Inspection on 30/06/06 for Kinoo Lodge

This inspection was carried out on 30th June 2006.

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 3 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 19/10/05

Kinoo Lodge 12/04/05

Kinoo Lodge 16/02/05

Kinoo Lodge 13/09/04

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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 Mr Richard Slimm Unannounced Inspection 30th June 2006 10:00 Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 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.V289392.R01.S.doc Version 5.2 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.V289392.R01.S.doc Version 5.2 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.V289392.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 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 accommodated, four within shared bedrooms. The owners, Mr. and Mrs. Keeno, own the home. They also live on the premises with their family. Members of their immediate and extended family including Mr and Mrs. Keeno, provide all staffing at the home. There is staff cover for 24 hours per day. The home has links with local health and social service teams for people with a learning disability, including local day care services run by Portsmouth City Council. The building consists of a conversion of two houses into one property. Communal facilities consist of a lounge and kitchen-dining area, communal toilets and bathroom and a small garden. The service is registered to accommodate up to eleven residents, however, the owner Mr. Keeno advised the inspector at the time of this site visit that he does not intend to accommodate more than six people, as the additional registered bedrooms are located in that area of the home used for his personal/family accommodation. Consequently the registered persons intend to reduce the homes capacity from 11 to 6. This will involve an application to vary conditions of registration being made to the Commission. The fees for the service are £324.00 per week. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site inspection visit to the home took place between the hours of 09.30 and 17.00 hrs on the 30th June 2006. This site visit was the culmination of prefield work activities including – • A full review of the history of the service since the last inspection • Gathering information from a variety of professional sources, including • The Commission’s database • Pre-inspection information provided by the home • Contacts with families and social workers and other external stakeholders • Linking with previous inspectors who have visited the service This was a key inspection, being part of a new inspection programme, which measures the service against the core and/or key national minimum standards. While in the home the inspector was able to meet three of the six residents currently accommodated. Additional paper work where necessary was reviewed, a tour of the premises took place, and the owner and staff members were interviewed. What the service does well: What has improved since the last inspection? Action had been taken to improve and develop the physical environment. Chimneys had been removed to create additional space. The bedrooms and some communal areas had benefited from redecoration and improvement. The home has started to introduce a person centred care planning system, that will support the home in tailoring individualised packages of care to each Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 6 resident based on their own wishes and needs, as well as beginning to identify and recognise their aspirations. Staffing levels appeared to have been improved, but how and when care/support staff are deployed to provide the best possible outcomes for service users still needs to be reviewed, and the owners are still working excessive hours each week. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 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 Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 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): 1-2 Service users needs and individual aspirations are assessed. Residents are not offered information in formats other than the written word. Resident who are profoundly disabled and have no naturally existing networks need to be provided with external/independent advocacy. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No residents had been admitted to the service since the last inspection visit. Current residents were unable to remember their experiences when admitted to the service, or communicate them. However, it was noted that information in written formats was evident in residents’ rooms. The degree to which service users understand these documents is very limited due to their special needs. Historical documents were inspected and a sample case tracked confirmed evidence of some good practice. There had been a number of developments and improvements in the area of planning which is informed by the assessment process. Risk assessment was relvant to the needs of the service user group and linked to planning documents. Pre-admission information is not available in formats that could be readily explained to residents who have a learning dissability. Mr Keenoo the owner Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 10 advised that all new admissions would be given the opportunity to visit the home before being admitted for a trial period, or to “test drive” the home. A social worker from the local commissioning team confirmed that in her view the home would do everything they could to make a new residents admission to the home as smooth and comfortable as possible. All residents are publicly funded and funding contracts and commissioner assessments were held on each residents personal file. A written copy of the service user guide was evident in each residents bedroom, and included a copy of the services complaints procedure. As identified above, given the needs of the service user group, there is a need develop more user friendly formats and meadias for information sharing and to increase the use of external and independent advocacy where residents do not have naturally existing family networks to support them. While no residents were able to remember or speak about their experiences when they entred the home for the first time, assessments identified likes and dislikes of residents in a number of different ways, and planning systems appeared to be moving toward a person centred approach. One resident said that she felt safe living at the home, but referred the inspector to her brothers and her social worker with regard to the service and how this was meeting her needs. Two other residents with no verbal communications skills were observed and the inspector spent some time with them both. They both appeared to be generally calm and contented while in the company of other resdients, staff, and the inspector, indicating a degree of satisfaction with the support they received at their home. The home has written guidance in the area of admissions, and fees are currently set at £324.00 per week. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 11 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): 6-7-9 Residents’ assessed needs and individual goals are reflected to some extent in their peronal care plans. There are elements of plans that could be further developed. Increased meaningful activities that promote greater decision-making and involvement in the home on the part of service users could be included in more detail on care plans and the home’s policies and procedures, especially in areas such as the promotion of independence in daily living. Increased use of independent advocacy is needed for some residents. As greater independence is promoted via person centred planning, risk assessments will need to develop further to support staff to enable residents to take increased risks as part of a more independent lifestyle. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has a care plan. The Care planning system appears to be developing into more of a person centred approach. However, there is a need to introduce improved methods of communication in a number of areas due to the special needs of residents. It was not evident that staff were being proactive in the use of comminication aids relevant to the needs of the service users. The service provides all of its resident based information in written formats with little acknowledgement of the needs of the resident group. Resient care plans and daily notes are recorded / typed onto the computer system without any pictorial aids for, or involvement of residents, and residents did not appear to be actively encouraged and supported to be involved in decision making or in one case where the resident had the skills, in the maintenance of their personal records to any real extent. There was no evidence of the pro-active use of communication aids such as MAKATON (a sign language that is verbally reinforced and spefically designed to support people with learning disabilities) that can be of significant use when enabling people with learning disabilities to improve and enhance their communication skills. It was also noted that staff had not benefitted from MAKATON training for some time, specific guidance about MAKATON was not evident in the care plan of one service user who would benefit from this, and only one staff member was engaged on a NVQ course. No staff had training linked to National Vocational Qualifications (NVQ) learning disability award framework (LDAF) at the home. Five of the six residents had significant communication deficits, and were unable to speak to the inspector about their experiences living at the service. One resident who was able to talk to the inspector said she felt quite safe living at the home, and referred the inspector to relatives and a social worker who support the placement at Kinoo Lodge. Care plans were beginning to develop the person centred approach in format but there was still some need to further develop the content of plans to provide evidence of positive outcomes for residents. The degree to which service users are enabled to make decisions appeared to be limited by their disability as well as poor staff training. Given the needs of five of the residents the use of advocacy from outside of the service was very low, and needs to be improved, especially for those people who do not have naturally existing family support networks who can assist with advacocy. There was only one example where a service user’s behaviours were challenging a local day service attended by this person and this had been noted. The inspector was advised that the day service and the home are trying to work together to identify possible reasons for the service users self-injurous Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 13 behaviour at times when at the day centre. The inspector also spoke to the mother of this resident who said she was very happy with the care her son received at the home, but she was worried about his current problems at the day centre run locally. There were no adverse challenging behaviours reported or evident for this resident while in the home. The degree to which service users are involved and pro-actively supported to be engaged in the daily running of their home and promoting increased independence in line with the abilities of individual service users was unclear. However, there was evidence of general satisfaction from three residents discussion, appearance and reactions at the time of the visit. One more able resident referred the inspector to her care manager, and the inspector has spoken to the care manager to establish her view of the service. General feedback from external care managers/social workers was fairly positive also, and it was acknowledged that the home is probably better at meeting the needs of more dependent residents. One parent of a resident said she was very happy with the home and her son had lived there over ten years and was quite settled, and the home supported her to see her son as often as possible. Her son always seemed happy to return to the home following a visit, which she felt was a good sign of his satisfaction. Residents are enabled to have annual holidays either with their families, the home itself, or with social clubs external to the home that the resident may be involved with locally. Resident plans provided evidence of residents having quite varied lifestyles across the week. This included day time opportunities as well as other social outlets residents chose to attend locally. One of the 6 residents journeys out alone with no need for support. No other residents are able to journey out unsupervised due to their special needs. Activites of daily living that involve elements of risk taking are assesed, relevant to the current identified needs of each resident. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 14 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): 12-13-15-16-17 Service users are encouraged to partake in a range of activities outside of the home that are aimed at providing opportunities to mix with others and to use their local community. Service users need more support and active encouragement to enable them to take more part in the running of their home and the development of their daily living skills. Service users are encouraged via daytime opportunities and care/support packages to engage in their local communities. Service users are encouraged and supported to maintain personal and family relationships. Residents with no families, or little family contact need to be provided with increased, appropriate advocacy services. Service users rights and responsibilities need to be further promoted by an appropriately trained staff team. Service users are provided with a healthy diet. Service users need to be supported individually to take increased control over what and when they eat, and in the whole process of shopping, preparing and cooking their food. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are receiving care packages external to the home. These include attendance to a locally run day service. The home are involved in day care reviews with the staff of this day service. Local social workers are also involved in working with service users placed at the home and will meet residents during reviews of the placement. Two residents have regular support provided by a local day care agency, that enable them to access their local community, and get involved in a variety of different activities outside of their home. A number of residents are involved in local clubs that provide social opportunities for those service users outside of the home. The home provides residents with an annual holiday away from the home as a group, and the last House holiday was in Cornwall earlier in the year. Care planning takes account of those residents with social networks and family, with residents’ being supported to maintain these relationships. In one case the home works hard to support the parent of one resident who is becoming more age frail. There are some residents who have very limited or no access to family networks, and there is a need to increase the use of independent advocacy for these people given their particular needs. Via the person centred planning system that is developing at the service, residents should be enabled to become more involved in opportunities to practice independent living skills. Given the needs of five of the residents these opportunities will need to be carefully tailored to each persons identified potential. Staff will need to be given the necessary skills via appropriate and relevant training courses, and an improved key worker system will need to be introduced that links with a modern system of staff support and supervision, that motivates best practice, innovation and energy into the service. External professionals believe that service users’ should be more involved in the running of their home, by being provided with individual support to carry out certain household chores for themselves, such as personal laundry, cleaning their own bedrooms, shopping for at least one personal meal a week that they prepare and cook with support for themselves. One of the challenges the service faces is to prevent falling into the trap of doing too much for service users, as opposed to supporting residents to do more for themselves. This will become more achievable by providing a motivated and appropriately trained staff team. Residents without advocates Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 16 will need to be provided with independent representatives to support less able residents to take up increased rights, responsibilities and choices in their dayto-day lives. There was some evidence that currently the staff team feel they are employed to do things for residents as opposed to supporting residents to do things for themselves. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 17 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): 18-19-20 The service users receive their personal support and care in the way they wish and need. Service users physical and emotional health needs are identified and action taken to meet these needs, either externally or inside the home. Service users’ do not currently have any control over their own medications. Arrangements for the staff administration, storage and recording of drugs and medications were safe. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Plans of care indicated a level of understanding of service users needs and wishes, and outlined how best to meet any personal care needs. Five of the six residents need regular daily input and support in this area of their lives. External stakeholders stated that residents are always dressed to a good standard, and their clothing is personalised, shop purchased and age appropriate. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 18 There was evidence of staff and the owner being close and understanding toward the residents, and the inspector witnessed a good degree of trust between two very vulnerable service users and the staff members on duty. Care plans outlined the needs of service users to some extent, and the daily lives of residents are monitored via a written record. While there was some evidence of positive lifestyle choices and outcomes for service users, these were not always recorded in any detail, with more emphasis placed on recording the inputs being made, or already known behaviour/routines, rather than any progress the resident has made in gaining new skills or independence. One case record provided evidence of a recent, thorough health care check being carried out, however, in one instance this appeared to have missed the hearing needs of a resident. The care manager is aware of this issue and has brought this matter to the attention of the provider. While there was evidence that physical health care needs are identified and action taken to meet these needs, it was difficult to assess how residents’ emotional needs were being met, as 5 of the 6 residents are unable to communicate verbally. Given that there is little behaviour that significantly challenges the service, this provides some evidence that service users appear to be quite contented. However, as identified above there was some evidence that residents may benefit from being stretched a little more in the area of learning new skills with skilled staff support. At the time of this site visit there were no service users taking their own medication independently. All medications are kept in a lockable office, in a locked drug cupboard, in line with the home medication and drugs policy. Medicines are given out by one of three trained staff members, and a dossette system is used to administer medicines over any period of 7 days. All medications given out are recorded in the medicine administration record (MAR sheet), and signed by the person giving out the drug or medicine. At the time of the visit there was evidence that arrangements for the administration storage and recording of medications was safe, and in-house policies appeared to follow national guidance as developed by the Royal Pharmaceutical Society. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 19 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): 22-23 The service needs to develop innovative communication and advocacy systems to establish the views and wishes of service users who do not have verbal or literacy skills, and develop formal systems to ensure these views and wishes are fully integrated into the service provision. The service makes arrangements to promote the protection of service users’ from abuse and neglect. The service needs to work pro-actively with a local day care service where a resident attends, and while there is currently displaying self-injurious behaviours. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been no complaints about this service since the last inspection visit. The service has a written complaints procedure that is included in documentation and information about the home, and is available to residents’, relatives and external stakeholders. Written information packs were observed within each service users’ bedroom, however, the degree to which residents would be able to understand these documents is very limited. Other forms of media such as pictorial and/or video/audio formats that could be used to promote independence and/or Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 20 explain the complaints process with service users when necessary were not available. The service needs to develop innovative methods to enhance the way service users are listened to and consulted in the running of their home. This will need to link to increased use of independent advocacy for those residents’ who do not already have family or naturally existing support networks from outside of the service. One service user stated that she felt safe at the home. Two service users’ with profound learning disabilities and poor verbal skills were observed and appeared to be quite calm, confident and relaxed in their home, waiting to go out with day service support. Given the high incidence of communication deficit with five residents, there were no reported or recorded incidents of behaviours that directly challenged the service provided at Kinoo Lodge since the last inspection visit. However, it was noted that one service user when attending a local day centre is displaying self-injurious behaviours. This behaviour is not manifesting at the home. There needs to be some guidance drawn up with care manager and family input to see if this behaviour can be better understood and reduced, and input from the care home where this behaviour is not evident may be useful to the day centre staff in developing management techniques that better meet the service users needs while he is in their care. The service has policies, procedures and codes of practice in place, including clear guidance for staff in the area of adult protection and the prevention of abuse. A staff member who assisted during the inspection was able to demonstrate an awareness of these documents and procedures and confirmed that she had been provided with training in adult protection. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 21 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): 24-25-30 The service provides a homely environment. The service provides a high proportion of shared bedrooms with single sinks. More attention is needed to maintaining tidiness in the home. The environment included personal alarms and fire detection systems, policies and procedures, to promote resident and staff safety. The home was clean and hygienic. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Kinoo Lodge is 2 large Victorian terraced houses joined together, with one being the end of terrace. The private accommodation of Mr. And Mrs. Keeno is sited on one half of the building with a number of these rooms registered but not used to accommodate residents. Residents are accommodated in the other side of the building. All alarm systems are linked across the building. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 22 The registered owner Mr. Keeno advised the inspector that he and his wife were considering when to retire from their business, and it was not their intention to accommodate any more than six residents. The inspector advised Mr. Keeno that he could apply to vary the home conditions of registration to reduce numbers, and should keep the CSCI advised of any planned closure, as an application to cancel the registration would be needed. Accommodation is organised over two floors with a high number of shared bedrooms. One resident had a single bedroom, one was using a double room as a single and the four other residents were sharing double bedrooms. However, the owner advised the inspector that those four residents appeared to be quite happy with shared rooms. A family member of one service user said she felt her son was happy with his living arrangements at Kinoo Lodge. There is an emergency alarm call system. Shared rooms were fitted with single sinks. All rooms were within easy reach of a communal toilet/bathroom facility. There was evidence that service users’ had been supported and encouraged to personalise their individual rooms. One resident spoken to said she liked her single bedroom. Since the last inspection there had been a number of investments, improvements and developments made to the physical environment. Some chimneys had been removed to increase space, and bedrooms had benefited from redecoration. All second floor windows were checked and were fitted with opening restrictors suitable to the needs of the resident group. Lighting facilities in bedrooms were found to be appropriate to the assessed needs of residents, and furniture in bedrooms was suitable to the needs and wishes of the residents’ concerned. The owner stated that the service attempts to provide a homely relaxed environment. It was noted that some areas of the home were littered and untidy, an issue that has been identified in previous reports. However, action was taken to tidy up when this was pointed out. The office area was also found to be untidy and disorganised at the time of the inspection. The home was cleaned to a reasonable standard and there were no offensive odours. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 23 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): 32-34-35 The service fails to meet the 2005 target of having 50 of staff trained to a minimum of NVQ 2. No staff member has a learning disability related qualification. No staff member is engaged on a NVQ course linked to the learning disability award framework. Staff training is not adequately linked to the assessed needs of residents accommodated, or the conditions of registration for the service. Staff need specific training in person centred planning. The staff team needs to be deployed in a manner that fully supports and enables service users to lead more independent lifestyles. The services’ recruitment and selection practices do not fully promote protection of residents’ as required. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Kinoo Lodge is run as small family business. The owners live within the same building as the registered premises as identified above. The staff team is made up of family members and people who are very close to the family. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 24 Consequently there is a risk of a rather closed environment developing in the context of the residential aspect of the residents care package. This has been discussed with the manager and this report will recommend the increased use of independent advocates in consultation with residents, where appropriate, families and other stakeholders. During the day from Monday to Friday each resident is provided with day care / support. Three residents attend five-day care packages at a local day service, and two service users receive support from an organisation providing outreach services, that enable those residents to participate and integrate in their local community. Consequently staffing during the daytime during the week is low. However, staff members need to be deployed at those times when residents are at home and needing support to engage in independent living activities. Most support is needed in the mornings, supporting residents’ to get ready for their daytime activities; in the evenings when residents return from their activities outside of their home, and at week ends. Staff rotas indicated that the service provides 268 hours per week, not counting the night duty that is sleep-in as the current residents do not need a waking night staff member. It was noted that the owners Mr. And Mrs. Keeno are still working on average 112 hours per week each, which is excessive. There was some evidence that residents may need to be supported more frequently and in a more structured and planned way to become more involved in the day-to-day running of their home. The inspector was advised that the service runs a key working system, but it was unclear how this linked with professional supervision or the developing person centred care plans and achieving clearly identified outcomes with service users, improving their quality of life, developing their opportunities for increased independence and improving daily living skills. A local care manager felt that service users are quite safe living at the home, but more able residents may find their opportunities for independence limited by the way the service is currently configured. The care manager felt that the service meets the needs of less able residents quite well, and that staffing levels were of a reasonable standard. It was also felt that staff could be trained to a better standard. A sample of staff members records required to be maintained were inspected. Staff members are receiving the necessary checks to the criminal records bureau and the protection of vulnerable adults list. It was noted that the home was routinely accepting testimonials from staff in place of seeking references. The owner explained that he knew all staff employed, as they were either family or very close relations, but did understand the need to seek references rather than accept pre-written and sometimes dated testimonials. Other Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 25 aspects of the staff recruitment and selection process appeared to be satisfactory. Staff members are not trained to the national minimum standard. The manager is currently undertaking a course at NVQ 4 with the registered managers’ award, and Mr Keeno is undertaking a NVQ 2 course, but without any linkage to the learning disability award framework. Consequently it is unclear how relevant this course will be in the context of the registration of the care home and the needs of service users? This left five other care staff with no qualification relevant to working with adults with a learning disability. One of these staff is a registered first level nurse, but not learning disability trained. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 26 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): 37-39-42 Management systems are sufficient and relevant to the size and nature of the service. Service users need to be more fully involved and consulted about the daily running of their home. Arrangements are in place to promote the health, safety and welfare of service users. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is currently undertaking the National Vocational Qualification at level 4 with the Registered Manager Award course for registered managers of care homes. The home has a computerised records system, which aids the effective running of the home. There were policies and procedures in place to guide staff in those areas identified in the standards. Staff members were able to demonstrate an awareness of these documents. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 27 Management systems were relevant to a care home providing a service to six adults with learning disabilities. The registered persons may wish to consider making an application to reduce numbers from eleven to six, as there is no intention to admit more than six service users. An external professional interviewed by ‘phone felt the service was managed quite well, given the nature and size of the service. The mother of a resident said she was happy with the way the home ran, and felt that residents best interests were at promoted. One of the primary aims of the service is to provide a safe family type environment. There are some areas the management need to consider where further development would be beneficial to the ongoing improvement and development of the service as identified above: • • • • The management should consider the use of independent advocacy as part of the introduction of more innovative ways of seeking the views of service users and using this information to inform service development. The service should introduce information and other communication packages in formats that can be better understood by service users who have a learning disability. Staff members need to be better trained in current best practice in the provision of enabling residential services to adults with learning disabilities. Person centred care planning systems need to link clearly to key worker groups and staff supervision, monitoring carefully the successes of the service and outcome for residents, as well as identifying how the service needs to develop and improve. The service needs to link with care management and the local day service with regard to one service user who is exhibiting self-injurious behaviours at the day service, but not at the home, in order to review how the service users needs may be better met. • A fire officer last visited the service on the 24/5/05 on the request of the manager. Fire arrangements were found to be satisfactory, and the manager was maintaining records of fire systems and staff fire training and fire drills. An officer of the local environmental health department last visited the home on the 19/4/05. The gas central heating system if serviced annually, and there are regular checks to the water system. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 28 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 x x 3 x Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 29 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 YA32 YA35 Regulation 18 Requirement Timescale for action 15/08/06 2. YA34 18 Schedule 2 The registered persons must ensure that at least 50 of staff members are trained to NVQ with the learning disability award. This standard should have been achieved by 2005. The registered persons must send written evidence that staff members are being trained to the national standards applicable to a learning disability registered care service. At least 50 of Staff must access the relevant training course in September 2006, and written evidence that 50 of staff have been placed on the next academic cohort forwarded to the CSCI. The registered person must take 01/08/06 up two references on any staff as part of the checks needed to assess suitability, as identified in Schedule 2. Testimonials must not be used in place of references that must have been sought by the registered persons. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 30 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 YA7 YA39 YA8 YA11 Good Practice Recommendations The home needs to develop innovative methods to facilitate and enable service users with communication deficits to be consulted and as fully involved in the running of their home as possible. As person centred planning develops it will be possible to formalise sessions with key workers where residents are enabled to become more involved in activities of daily living at their home. As more and more preferences and like and dislikes are identified, it will be possible to develop the service along the lines of what the service users want as well as what may be needed. It will be important to introduce more use of advocacy that is independent of the home and other professional organisations, where naturally existing advocates are not available. This may assist in the support of residents with communication deficits being consulted about the services they receive, and how those services continue to develop and improve. The home should liaise with the care managers and day service staff about behavioural challenges resulting in self-injury of one resident who’s complex needs may need further assessment and review. The family and/or advocate of the service user concerned should also be involved, given the dependency levels of the resident. As staff training improves providing staff with increased understanding and a deeper knowledge base of the needs of people with learning disabilities. It should be possible to develop more effective key worker systems, that link to person centred planning and the regular meaningful involvement of residents, with support from a skilled staff team, that is deployed a times when service users most need support with activities of daily living that promote more independence in their own home. Kinoo Lodge DS0000011738.V289392.R01.S.doc Version 5.2 Page 31 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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