CARE HOME ADULTS 18-65
Kirby Close (10) South Shields Tyne And Wear NE34 9QF Lead Inspector
Miss Nic Shaw 17th January 2006 Unannounced Inspection 8:30am Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kirby Close (10) Address South Shields Tyne And Wear NE34 9QF 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) 0191 454 5527 0191 454 5527 None United Response Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th September 2005 Brief Description of the Service: Kirby Close provides ordinary housing for two people who have a learning disability. The service cannot provide nursing care. The home is a three bedroomed semi detached house situated in a residential area. There is a lounge, kitchen, three bedrooms, (one of which is a sleep-in room/office), and a bathroom/WC located on the first floor. There is a lawned garden to the rear of the home and off road parking facilities to the front of the house. The home is situated in South Shields within close proximity to a range of community facilities such as shops, public houses and places of worship. There are bus stops nearby which link with the main regional centres. The home also has its own transport. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 4.5 hours in January 2006 and was a scheduled unannounced inspection. The service users who live at Kirby close are not able to communicate their views by use of speech, as such the inspection process focused upon observing interactions and communication between the staff and service users as well as talking to the staff and manager. A sample of records were examined including care plans, staff files and the quality assurance system. A tour of the building took place which included all communal areas and both service users bedrooms. The judgements made are based on the evidence available on the day of the inspection. What the service does well:
The home provides the two service users with a homely, clean environment in which to live. The manager and staff have taken positive steps to ensure the house is treated as the service users home. For example: in the past United Response staff, who did not work at Kirby Close, entered the home each weekday morning in order to collect the keys for the transport, which is parked there overnight. This no longer occurs as the staff recognised that such a practise did not respect the right of service user’s to enjoy the privacy of their own home. Service users are supported to take part in a range of activities in the home and on the morning of the inspection were encouraged to take part in household chores. The staff continue to find ways of enabling the service users to take part in activities in the community. Examples of these include providing one to one staff support so that the service users can collect their own money from the bank. Good contact is maintained between the service users and their families and their families are encouraged to take part in the service users review meetings. There is little turn over of staff and on-going training provided by United Response helps them to carry out their role as care staff. The manager is experienced and competent and knows the service users well. She is able to successfully direct and demonstrate to staff how service users are to be supported.
Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Although there has been improvement to the care plans, these should continue to be developed. Medication procedures need to improve. For example: the manager must ensure that the instruction on the pharmaceutical label matches the instruction on the medication record. In addition to this all prescribed items must be recorded on the medication administration record so that staff know the service users have received their medication appropriately. Some of the staff need to complete NVQ level 2 training in care. The kitchen units show signs of wear and tear and must be addressed. There is only one member of staff on duty during the night. This needs to be reviewed in order to ensure that the needs of the service users are effectively met. A representative of United Response must carry out an unannounced visit to the home each month, which is a legal requirement. The quality assurance system also needs to be developed so that each year a report is published on the performance of the service. Any shortfalls identified should be used to help plan the future development of the service. The manager needs to carry out a fire risk assessment so that any hazards are identified and addressed. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Each service user’s care needs were assessed prior to their move to the home, and have been periodically thereafter. This will help ensure that each service user’s needs are met at the home and inappropriate admissions avoided. Service users have been issued with a contract, therefore, their rights as residents are protected. EVIDENCE: All current service users have had an assessment carried out by the Local Authority social worker prior to their admission to the home. Discussions with the manager confirmed that should a vacancy become available, then any future prospective service user would be referred to the home through a social worker where a full comprehensive assessment would be carried out. The service users have been issued with a “service user agreement” and “individual charter” which includes details of the terms and conditions of residency. These documents need to be signed by the manager and the relatives, as advocates for the service users. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 Care plans and risk assessments have improved since the last inspection, however, care plans need to continue to develop to ensure that the service users welfare is fully promoted. EVIDENCE: It was evident form discussion with the staff, manager and records examined that much work has been undertaken to improve the care plans. It is the responsibility of the “keyworker team” to develop and up-date the care plans and this process is overseen and monitored by the manager through staff meetings and individual staff supervisions. Those care plans, which had been completed, were of a good standard providing the reader with clear step by step guidance of the action needed of them to meet the service users daily care needs. Discussion with the manager confirmed that she has identified the need to develop communication passports in order to ensure that further opportunities for the service users to make choices and decisions for themselves are provided.
Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 11 Discussion with the manager during the last inspection confirmed that a review of the care plan consists of a written acknowledgement that it has been reviewed together with the date and a recording to indicate that there has been no change. The manager has carried out a review of this procedure and a care plan review format has been developed. Once implemented the manager confirmed that this will provide details as to who has been involved with the review together with documented evidence to support any changes made to the care plan. Risk management plans are available which provide guidance to staff on strategies to be implemented to ensure the service users safety whilst carrying out activities independently. The manager confirmed that she is in the process of supporting the keyworker teams to carry out a review of all risk management plans. The development of these will be monitored during future inspections. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15&17 Service users have a regular community presence and are supported to access a range of community facilities as well as maintaining good contact with their families. This assists them with leading a full and enjoyable life. A good range of meals is available to service users, which meet their dietary needs. EVIDENCE: During the week the service users attend a day service provided by United Response. It is the philosophy of the day service, known as “Access” to provide opportunities for the service users to take part in activities in the community. Examples of regular activities provided by Access include swimming, going to the cinema as well as day trips out to places of interest such as the Roman Forts. The planned activity on the day of the inspection was for one service user was to go shopping for personal toiletries. On the morning of the inspection good communication was observed to take place between the staff of Access and the staff working in the home and this ensures continuity of care.
Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 13 Discussion with the staff confirmed that they were currently in the process of developing a plan to support one service user to be weighed each week in a local pharmacist. Staff also confirmed that service users are always encouraged to accompany them if they need to “pop” out to the local shops. The manager is in the process of two additional staff becoming “signatories” for the service users bank accounts in order to ensure that staff are available to support the service users to withdraw and deposit their own money and in these ways the service users have links with the local community. Service users have contact with their relatives and this is encouraged by staff who invite them to take part in review meetings as well as involving them in decision making processes. Although the breakfast meal was not sampled it was evident that the service users enjoyed the food and that this was a relaxed occasion. Service users were encouraged to choose which cereal they would like to eat and fresh fruit was also available and offered to the service users. Discussion with the manager confirmed that a healthy diet is encouraged and a record of meals is maintained, including the meal provided at the day service. In order to provide opportunities for the service users to become involved in the menu planning process the manager stated that it is her intention to develop a picture menu. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Some of the medication administration procedures are unsafe. This means that the service users welfare is potentially at risk. EVIDENCE: Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 15 Medication policy and procedures are in place, which covers the storage, handling and administration of medication. However some of the prescribed items held in stock, for example paracetamol, had not been recorded on the medication administration record. Information recorded on the original dispensed pharmaceutical container did not always correspond with instructions recorded on the medication administration record. For example; it was unclear as to whether a service user should be administered either one or two of their prescribed medication each evening. In addition to this the staff had opened and resealed the monitored dosage system, which had been dispensed by the pharmacist. The purpose of the sealed monitored dosage system is to minimise the risk of medication administration errors occurring and should not be tampered with by staff. In view of the of the above issues an immediate requirement notification was issued to the manager for a full audit of the medication to be carried out in order to address these and any other medication issues identified. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 16 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): 23 Appropriate policies and procedures and training provided ensures that service users are protected from abuse and neglect. EVIDENCE: The home has policy and procedure documents relating to abuse which are available to staff to guide them if they have any concerns in this area. Since the last inspection the manager confirmed that all but one member of staff have received training on how to follow the Local Authority’s protection of vulnerable adults procedures (POVA). Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 17 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&30 The home is homely and clean providing service users with a comfortable environment in which to live. However, maintenance issues are not dealt with quickly which means that the safety of the service users may be compromised. EVIDENCE: Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 18 All communal areas and both service users bedrooms were viewed and found to be clean, bright and airy. Since the last inspection one service user’s bedroom has been decorated and re-furbished providing them with a personalised private space in which to spend their time if they so choose. Furnishings and fittings are domestic in style, however, discussion was held with the manager in relation to the provision of a small portable television in the communal lounge. The manager stated that the reason for a small television was so that it could be easily moved, and this was a past recommendation made by a psychologist working with one service user at that time. The manager agreed to review whether or not this continues to be necessary with a view to purchasing a larger size television which would be more suitable for this area. The kitchen area continues to show signs of wear and tear with chipped and worn work surfaces and cupboards, which present a risk of cross infection. The manager stated that she has reported these issues to the Housing Association who is responsible for building repair issues. This issue is outstanding from the last inspection. Policies and procedures are available in respect of infection control and the manager confirmed that all staff receive training in relation to this issue during their induction. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 19 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): 32,33&34 The service users welfare is promoted and protected by staff recruitment procedures and good training provided to the staff, however, some of the staff need to complete NVQ level 2 training in care. Staffing levels during the night may not be sufficient and a review of this must be carried out in order to ensure the welfare and safety of the service users is protected. EVIDENCE: Staff spoken to confirmed that they are provided with a range of training by United Response. This has recently included communication training which the staff said they found very interesting and beneficial to them. Three out of the seven staff have achieved the NVQ level 2 qualification in care, which falls short of the required minimum standard of 50 . The manager confirmed that the remainder of the staff are in the process of completing this. All new staff are required to complete induction and foundation training which is linked to the Learning Disability Award Framework (LDAf). The minimum staffing level for the home is two staff on duty during the day when the service users are at home and records examined confirmed that this has been maintained. An issue raised during the last inspection relates to the staffing levels during the night which consists of one sleep-in member of staff only, and whether or not this was suitable to the needs of the service users.
Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 20 The manager confirmed that she has raised this issue with the service users social workers who are to carry out a review of the service users care needs. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 21 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 The home continues to operate without a registered manager, however the current manager offers clear leadership and support to the staff team to ensure service users rights and best interests are promoted. Arrangements to make sure that the service continues to improve have begun to be introduced. However, in order to safeguard the best interests of the service users further developments are needed in this area. Further work is required in the area of risk assessment to ensure that the service users health, safety and welfare is fully promoted. EVIDENCE: The Commission for Social Care Inspection, (CSCI), have not received a registered managers application. Discussion with the manager, however, indicated that it is her intention to apply to become the registered manager. This application must be submitted without further delay. As discussed during the last inspection the manager is also responsible for managing a day service belonging to United Response and as such is employed to manage Kirby Close on a part time basis. CSCI have not formally agreed to this arrangement and Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 22 United Response must write to the Commission confirming their intention in relation to this matter. The job description for the manager was discussed. This does not make reference to the role and responsibility of the registered manager in line with the Care Standards Act 2000, Care homes Regulations 2001 and National Minimum Standards and is an outstanding recommendation from previous inspections. A monthly audit is carried out under the requirements of regulation 26 of the Care Homes Regulations. However, copies of these have not been forwarded to CSCI each month in accordance with this regulation. Discussion was held with the manager in relation to the requirements of regulation 26 in which it clearly states that a person external to the home must carry out such a visit. This issue is outstanding from previous inspections. The manager confirmed that within United Response there is a quality department and it is their responsibility to implement the quality assurance system. This consists of staff satisfaction surveys and questionnaires for families. The manager stated that the quality department, on a national basis, evaluates this information and the managers of services informed of the outcome. However, there is no specific information available on the performance of Kirby Close and the manager agreed that this is an area for future development. Internal quality assurance processes continue to be developed by the manager. Recent examples include the manager placing herself in the position of a relief member of staff and asking staff on duty to provide her with an induction. In this way the manager is able to monitor and evaluate the effectiveness of this process. Discussions with the manager confirmed that she is also considering appropriate meaningful ways of involving the service users in service user meetings. The manager has begun to develop a detailed fire risk assessment for the service and has contacted the local fire liaison officer for assistance in relation to this. The stairs leading to the first floor of the home are steep in gradient. The manager agreed that, due to the mobility of one of the service users, it is necessary to carry out a risk assessment for these. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 1 X 2 X 2 X X 2 X Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 24 Yes Are there any outstanding requirements from the last inspection? Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 25 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. 2. Standard YA6 YA9 Regulation 15(1) 13(4)(b) Requirement Care plans must continue to be developed. Risk management care plans must continue to be reviewed and up-date for all activities the service users are involved in which involve a degree of risk. Medication Administration Records must be completed accurately to reflect whether one or two tablets have been administered. Staff must not tamper with the sealed Monitored Dosage System provided by the pharmacist. All prescribed medication must be recorded on the Medication Administration Record. The kitchen units showing signs of wear and tear must be addressed. (Timescale not met 31/12/05). 50 of staff must have a care NVQ level 2 qualification. (Timescale not met 31/12/05). Timescale for action 31/07/06 31/07/06 3. YA20 13(2) 17/01/06 4. YA24 23(2)(b) 30/04/06 6. YA32 18(1)(i) 31/05/06 Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 26 7. YA37 8(1) A registered managers application must be forwarded to the CSCI without further delay. (Timescale not met 30/11/05). The quality assurance systems must be developed and used to inform and improve the services provided within Kirby Close. The registered provider must arrange a monthly unannounced visit to the home in accordance with regulation 26. (Timescale not met 31/10/05). 28/02/06 8 YA39 24 31/07/06 9. YA39 26 31/03/06 10. 11. YA42 YA42 13 23(4)(a) A risk assessment must be 31/03/06 completed for use of the internal stairs. A fire risk assessment must be 31/03/06 completed. (Timescale not met 30/11/05). RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA5 YA24 YA37 Good Practice Recommendations The contract should be signed by the service user’s relative on behalf of the service user. A review of whether or not it continues to be necessary to use a portable size television in the lounge should be carried out. The registered manager’s job description should be reviewed to include the responsibility of ensuring the home’s compliance with the Care Standards Act 2000. Kirby Close (10) DS0000000263.V265711.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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