Inspection on 19/10/05 for Kinoo Lodge

This inspection was carried out on 19th October 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kinoo Lodge 18/06/07

Kinoo Lodge 30/06/06

Kinoo Lodge 12/04/05

Kinoo Lodge 16/02/05

Kinoo Lodge 13/09/04

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

CARE HOME ADULTS 18-65 Kinoo Lodge 86 Gladys Avenue North End Portsmouth Hampshire PO2 9BH Lead Inspector Ian Craig Unannounced Inspection 19 October 2005 09:00a Kinoo Lodge DS0000011738.V254098.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 Kinoo Lodge DS0000011738.V254098.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. Kinoo Lodge DS0000011738.V254098.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kinoo Lodge Address 86 Gladys Avenue North End Portsmouth Hampshire PO2 9BH 023 9261 4219 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 Bibi Saheyda Keeno Mr Abdool Taleb Keeno Mrs Bibi Saheyda Keeno Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Kinoo Lodge DS0000011738.V254098.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th April 2005 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 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 members 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 DS0000011738.V254098.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector was assisted by the home’s manager, Mrs. Keeno. Three residents were briefly spoken to during the visit. Residents have specific communication needs, that limits the extent of any interviews. What the service does well: What has improved since the last inspection? The home was found to be a great deal tidier than found at the previous inspection, although this still needs to addressed further. A ‘Person Centred Planning’ approach to assessing needs and recording care plans has been introduced. The system of administration of medication has been improved as required by the previous report. Improvements have been made to the home’s physical environment. One bedroom has been redecorated since the last inspection and the windows have been replaced. Staffing levels have been increased, but mainly, as a result of the two owners working in excess of 100 hours per week each. Night time staffing has also been improved. The home plans to recruit additional staff in the near future. A criminal record bureau check has now been obtained for each staff member. Formal supervision of staff has been introduced, although records of supervision sessions are not maintained. Kinoo Lodge DS0000011738.V254098.R01.S.doc Version 5.0 Page 6 What they could do better: 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. Kinoo Lodge DS0000011738.V254098.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 Kinoo Lodge DS0000011738.V254098.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): 2 Resident’s needs are assessed on a regular basis by the social services day centre, care manager and by the home. EVIDENCE: The home has communication links with the local social services care management team and with community day centres who are involved with the residents. Copies of the social services reviews were held with each resident’s records as well as day service reviews. Kinoo Lodge management attend these reviews. The home also updates its care plans on an annual basis. The assessment of risk for certain activities requires attention to ensure risks are minimised (this is referred to in more detail in Standards 6 and 9). Kinoo Lodge DS0000011738.V254098.R01.S.doc Version 5.0 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 the following standard(s): 6, 7 and 9 Progress has been made in developing the care planning system by the introduction of ‘Person Centred Planning.’ Assessments of risk need to be in greater detail and care plans expanded to show how the staff deal with behaviour. Whilst the home’s manager has a thorough knowledge of the needs and preferences of individual residents communication with the residents could be improved by the use of pictorial diagrams, notice boards, photographs etc. EVIDENCE: At the time of the inspection the manager was in the process of recording a ‘Person Centred Planning’ care plan for each resident. These are focussed on the preferences, needs and wishes of the individual and represent an improvement on the previous care plans. Personal care, activities, food preferences etc are included in the care plans. The manager described in detail how specific behaviours are handled, such as aggression. These were not recorded in the detail as described by the manager. Where residents undertake activities involving elements of risk, an assessment had been completed and recorded. For one activity of going out alone there was an assessment that highlighted areas of risk and how staff should remind the person of road safety. The inspector suggested that this needs to be Kinoo Lodge DS0000011738.V254098.R01.S.doc Version 5.0 Page 10 assessed in greater detail as the care manager’s assessment stated that support was needed regarding road safety and the records showed areas of concern for road safety, but the person was going out unaccompanied. A requirement was made in the previous report for the home to develop communication aids for the residents. At this inspection the home were found to be using photographs to help residents choose meals. This needs to be developed further. For instance, pictorial diagrams to help residents understand their care plans, complaints procedure, plus displays of photographs and diagrams on notice boards to let residents know about staff, events etc. Kinoo Lodge DS0000011738.V254098.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): 11, 12, 13, 14, 15, 16 and 17 Residents have a full and varied lifestyle, including opportunities for social, occupational, social and recreational activities. These include making use of local facilities and time spent with relatives. A varied and nutritious diet is provided. EVIDENCE: Residents have opportunities for developing personal skills at local day services where educational and craft classes are provided. Some of the residents attend the local day services 5 days per week. Copies of day service reviews are held with each resident’s records and these show that the home is involved in review meetings. Residents attend a variety of social clubs, including evening and afternoon clubs. One resident takes part in activities at a local church, which includes working in the kitchen. The hobbies and activities of each resident are detailed in the care plans. The manager was able to describe in detail the schedule of activities for each person. At the previous inspection, the home’s management stated that each resident will have the opportunity of a holiday at Butlins in June 2005; whilst some of the residents have had a holiday with the Gateway club the Butlins holiday has not taken place. Kinoo Lodge DS0000011738.V254098.R01.S.doc Version 5.0 Page 12 Residents have regular contact with relatives. Choice in food is available to the residents by the use of photographs. The home does not have a menu plan but maintains a record of each meal, including individual diets. This showed a varied and nutritious diet. At the time of the inspection three residents were eating a lunch of sandwiches, crisps and cake. More substantive meals are provided in the evening such as curry, chilli con carne and roast dinners on Sundays. Kinoo Lodge DS0000011738.V254098.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 Residents receive assistance and support with personal care. The home arranges for resident’s healthcare needs to be addressed via the health service etc. Medication procedures have improved and are now satisfactory. EVIDENCE: Each resident’s health care needs are recorded. This includes details of the support needed plus the abilities of the person. Specialist health care needs are addressed with residents receiving input from general practitioners, dieticians, opticians and dental services. A record of appointments with health professionals is maintained in the daily running records. The inspector advised that a separate record in a table format would allow the home to monitor the need for check ups more easily. Each resident’s weight is monitored and a record maintained. The home has adopted a new system of administering medication in the form of a NOMAD system, whereas the medication was previously predispensed from pharmacist’s containers into dossett trays. Examination of the medication containers and medication administration recording sheets showed the procedures were satisfactory. There has been liaison between the home and the district nursing team and community learning disability team regarding the administration of rectal diazepam. Written confirmation from the community learning disability team Kinoo Lodge DS0000011738.V254098.R01.S.doc Version 5.0 Page 14 showed that training in this will be provided in the future. In the meantime the home has refrained from the practice. Procedures for staff to follow in contacting emergency health services are recorded. The home’s written procedure for the receipt, recording, administration, handling and disposal of medication need to be amended as it reflects the previous system of predispensing. As the manager agreed to complete this, it is not a requirement. Kinoo Lodge DS0000011738.V254098.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): 22 and 23 Residents have a copy of the home’s complaints procedure. The home has a copy of the local authority adult protection procedure and the system of handling resident’s finances is secure with one slight exception, which is detailed below. EVIDENCE: Copies of the complaints procedure are held in each resident’s bedroom. This is in a written format that residents would not be able to read. As previously referred to, the home should consider the use of pictorial diagrams, which may help residents in understanding the procedure. A copy of the latest local authority adult protection procedure is available in the office. The manager stated that staff are aware of the procedure. The inspector was not able to check this as there were no staff on duty at the time of the visit with the exception of the two owners, one of whom is also the manager. The home handles the finances of the individual residents. Records had been maintained of each of the transactions made. There was a lack of clarity as to whether the resident’s bank accounts are jointly in the names of the resident and the home’s manager or solely in the name of the resident with the home’s manager included as a counter signatory. The inspector explained that this should be checked and that the latter of the two arrangements is much more preferable in providing security for residents’ bank accounts. Kinoo Lodge DS0000011738.V254098.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, 26, 27 and 30 There have been a number of improvements to the home’s environment, such as the redecoration of a bedroom, but there is also a need to address tidiness, lack of bedroom facilities and window safety; all of which were requirements in the previous report. EVIDENCE: The previous report required that areas of the home are kept tidier, including the disposal of clinical waste. At this inspection the home was found to be cleaner. Clinical waste had been disposed of and bedrooms were much tidier. Communal areas still contained piles of leaflets, letters and paper on surfaces of furniture and in corners of the dining room. The office was also in need of attention. For instance numerous items were left discarded on the floor including a battery, an empty medication bottle, cotton wool, leaflets, a dental appointment card, a 2p coin, carrier bags and so on. At the time of the inspection, scaffolding had been erected on the exterior for repairs and the dining room was being redecorated. One bedroom has been redecorated since the last inspection and the home plans to extend this to other rooms in the near future. Bedrooms were clean and tidy. Bedside lighting was not provided even though this was a requirement in the previous inspection report. The manager explained that this will be provided once redecoration takes place. In the view Kinoo Lodge DS0000011738.V254098.R01.S.doc Version 5.0 Page 17 of the inspector there is no reason why the bedside lighting cannot be installed before this. Tables are not provided in bedrooms. The manager stated that none of the residents wish to have a table in their bedrooms, as they prefer to use the communal facilities. The inspector advised that a record should be made where a resident does not wish to have a table in their bedroom, as this is a minimum standard. Toilets and bathrooms are clean and tidy. A privacy blind or curtain has not been installed on a bathroom window. Since the last inspection new windows have been installed, which, according to the owners, should have resulted in windows with restrictors to prevent any risk of falls from first floor windows. The window restrictors are easily disengaged which leaves them as a risk to residents. Radiator covers and water temperature controls have been installed to prevent any possible burns to residents. Kinoo Lodge DS0000011738.V254098.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): 33, 34, 35 and 36 The owners are considering recruiting additional staff from overseas which will help reduce the excessive hours worked by the owners. A staff rota was not available for the 3 weeks preceding the inspection. Suitable checks are made on staff working in the home. Staff receive an induction, but there is a need for additional staff to complete NVQ level 2. A contract of supervision is drawn up with each staff member, but there was no record of supervision taking place. EVIDENCE: The last available staff rota was for the week commencing 26/9/05 which showed the provision of 334 staff hours. This is an increase from the 172 hours provided when the home was last inspected. This has been achieved by the owners working 112 hours each per week. This is excessive, and whilst residents spend many hours at day time activities, must be considered as having a detrimental effect on the performance and health of the owners. Night time staffing has been improved and the home now has a ‘waking’ staff member on duty from 9pm to 7am the following day. At the time of the inspection the owners were on duty for 3 residents, all of whom went out to activities after the midday meal. A staff rota was not available for the three weeks preceding the inspection. The manager discussed the possible recruitment of additional staff. Criminal record bureau checks had been completed and were available for each staff member. Kinoo Lodge DS0000011738.V254098.R01.S.doc Version 5.0 Page 19 It was identified that additional staff need to undertake NVQ level 2 training as only one of the owners has this. The manager stated that the new staff she is considering employing will have NVQ equivalent qualifications. Contracts of supervision have been signed by the manager and employees, and there is a policy on staff supervision. There were no records to show that staff had received supervision. The inspector advised that a pro forma is devised to record the content of supervision. This will be checked at the next inspection. Kinoo Lodge DS0000011738.V254098.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): 37 and 42 The manager is studying NVQ level 4. Health and safety precautions are satisfactory with the exception of the windows being a possible risk. EVIDENCE: The manager is completing the NVQ level 4 in care and management. Training certificates were available to show that each staff member has received training in first aid, food hygiene and moving and handling. Four staff have completed a course in infection control. Records showed that fridge temperatures are monitored. Service certificates and the fire log book showed that the fire safety equipment is serviced and tested as required. The gas heating is serviced on an annual basis by an appropriately qualified engineer. The situation regarding the first floor windows has already been referred to. Kinoo Lodge DS0000011738.V254098.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 X X 3 X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 3 X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 2 3 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Kinoo Lodge Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 2 X DS0000011738.V254098.R01.S.doc Version 5.0 Page 22 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 YA9YA6 Regulation 15(1) Requirement Care plans must detail how staff deal with behaviour such as aggression. Risk assessments must be carried out in greater detail for activities such as going out alone, using public transport alone and road safety. The above are outstanding from the previous report. Bedside lighting must be provided where residents wish to have this, unless risk assessments show this to be a potential hazard where consideration should be given to overhead wall lights that are not made of glass. This is outstanding from the previous report. The home must be able to demonstrate that residents have been offered a table and chair. Curtains or blinds must be installed on the bathroom window for privacy. The home must be kept tidy. This is outstanding from the previous report. The home must maintain a staff DS0000011738.V254098.R01.S.doc Timescale for action 30/11/05 2 YA26 16 and 23 30/12/05 3 4 5 YA27 YA30 YA33 23 16 18 30/12/05 19/11/05 19/11/05 Page 23 Kinoo Lodge Version 5.0 6 YA42 13 rota. Additional staff must be recruited so that the owners do not have to work excessive hours. Measures must be taken to 19/11/05 protect residents from the possibility of falling from first floor windows. Risk assessments must be completed or restrictors installed. This is outstanding from the previous report. 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 YA14 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 inspection report. Kinoo Lodge DS0000011738.V254098.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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