CARE HOME ADULTS 18-65 Kinoo Lodge 86 Gladys Avenue North End Portsmouth PO2 9BH
Lead Inspector Ian Craig Unannounced 12 April 2005 9:00 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. Kinoo Lodge Version 1.10 Page 3 SERVICE INFORMATION
Name of service Kinoo Lodge Address 86 Gladys Avenue, North End, Portsmouth PO2 9BH 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) Mrs Bibi Saheyda Keeno and Mr Abdool Taleb Keeno Mrs Bibi Saheyda Keeno Care Home 11 Category(ies) of Learning disability registration, with number of places Kinoo Lodge Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 16/2/05 Brief Description of the Service: Kinoo Lodge provides care and accommodation for up to 11 adults with a learning disability. At the time of the inspection there were 6 residents. The registered persons intend to reduce the homes capacity from 11 to 6. This will involve an application being made to the Commission. The owners, Mr. and Mrs. Kenoo, own the home. They also live on the premises with their family. Staffing is provided by Mr and Mrs. Kenoo, and by memebrs of their immediate and extended family. There is a staff cover for 24 hours per day. The home has links with local health and social service teams for people with a learning disability. The building consists of a conversion of two houses into one property. Communal facilities consist of a lounge and kitchen-dining area. . Kinoo Lodge Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on 12th. April 2005. Commission Regulatory Manager Mr. Andrew McMullen accompanied the inspector, due to concerns raised by the previous inspection report regarding the physical environment, staff recruitment procedures and training for staff. Some of these issues still require action, especially in maintaining an environment that is clean and decorated to a satisfactory standard. Assistance was given throughout the inspection by one of the two owners; the manager was not present. What the service does well: What has improved since the last inspection?
Arrangements have been made for staff to commence NVQ training in September 2005. Residents will be able to have a holiday at Butlins in June 2005. One resident will have a holiday at Blackpool. The individual needs of resident’s have been reviewed by the home in conjunction with social services care managers. Kinoo Lodge Version 1.10 Page 6 The home is improving the opportunities for residents to access local facilities, such as shops and restaurants. Residents described attending various activities in the area, including college courses, trips out with family members, and voluntary work. At the time of the inspection one bedroom was in the process of redecoration. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kinoo Lodge Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Kinoo Lodge Version 1.10 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 standard(s) 2 Whilst individual residents needs were being assessed and reviewed the home could not demonstrate that steps were being taken to meet these needs. EVIDENCE: There have not been any admissions to the home since the last inspection. Records were examined for 4 residents. Reassessments of need have been carried out by social services’ care managers for each resident. The home were involved in the process. There were copies of these assessments in individual resident’s files as well as a copy of the care manager’s care plan. Kinoo Lodge Version 1.10 Page 9 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 and 9 Whilst individual resident’s needs had been reassessed there has been limited progress to show that specific needs and behaviours are addressed in a coordinated manner. EVIDENCE: Case records were examined for 4 residents. Daily running records are maintained for each resident and are in a typed format. These were satisfactory, although many of the entries were repetitive. Each resident has a care plan, which is reviewed on a regular basis. The previous inspection report required that care plans must include details of how specific behaviours should be dealt with. This still needs to be addressed as it was found that where aggression and ‘self harm’ were identified in assessments, the care plans did not give clear instructions for staff to follow, but instead made a generalised remark for staff to interpret. Also, the care plans failed to record how specific identified medical needs should be handled; this is also referred to in the medication standard of this report. The inspectors discussed with one of the owners of the home, the requirement made in the previous report that, specialist resources should be used to assist residents in making choices. The home relies on knowledge about residents’
Kinoo Lodge Version 1.10 Page 10 individual preferences without the use of pictorial diagrams, photographs and other tools. Whilst choice may be available to residents the home is unable to demonstrate this. The benefits of using communication aids were highlighted to the owner of the home. Assessments of risk had been completed for specific activities. The home needs to consider expanding these as they were found to be lacking in specific detail. Kinoo Lodge Version 1.10 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 standard(s) 11, 12, 13,14 and 15 Progress has been made on the provision of leisure pursuits and access to nearby facilities for all residents. EVIDENCE: A resident described attending college courses and social groups, as well as voluntary work. The inspectors were informed that all residents will have the opportunity of a holiday at Butlins in June 2005. A resident has had regular holidays with the Gateway Club in Weymouth and Blackpool. Care plans included details of individuals attending day centres, as well as having designated ‘one to one’ with a staff member from another provider in order to carry out an activity; this is funded by social services. Nearby facilities are accessed by the residents, including restaurants and ‘fast food’ eateries. The home has links with resident’s relatives. These standards will be assessed in greater detail at the next inspection. Kinoo Lodge Version 1.10 Page 12 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) 20 The system of dispensing medication is flawed and has the potential to place residents at risk of receiving incorrect medication, or medication being administered contrary to health guidance. EVIDENCE: Medication is predispensed from pharmacist’s containers into dossett boxes for a week in advance. A record of this is not maintained. The details of the amounts and times medication should be given as recorded on the dossett boxes did not tally with that on the home’s medication recording sheets. Where there was insufficient space in the dossett box for all medication to be held, this was stored at an alternative slot, thereby increasing the possibility of the resident receiving medication at the wrong time. When medication was administered the staff had not entered a signature acknowledging this. The inspectors highlighted the risks associated with predispensing medication, as well as the home’s errors in recording, and strongly advised that a system such as NOMAD or monitored dosage system is used where the pharmacist compiles medication in weekly or monthly boxes. Records showed that the home are carrying out an invasive procedure without a care plan for this and without first obtaining the written agreement of the district nursing team. Kinoo Lodge Version 1.10 Page 13 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) 23 It was unclear if staff knew what steps to follow should there be an occurrence requiring referral to the social services adult protection team. EVIDENCE: The previous inspection report required that staff read the vulnerable adults policy. Unfortunately, the home’s management had confused this policy with a similar policy. Staff had recorded a signature to acknowledge they had read this. The inspectors highlighted that the staff must read the inter agency adult protection policy which refers to procedures for dealing with any suspected abuse. Kinoo Lodge Version 1.10 Page 14 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 Greater attention is needed to maintaining a clean environment, as well as basic tidying, so that the environment could be said to promote residents’ dignity. EVIDENCE: All bedrooms were seen. One vacant room was in the process of redecoration. Bedrooms were untidy, with clothing scattered on chairs and flooring. Bed linen was worn and in need of replacement. Carpet was badly worn in one bedroom. Towels were draped over radiators and chairs in bedrooms; some were not clean and others needed to be replaced. Bedrooms contained some items of personal possession, but in one instance this was totally lacking giving a stark and ‘unhomely’ appearance. There was no bedside lighting in any of the bedrooms. Tables were not provided for residents to work at in their rooms. It is a minimum standard that a table is provided. The first floor bathroom was in a poor state. Toilet roll was not on a holder, but was at least 2 metres from the toilet. A yellow polythene bag of clinical waste had been left there and two face flannels had been left in a bowl on the floor. Curtains or roller blinds are needed on the bathroom window for privacy. The inspectors were informed that all bedrooms will be redecorated.
Kinoo Lodge Version 1.10 Page 15 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) 33, 34, 35 and 36 Staff were not provided in sufficient numbers in order to meet the needs of the residents. Progress is being made to provide staff with training. EVIDENCE: The staff rota was examined. This showed that for one day only one staff member would be on duty from midday until the following morning. The owner stated that the rota was inaccurate. A resident’s assessment by social services stated that additional funding would be provided for extra staff to meet the person’s needs. It was unclear if this had commenced and there was no written agreement as to how many staff hours this would be. In fact, the staff rota showed a reduction from 290 staff hours for the week commencing 31st January 2005 to 172 hours for the week commencing 11th April 2005. The provision of night staff was unclear. Residents’ assessments showed that ‘waking’ night staff are needed. The rota showed staff on duty for certain hours at night and the owner stated that negotiations with social services are ongoing regarding the funding of night staff. There has been an improvement in the maintenance of staff records. These were available and showed that checks were being carried out on staff. Criminal record bureau checks for overseas workers were available from the country of origin, but not from the UK.
Kinoo Lodge Version 1.10 Page 16 Staff are to commence NVQ training in September 2005. There was a certificate to show that staff had recently completed a training course in continence. There were no records to demonstrate that staff receive formal supervision. Kinoo Lodge Version 1.10 Page 17 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, 39 and 42 Whilst the home has sought the views of relatives’ of residents about the service provided, there are significant areas of improvement needed to ensure that care practices and health and safety procedures protect the residents. EVIDENCE: Staffing levels have been considerably reduced for no apparent reason. The owner of the home was unaware that this had occurred. The general upkeep of the home’s interior and office reflected a degree of untidiness. The views of relatives have been obtained by the use of a questionnaire. These were complimentary about the service provided by the home. Letters had also been written to relatives inviting them to a previous Commission inspection. Covers have been installed on radiators to protect residents from possible burns. It was noted that one bedroom window posed a considerable risk as the window opened without the use of a restriction mechanism and was below waist height. The owner stated that this would be addressed with the
Kinoo Lodge Version 1.10 Page 18 representative of the window company who was visiting the home at the time of the inspection. An iron had been left on a radiator cover in the hall and was still plugged in. there was damage to the carpet from the iron being dropped on the carpet. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 x x x Standard No 22 23
ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 x x 2 x Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 2 2 x x 2 Standard No Score Kinoo Lodge Version 1.10 Page 19 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score 3 3 3 3 3 x x 31 32 33 34 35 36 x x 1 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 1 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 2 x Kinoo Lodge Version 1.10 Page 20 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 and 9 Regulation 15 (1) Requirement Care plans must detail the following: how staff deal with behaviour such as aggression and agitation, specfic procedures for administartion of medication where there is an element of body invasion.this is a requiremnt from the previous inspection report. Previous timescale 31/5/05 Risk assessments must include sufficient detail so that the reader can ascertain any safety measures that need to be taken to protect the resident.l Residents need to have specialist resources available to enable them to make choices about their care e.g. meal times, holidays, and activities e.g. picture diaries or object of reference libraries. This is outstanding from the previous report. Previous timescale 31/7/05 Residents bedrooms must redecorated on an ongoing basis and bedrooms must be appropriately personalised. Bed linen and towels must be replaced where worn. This is
Version 1.10 Timescale for action 12thJuly 2005 2. 7 12 (1) (a) (3) 12 th. september 2005 3. 26 16 (1) and 23 12th. September 2005 Kinoo Lodge Page 21 4. 30 16 5. 20 13 (2) 6. 23 13 (6) outstanding from the previous report. Previous timescale 31/5/05. Carpets must be replaced where worn. Residents must be supplied with a table and chair if they wish. Bedside lighting must be provided where residents wish to have this, unless risk assessments show this as a potentail hazard where consideration should be given to overhead wall lights that are not made of glass. Clinical waste must be appropriately disposed of in accordance with health and safety legislation. the home must be kept tidy. this is outstanding from the previous inspection report. Previous timescale 31/3/05. The person administering medication must sign a record at the time carying out this action. The home must review the system of predispensing medication into dossett boxes. Records of predispensing must be accurate. Specific procedures for medication requiring an element of body invasion must be recorded. Written confirmation from the district nurse must be obtained before this takes place; this must include written agreement and consent as well as confirmation that the district nurse is satisfied that named individuals are competent to do this. All staff must read the most relevant sections of the local social services vulnerable adult protection procedure, including care practices, abuse and reporting. This is outstanding from the previous reort. Previous timescale 31/3/05
Version 1.10 30th june 2005 12th. june 2005 12th July 2005 Kinoo Lodge Page 22 7. 33 18 (1) (a) 8. 36 18 (1) 9. 10. 34 42 19 13 Written confirmation must be sent to the Commission of the agreemnt with social services for funding for additional staff. This must detail how many additional hours per week are being funded and the start date. Written confirmation must also be sent to the Commission of the negotiations with social services for waking night staff. Staffing levels must be increased to levels sufficient to meet the needs of the residents and to levels at least the equivalent as that being provided the week commencing 31/1/05. Staff must receive formal supervision at least 6 times per year. this is outstanding from the previous inspection report. Previous timescale 31/5/05. All staff must have a criminal record bureau check from the United Kingdom. Measures must be taken to protect residents from the possibilty of falling from first floor windows. Hot irons must not be left unattended. Ironing must only take place in a safe area. 30th July 2005 30th June 2005 30th. june 2005 30th. May 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. Refer to Standard 14 Good Practice Recommendations The home needs to be able to demonstrate that residents can choose their holidays and leisure activities. Whilst it is appreciated how difficult this can be, the managers must be able to show how activities and money are chosen and used. Such activities must be individualised and appropriate. this is outstanding from the previous
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