Inspection on 13/12/05 for Kingswood House

This inspection was carried out on 13th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingswood House 21/10/08

Kingswood House 23/10/06

Kingswood House 12/06/05

Kingswood House 10/11/04

Kingswood House 15/06/04

Kingswood House 16/07/02

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

CARE HOME ADULTS 18-65 Kingswood House 21 - 23 Chapel Park Road St Leonards On Sea East Sussex TN37 7HR Lead Inspector Liz Daniels Unannounced Inspection 13th December 2005 11:15 Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 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 Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 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. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kingswood House Address 21 - 23 Chapel Park Road St Leonards On Sea East Sussex TN37 7HR 01424-716303 01424-423737 master1410@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Deirdre Hogan Mr Abraham Hogan Mrs Deidre Hogan Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum number of service users to be accommodated is twentythree (23) The service is for users thirty (30) years and over with continuing mental health care needs 12th June 2005 Date of last inspection Brief Description of the Service: Kingswood House is a 23 bedded home in St Leonards-on-Sea, situated approximately a quarter of a mile from both the railway station and the seafront. The Home is able to admit people aged 30years or above and it specialises in supporting those with enduring mental health problems who require 24 hour nursing care. A range of shops is within easy walking distance and there is a nearby drop-in support centre for people with mental health problems. Kingswood House caters for diverse needs and promotes a lifestyle that supports residents to integrate into the community. Many are referred by forensic social workers. The Registered Manager who is also a part owner, is on shift during the day and qualified nurses take charge in her absence. The Home has steps up to the front entrance but also a sloped pathway and level access throughout the building, enabling wheelchair access. There is a passenger lift to all floors. The Home has 7 shared and 8 single rooms, all of which meet the space requirements laid down in the National Minimum Standard. Two lounges and a dining room provide communal space inside and at the back of the Home there is a patio area and large raised garden that can be accessed from both the dining room and the “smokers’ lounge”. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a period of five and a half hours beginning at 11.15am. The Inspector met with the Registered Manager and two other staff. There was the opportunity to look around the Home and meet with several of the residents informally before chatting in more detail with three residents. A range of documentation and key records was then inspected. This report should be read in conjunction with the report from the first inspection this year, on 12th June 2005. What the service does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User guide need to be updated to reflect the change from the NCSC to the Commission. Resident’s particular interests or hobbies should be identified as part of the pre-admission assessment and reflected in their care plans. The Home struggles to engage residents in activities but they must continue to explore different alternatives and provide Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 6 opportunities for structure in the residents’ day. Thorough recruitment checks must be in place. Two written references must be obtained before appointing a member of staff and proof of ID including a photo must be kept on file. A copy of the Terms & Conditions of posts and the appropriate Job Description should also be retained on file. 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. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 There is a comprehensive Statement of Purpose available, enabling a prospective resident to make an informed choice about the services available at Kingswood House and its suitability for them. They need to be updated to reflect the change from the NCSC to the Commission. Good practise is in place by ensuring all residents are aware of their Terms & Conditions of residency and good information about advocacy services is available. EVIDENCE: Kingswood House has a Statement of Purpose, which sets out the aims and objectives of the Home and the philosophy of care that is offered. Details of how complaints and concerns are managed and how to access advocacy services are included. The number of residents catered for and the categories of registration are also incorporated. There is a Service User guide providing a summary of the information in the Statement of Purpose. This and a Service User guide Statement of Terms & Conditions are given to each resident on arrival. The resident then signs and dates their terms of residency, indicating that they agree with them. The documentation makes reference to the NCSC. When an enquiry is made to the Home, prospective residents are invited to visit to view the available rooms and discuss the Home’s suitability. The Manager undertakes an assessment either at Kingswood House or in the resident’s current accommodation. Any preferences of specific minority ethnic communities or cultural/religious needs are explored as part of the assessment. If it appears the Home is suitable and can meet the needs of the resident, they are then encouraged to visit and stay for periods, extending Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 9 overnight if possible. The Registered Manager and other owner are both trained nurses in mental health; the other trained staff that are employed are general nurses with experience gained over several years at Kingswood House. All residents that are admitted have been diagnosed with mental health needs and some do have addictive behaviour - the Home requires a commitment from the resident to work in reducing that addiction. This discussion and agreement is part of the pre-admission assessment process. The agreement is then documented and the resident asked to sign, to demonstrate their aim to comply. The Home aims to take residents for long-term placement with rehabilitation rather than short-term care. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 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 Staff respect the rights of residents, encouraging them to make choices and decisions. Limitations and restrictions are only put in place if the individual is at risk to themselves or others. Individual interests, hobbies and emotional needs must be reflected in the resident’s care plans. EVIDENCE: Each resident has a file containing their personal details; a history prior to admission, risk assessments and a care plan identifying their individual needs are also included. The care plans prescribe the care required to ensure all aspects of health, personal and social needs are met. They are specific in detailing how each individual needs assistance and what care they are not able to provide for themselves. A daily record is then maintained detailing specific care or activities for each individual. Some residents belong to clubs and the inspector witnessed residents coming and going as they chose, on the day of inspection. Staff confirmed that restrictions are only put in place if it is in the resident’s best interest because they are at risk to themselves or others: where at all possible, there is negotiation and agreement, enabling residents to make decisions about their lifestyle. Individual hobbies and interests were not evident in the care plans and admission assessment. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 11 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): 12, 13, 15 and 16 Kingswood House struggles to engage residents in activities but they must continue to explore different alternatives and provide opportunities for structure in the residents’ day. Particular interests or hobbies should be identified as part of the pre-admission assessment. The Home works hard to encourage residents to go out with friends and also welcomes friends or relatives in joining in with meals and events. The staff recognise the importance of ensuring individual needs and beliefs are met, offering choice and flexibility for the routines of daily living. EVIDENCE: Currently no residents at Kingswood House have jobs, but two residents attend vocational classes to support them in developing life-skills. The Home endeavours to provide recreational activities but staff reported that uptake is poor. All the residents have been given an “Activity Interests” questionnaire to complete, meeting the Requirement from the last inspection. Unfortunately there was minimal response. A notice promoting the Home’s Christmas party was on display on the day of inspection and, as residents had previously identified they’d like an outing, a trip to Sea World had been arranged in September, which was well attended. The difficulty with engaging residents in activities was discussed as younger residents in particular, who enter the Home, need activities and the chance to have some structure in their day, to Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 12 support their long-term rehabilitation. The Manager aims to identify individual interests as part of the pre-admission assessment, with a view to planning particular activities. Individuals are encouraged to pursue hobbies - the inspector was shown one room belonging to a resident who has a keen interest in artwork. The room was personalised and reflected his interest. Many of the residents do not have family or relatives who are local, but the Home encourages visitors at any time. Friends or relatives are welcomed for a meal or to join in with any events that have been organised. The Manager recounted examples of how the Home supports individuals in going out and spending time with friends, but at the same time ensuring their safety. One resident explained that he regularly meets with a friend at the week-ends and shares a meal out with him. On the day of Inspection the atmosphere within the Home appeared happy and comfortable. Residents were choosing to spend time either in their own bedroom, in one of the two lounges, or they had chosen to go out into the town. During the tour of the Home, the Inspector witnessed the staff treating the residents with dignity and respect. All the rooms have locks and if appropriate following an assessment, residents have their own key. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 13 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, 19 and 20 Staff are flexible and sensitive in the way they support residents, treating them with respect and maintaining their privacy. Health care needs appear to be met well and good practises are in place for the ordering, administration and disposal of medication. EVIDENCE: All the residents have a plan of care that identifies the areas of support or assistance that each individual needs. During the inspection residents were seen to be wearing their own clothes and reflecting their own personality. Residents are assisted with personal care if it has been assessed as being necessary. For those residents who are independent, the staff informally monitor how they are caring for themselves. If their ability changes they are then re-assessed and the level of intervention is increased as necessary. Personal care is given in the privacy of an individual’s room or in the bathroom. All the residents have a key worker who they know and are happy with, and who oversees their plan of care. The Manager explained that where possible, residents are encouraged to choose their own bed linen and furnishings and that those who have previously enjoyed cooking are encouraged to do some baking with the staff, as they wish. There are set mealtimes within the Home but that can be flexible if there is a particular need. Residents are asked to inform the nurse-in-charge if they wish to be out over mealtimes or prefer to take their meal at a different time. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 14 The Inspector found that health needs were reflected in two of the care plans seen. The staff within the Home were managing these, but the Manager confirmed that health professionals are accessed as necessary and residents are accompanied to hospital appointments if needed. Residents are asked on admission as to whether they wish to administer their own medication or whether it is more appropriate for them to hand over the responsibility to the Home. If they wish to self medicate, a Risk Assessment is undertaken. Currently there are no residents who self medicate. The medication for the Home is kept in locked cupboards in the clinical room. All the medication is stored in measured doses for a 4-week period. The medicine charts were seen and were correctly maintained. The medication is administered by the Nurse-in-Charge. A Waste Management Company will be disposing of the unwanted medication but the Home is currently waiting for them to supply the appropriate container. Meanwhile all the unwanted medication has been locked in a separate cupboard until the container arrives. The Manager was advised that it is good practice for two staff to sign once medication is ready for disposal. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 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): Neither of these standards were assessed at this inspection. Please refer to the report from the inspection on 12th June, when both key standards (22 and 23) were assessed. EVIDENCE: Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 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, 25, 28 and 29 The accommodation at Kingswood House is appropriate, comfortable and safe for the residents that are there, although it is now showing signs of wear and tear. However, the current re-decoration and re-furbishing programme has been well planned to cause minimal disruption to the residents. This meets the Requirement from the last inspection. EVIDENCE: Kingswood House provides accommodation for up to 23 residents. On the ground floor there is a lounge for those who prefer not to smoke and another lounge for smokers. There is also a dining room and a kitchen. There are then bedrooms on the first and second floor. All floors are serviced by a shaft lift, enabling access for those with limited mobility. The Home is currently undertaking a major refurbishment programme and the lift is scheduled to be replaced as part of that. The ground floor carpeting has been removed and a wood type floor has been laid. Curtains in all the bedrooms have been replaced and the vanity units are being renewed. Redecoration of some bedrooms has already been completed and once the work has been finished the furniture in the bedrooms will be replaced. Residents are being asked if they are happy to move for short periods as necessary to enable their rooms to be upgraded. Residents are given the opportunity to have a single room if available or to share with another resident in a double room. All the rooms seen had Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 17 evidence of personal possessions. However, some residents appear to spend more time in their rooms and have their own television, music centre and kettle, whilst others apparently prefer to use the facilities in the communal areas. There are toilets and two bathrooms in the Home: one bath has a ‘Parker’ bath enabling assisted bathing for those who are less mobile. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 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 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): 34 and 36 Thorough recruitment checks must be in place. Two written references must be obtained before appointing a member of staff and proof of ID including a photo must be kept on file. A copy of the Terms & Conditions of the post and the appropriate Job Description should also be retained on file. There is a good programme of staff supervision in place. EVIDENCE: Two staff files were reviewed and the Inspector then also met with those two staff. One staff member who is a trained nurse in her own country, had been recruited as part of a rolling programme, to work as a carer for approximately six months prior to undertaking her adaptation training at a local nursing home. Verbal references had been received prior to appointment and copies of identification had been retained on file. A copy of the Terms & Conditions of the post and the Job Description were not evident. A copy of the police check for the carer’s own country was on file. The other staff member had been in post for several years. There was evidence of a CRB disclosure and records of verbal references obtained: a set pro-forma had been used, and standard questions asked over the ‘phone. A record had been made of all the referee’s answers. The Manager confirmed that although requests for written references are sent out, they are often not returned. It was agreed a copy of the reference request and the date it was sent, would be kept on file. There was no photo on file. Supervision records were examined. These are held with each member of staff every 2 months and used as an opportunity to discuss issues within the Home Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 19 and each staff member’s progress. Both the supervisor and the staff member then sign the record. Both staff who met with the Inspector acknowledged that they appreciate their supervision sessions and see them as an opportunity to discuss any learning needs and to share ideas about the care and services provided for the residents. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 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 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): None of these standards were assessed at this inspection. Please refer to the report from the inspection on 12th June, when a selection of standards, including the key standards, was assessed. EVIDENCE: Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 21 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 X 3 X x Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x 2 X X x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X X 3 3 X LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 2 X 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Kingswood House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000014007.V273775.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 16 (m)(n) Requirement Individual interests, hobbies and emotional needs must be reflected in the resident’s care plans. Thorough recruitment checks must be in place. Two written references must be obtained before appointing a member of staff and proof of ID, including a photo, must be kept on file. Timescale for action 31/03/06 2. YA34 19 Schedule 2 (1)(5) 31/03/06 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. Refer to Standard YA1 YA14 YA34 Good Practice Recommendations The Statement of Purpose & Service User guide both need to be updated to reflect the change from the NCSC to the Commission. Particular interests or hobbies should be identified as part of the pre-admission assessment. A copy of the Terms & Conditions of posts and the appropriate Job Description should be retained on file. Kingswood House DS0000014007.V273775.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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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