were able to feel comfortable and confident in expressing their views and were reassured with the responses offered. This resulted in a stable team of care staff and confident service users. All aspects of health and safety were satisfactorily maintained to ensure the safety and welfare of the service users. EVIDENCE: The manager created a warm and welcoming environment where the service users were able to speak to the manager at any time. There was evidence that an open door policy was in operation and service users were observed going to the manager just to tell him about their days activities or seek reassurance. Care staff also shared the same working station and as a result a united team was evident.
KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 21 The fire procedures in the home were satisfactorily maintained with the exception of some records that showed fire checks were not carried out over a 4-month period. Service users said they received regular fire drills and evacuations. The home had a recent fire inspection from the fire officer that showed that satisfactory fire procedures were in place. Staff also said they received regular fire training. The fire assessment seen needed to be reviewed for 2005. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 22 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 3 3 3 3 3 Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 1 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 2 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
KingsWalden Villas Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x 2 3 I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 23 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 6 Regulation 14 (1) (a) Requirement Arrangements must be made to ensure all service users have a full and comprehensive assessment that identifies their needs. All service users must have a full and detailed care plan that illustrated the care interventions to be carried out for all identified needs. All care plans must be reviewed and updated on a regular basis. Timescale for action Original date: 30.2.05. New date:30.10 .05 Original dates:30.7. 04.30.2.05 new date:30.10 .05 Original date:30.2. 05. new date:30.10 .05 Original date: 30.9.04/30 .3.05. New date 30.11.05 30.10.05 2. 6 15 (1) 3. 6 15 (2) (b) ( c) 4. 28 16 (2) (e) (f) Arrangements must be made for adequate facilities for service users to wash and iron their clothes in a comfotable environment. Arrangements must be made to replace broken furnitures in service users bedrooms where appropriate. Arrangements must be made for sufficient numbers of staff to be on shift at all times especially on 5. 25 23 6. 32 18 (1) (a) original date:30.2. 05.
Page 24 KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 7. 39 24 (1) weekends when all the service users are in the home. The ratio must be 6:1 for service users of medium care needs. Arrangements must be made for a quality monitoring system to be implemented within the home, that reflects effective monitoring of the care provided. new date;30.10 .05 original dates:30.0 9.05/30.03 .04. new date;30.10 .05 8. 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. Refer to Standard 20 42 Good Practice Recommendations All administration of medications should be recorded on the medication administration record sheets. Arrangements should be made to ensure all aspects of fire regulations are upheld by ensuring regular tests are carried out on all fire equipments and records kept up to date to ensure the health and safety of the service users. KingsWalden Villas I51 S14921 Kingswalden Villas V242966 220805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Bedford Office Clifton House 4a Goldington Road Bedford, MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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