CARE HOME ADULTS 18-65
Kingswalden Villas 40 The Baulk Biggleswade Bedfordshire SG18 0XS Lead Inspector
Dragan Cvejic Unannounced Inspection 6 February 2006 13:30
th Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kingswalden Villas Address 40 The Baulk Biggleswade Bedfordshire SG18 0XS 01767 318674 01767 318674 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.hft.org.uk Home Farm Trust Mr Ian Chambers Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 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 towns 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 DS0000014921.V281821.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by the inspector Dragan Cvejic. The inspection was carried out from 13.30 to 17.30 and within that time all service users were seen upon their return to the home from daily activities. Two service users provided evidence for this report, demonstrating the final outcome of the care process. The outcomes, as presented by service users, were confirmed by two staff, who also provided extra information and were observed working with service users. This inspection was carried out focusing entirely on the outcomes, comments and perception of service users and no documents or paperwork were inspected. What the service does well: What has improved since the last inspection?
The home worked hard to meet the requirements set on the last inspection. Service users commented that in their opinion the assessment was full and comprehensive and covered all areas that needed to be covered. The staff
Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 6 added that the assessment of service users was full now and that findings were incorporated in care plans. Three service users stated that their care plans were appropriate and written down as they wanted and that reviews were regular. An acting senior worker stated that there was a new time-scaled plan to review care plans regularly. Although the laundry room was located in a separate building, three service users stated that they did not have any problems using it there and that ironing was done in the more comfortable and warmer conservatory, which was a part of the main building. Broken furniture in users’ rooms was replaced. Medication records were now accurate and better monitored by the acting senior staff, to reduce the risk of mistakes. All staff were discussing the fire arrangements and, although the best solution had not yet identified, the review process of this procedure was to be taken further and the fire service was going to be invited to provide advice and training to staff and to service users too. What they could do better:
Service users identified the areas for improvement and presented them to the inspector. They included the atmosphere in the home, as there was a communicative barrier between 4 more able and 3 less able service users. Two service users stated that they did not find it easy to share all aspects of home life with those with limited abilities. Frustration was high and one service user in particular found it difficult up to the point that she was considering moving out. The staff were aware of this issue, but did not have a specific plan on how to overcome this situation and improve users satisfaction. The home still did not have the arrangements for a quality assurance review or a system for monitoring quality of services and provisions, despite the repeated requirements set on the previous inspections. Three service users spoken to stated that in their opinion the staffing level was not always satisfactory and identified weekends as one of these periods. This issue was also addressed on previous inspections, but there was no visible improvement in this area. The staff spoken to admitted that there were short periods during their shifts when another member of staff was needed, even for a short period of time, to cover a peak period. They continued by expressing their concerns with the low speed of the recruitment process, mainly dictated from the senior management level of the Trust. An example was a long ongoing acting up position of the senior staff member. The home still has to find the most effective fire procedure, where evacuation should be focused on. Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 7 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 DS0000014921.V281821.R01.S.doc Version 5.1 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 Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 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 the following standard(s): 2,3 Service users were happy with the information given to them, and with the assessments that they considered comprehensive and appropriate. EVIDENCE: A service user stated that staff supported her in obtaining all the information she needed to make an informed choice of home. Three service users stated that their needs were properly assessed. They confirmed that their preferences and likes and dislikes were taken into account when care plans were devised. Service users assessed the home’s success in meeting their needs. They stated that their needs were met and that the staff considered their wishes and individually set goals. Staff demonstrated during the observation that they were meeting users’ needs. Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 Service users were proud that they were creators of their care plans and influenced what was in them. Their participation in life in the home was significant, made them confident and promoted their independence. EVIDENCE: Three service users stated that they were asked and were the main creators of their care plans. They confirmed that they signed the plans and understood the goals and actions recorded in plans. Two users stated that care plans covered all essential needs and were not too long and did not omit any necessary staff input. They also stated that their key-worker’s input was very good when the plans were structured. Two staff members stated that care plans were improved since the last inspection and that the requirements to address the actions were now recorded. They continued confirming that care plan reviews were now regular. All service users and staff confirmed that users were encouraged to make decisions and respected what they decided. Service users stated: “We decide what we want during our meetings and then present that to staff.” A service user who let the inspector in showed how she was making decisions, thinking of safety and properly assessing situation.
Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 11 Service users discussed in detail risk taking when daily life in and out of home was discussed. Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 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 the following standard(s): 11,12,13,14,15,16,17 Service users were fully in control of daily life in the home and their preferences were fully respected and taken into account when decisions were made. EVIDENCE: Service users explained in detail their daily programmes which illustrated how their personal development fitted into home’s philosophy. Four service users were working in addition to their educational programmes. Their activities determined the high level of their connections with community. Two service users were members of community clubs and had a number of friends in the community. Two users were using the train independently to get to college. All users spoken to stated that they had chosen leisure activities that suited their aspirations and enjoyed the choice Two service users built a close relationship between them and one user had a relationship with a friend outside the home. Service users explained how they chose the menu and decided on house chores. A service user stated how she made her pack lunch and sandwiches and another service user was observed cooking with staff support. Two
Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 13 vegetarian users confirmed that their dietary needs were met and their preferences were respected. Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 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 the following standard(s): 18, Service users were supported to be in control over their health care and the staff were involved where needed to ensure safety and to avoid gaps in healthcare issues. EVIDENCE: Service users confirmed that they were helped in the way they wanted. They stated that their privacy and dignity were fully respected. As they dictated their care planning, the daily routine recorded in plans was the result of users’ preferences. Service users commented that they were receiving any specialist health services through day centres they attended. Three service users stated that they relied on their key-workers regarding all needs that required extra support. The home promoted independence through allowing capable service users to hold their medication. A self-medicating user proudly stated that she was in control of her medication, including insulin. The staff periodically checked the amounts of medication the users held, to ensure safety. Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 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 the following standard(s): Service users confirmed that they knew where and how to complain, but the standards were not fully inspected. EVIDENCE: Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 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 the following standard(s): 24,28 The home continued to provide a pleasant and homely environment, created and arranged with major service users’ involvement. EVIDENCE: The home was suitable for its purpose and provided a comfortable environment for service users to live in. The home was clean and bright at the time of the inspection. The location of the home allowed easy access to local amenities. Furnishing in communal areas was appropriate. Shared spaces provided an environment controlled by service users. One user had just returned back to the home from a shopping trip with a staff member to choose and buy renewal items for communal areas. Laundry room was still based in a separate building located in the garden. Service users stated that they did not mind using the laundry room there, especially since they had started using the conservatory for ironing, where it was much warmer than in the laundry room. Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,36 Staff were competent and determined to meet the users’ needs. There was, however, a period when the number of staff on duty was not sufficient. EVIDENCE: Service users stated that the staff rota was stable and that staff knew their roles and responsibilities. Staff spoken to also confirmed that they were clear about what was expected from them. They were aware of their limits and when external professionals needed to be involved. Service users stated that sometimes one member of staff on duty was not enough. Both staff and service users commented that training was appropriate. Service users considered staff to be well trained and knowledgeable of methods to meet their needs. Staff worked as a team, but admitted that there were peak periods when one staff member on duty was not sufficient to meet the users’ needs. The recruitment process was slow and affected staff morale, although their determination to meet the users’ needs prevailed and ensured users were not affected by staff recruitment issues. The example was a senior worker that had been in an acting position for more that 6 months. Staff were supportive of each other, both in an informal and formal way, through regular supervision and staff meetings. Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 The fire safety of service users was not ensured with the current evacuation procedure. EVIDENCE: The service users felt safe in the home. They considered that staff support was appropriate to their needs, and techniques used by staff were appropriate. However, all three service users and two staff commented on the effectiveness of the fire evacuation procedure that would not ensure safety for all service users. Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
Choice OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 X STAFFING Standard No Score 31 2 32 3 33 1 34 2 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X X X X X X X 1 X Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 20 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 YA28 Regulation 16 (2e) (f) Requirement Arrangements must be made for adequate facilities to be provided for service users to wash and iron their clothes in a comfortable environment. This is an outstanding requirement from the previous inspection. The home must produce an action plan to address this requirement in a timely manner. Arrangements must be made for sufficient numbers of staff to be on shift at all times especially on weekends when all the service users are in the home. The ratio must be 6:1 for service users of medium care needs. This is a requirement set on the previous inspection. The organisation must review the staffing level and respond with a plan on how to address this shortfall identified by staff and service users too. Arrangements must be made for a quality monitoring system to be implemented within the home, which reflects effective monitoring of the care provided.
DS0000014921.V281821.R01.S.doc Timescale for action 31/03/06 2. YA32 18 (1) (a) 31/03/06 3. YA39 24 (1) 31/03/06 Kingswalden Villas Version 5.1 Page 21 4 YA42 23(4) This was a requirement set on the previous inspection, but was still not met. Extended time scale is now set. Arrangements should be made to 31/03/06 ensure all aspects of fire regulations are upheld by ensuring regular tests are carried out on all fire equipment, and records kept up to date to ensure the health and safety of the service users. This was a recommendation set on the previous inspection, but due to inactivity, is now set as a requirement. The home must produce an effective evacuation procedure in agreement with the fire officer to ensure better safety and protection of service users. 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 YA2 Good Practice Recommendations The home should produce an action plan to address how the service users with different level of abilities could live together in a friendly and homely atmosphere. Kingswalden Villas DS0000014921.V281821.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area 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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