Inspection on 25/07/06 for Kirkstall Lodge

This inspection was carried out on 25th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kirkstall Lodge 25/05/07

Kirkstall Lodge 21/11/06

Kirkstall Lodge 06/10/05

Kirkstall Lodge 23/04/05

Kirkstall Lodge 07/02/05

Kirkstall Lodge 08/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Kirkstall Lodge 56 Kirkstall Road Streatham London SW2 4HF Lead Inspector Sonia McKay & Vashti Maharaj Unannounced Inspection 25th July 2006 09:00 Kirkstall Lodge DS0000053104.V305382.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 Kirkstall Lodge DS0000053104.V305382.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. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kirkstall Lodge Address 56 Kirkstall Road Streatham London SW2 4HF 01491 579 270 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) Kirkstall Lodge Limited Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th October 2005 Brief Description of the Service: Kirkstall Lodge is a care home for six adults with a learning disability. The semi-detached house is located in a residential street in Streatham, South West London. It is close to public transport routes, shops and leisure facilities. The home is unsuitable for people with restricted mobility as front access is via a number of steps. There is a small rear garden with an outbuilding that is used as an office. The home is owned and managed by Beacon Care, a private care provider with many other homes in London and the South East of England. Support is provided by a staff team of support workers and a home manager. The home has use of a vehicle and employs a support worker/driver to assist with the numerous journeys back and forth to the various day services/activities attended. Prospective service users are given a copy of the Service Users guide that gives information about the home and the services provided. A copy of the most recent CSCI inspection report is available in the home on request. Fees range from £950.00 to £1,514.09 per week and depend on the individual care needs of each service user. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out in nine hours over one day. It involved talking with the newly appointed regional manager, support staff on duty and three of the four service users. Records relating to individual care arrangements, staff recruitment and training and health and safety were examined and there was a tour of the premises. A relative, the homes GP, a placing authority care manager and one service user completed CSCI comment cards before the inspection. A manager, who has been providing temporary home management support in the absence of a registered home manager, completed a pre-inspection questionnaire. What the service does well: What has improved since the last inspection? What they could do better: Records must be kept of decisions made by service users about important things such as changing which bedroom they occupy and also of any verbal complaint or concern that they raise. The records of planned health and social care, and individual aims and goals must be updated regularly and there must be better assessment and record keeping of any risks to service users. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 6 There must be better assessment of the type of support that each person needs with managing their finances and increased safeguards for protecting service users from any potential financial abuse. Staff must be trained in recognising and preventing any form of abuse and authorities must be notified swiftly of any event that affects the health or well being of any service user to ensure their protection. Staff must have better information about when prescribed medications should be administered and there must be better stock checking of medications in the home. The competence of all staff administering medication must be tested and verified by an appropriately trained person. The garden is not accessible to a service user with a physical mobility need. The references of any new member of staff must be checked thoroughly and all staff must have a structured induction when they begin working in the home. Staff must receive regular supervision from their line manager. There must be better leadership of the home and a registered manager must be appointed. 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. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 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 Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users have an opportunity to visit and test drive the service before making a decision to move in for a trial period. There is a need to increase the information that is provided to prospective service users in the service users guide and for more detailed contracts. EVIDENCE: The newly appointed regional manager has recently reviewed the service users guide. The guide is user friendly and contains many colour pictures. The Statement of Purpose contains sufficient information. Current service users must be consulted about any significant changes to these documents and revised copies must be sent to the CSCI on completion. (See requirement 1) There have been two people admitted to the home since the last inspection. Both people arrived at the same time and stayed for two weeks. Documents relating to these admissions have been archived and were not accessible during the inspection. A senior manager provided information about these admissions by telephone. The two-week placements were part of a trial placement for long-term care and both prospective service users had decided Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 9 that they did not want to move in to the home permanently. Records of these placements must be retained and available for inspection. (See requirement 2) The regional manager described the process for assessing the needs of individuals referred to the service. Beacon care request a copy of the local authority community care assessment and care plan and any supporting evidence in the form of specialist assessments. The home manager and senior staff then visit the prospective service user and complete a comprehensive Beacon care assessment. Prospective service users are then given an opportunity to visit the home to experience life in the home and to get to know the service users and staff. These visits can include joining the current service users for meals and also staying overnight. The prospective resident can then move in for a trial period. Contracts do not provide sufficient detail about client fee contributions towards placement costs and what these contributions cover. The information provided to service users must be revised in accordance with recent changes in the Care Homes Regulations of 2001 that are due to come into force in September 2006. The service users guide and associated individual contracts must provide greater detail relating to the standard package of services provided. The terms and conditions (including fee levels) that apply to key services (both personal care and food) and the payment arrangements (service user contribution/local authority contribution) must be stipulated. The guide must also state whether the terms and conditions (including fees) would be different in circumstances where a service user’s care is funded, in whole or in part, by someone other than the service user (See recommendation 1) Occupancy contracts do not stipulate the bedroom to be occupied under the agreement. (See requirement 3) Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 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, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst care plans are detailed and comprehensive they do not reflects current care needs and goals in some cases. The process of assessing risks to individual service users is not effectively monitored and information about care needs and current risks is not readily available to staff. This is unsafe. Service users are generally supported to make day-to-day decisions to the best of their ability and multidisciplinary input is sought in their best interest as necessary in regard to health matters. However, some decisions have not been adequately documented and records relating to finances and financial support are incomplete. EVIDENCE: Each service user has two files of written information about their care needs. The care records for all four service users were examined. Records examined suggest that placing authorities have reviewed the needs of individual service users living in the home. The minutes of these reviews are available. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 11 Each resident has a comprehensive set of assessment documents providing detailed information about care needs and planned care and support. These documents include: • Contact information for family members and professional involved • A pen portrait of each person and a photograph • A brief life history • Health issues • Psychological support and mental health needs • Support required to manage any emotional needs • Communication skills • Guidelines for personal care • Self care skills • Relationships and sexual needs • Community presence and participation • Recreation and relaxation • Cultural and spiritual needs • Employment and education • Finances • Strengths and needs • Likes and dislikes • List of priorities (current goals) Service users who are able have, in some cases, also added their comments to each element of the care plan. This is good practice. Whilst the information is clear, some of the plans are not dated so it is unclear whether they reflect current needs. The list of priorities and current goals do not reflect the goals identified in recent placing authority care review minutes in some cases. (See requirement 4) It is also difficult to find some information as some of the files are overloaded with old information that would be better archived in a separate file. (See recommendation 2) There is a form for staff to sign to confirm that they have read and understood care information contained in the files. This is also good practice but few staff have signed the forms and it is not clear what records the forms refer to. A care manager involved in the placement of one of the service users confirmed that staff demonstrate a clear understanding of the needs of the service user. There are many files containing risk assessments. Some are stored in the files relating to individual service users and others are in the staff information file. This can be confusing for staff as there are different risk assessments in each file and staff reading the staff information file to obtain an understanding of Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 12 current risks may not be aware that different risk assessments are kept elsewhere. This could be dangerous for service users and staff. Some risks assessments were reviewed in October 2005 and others in February 2006. It is not clear whether all required risk assessments are in place as a risk audit tool is not in place. For example, one service user has PICA, excess salivation and difficulty swallowing, there is no specific risk assessment relating to the risks that this presents although a therapist report states that the frequency of coughing during meals should be monitored and any increase in coughing should trigger prompt referral back to the specialist team for adults with a learning disability. (See requirement 5 & recommendation 3) Service users have varying degrees of learning disability and communication skill. Evidence gathered through observation indicates that service users are encouraged and supported to make day-to-day decisions to the best of their individual ability. Each service user has a key-worker from within the team who has responsibility to assist them to understand documents, to make choices, to develop plans and goals and to keep records. There reports of keyworking activity available and these include records of discussion and meeting with service users. Relatives and advocates are also involved in some cases and multidisciplinary meetings in the best interest of individual service users are called when major decisions must be made, for example healthcare under any form of sedation. There are also house meetings where service users can discuss issues as a group and make decisions with staff. These meetings are held regularly and are used to decide on issues such as group outings. Service users require varying levels of support to manage their finances. In some cases they need full support and the registered provider is the state benefit appointee. A requirement was made during the previous inspection visit for the nature of financial support to be better documented and for financial transactions made on behalf of individual service users to be better recorded. This requirement is not met. (See requirement 6) Whilst records of cash balances are well recorded and receipts are retained for items purchased, the full financial picture for each service user is not clear. There is no record of benefits collected, charges to service users and bank account balances or of the nature of support required with managing finances. For example, one service user receives state benefits via direct payments into a bank account, there is no record of the nature of support required for the service user to the access funds despite the fact that the service users cash cards and pin number is retained for safekeeping by staff. (See requirement 6) Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 13 One service user has moved bedrooms and no longer has an en-suite bathroom. It is not clear how or why this decision was made or whether the service user was involved in making this decision. (See requirements 3 & 7) Kirkstall Lodge DS0000053104.V305382.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): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported to maintain and develop a fulfilling quality of life, and there are opportunities for personal development, appropriate activities and leisure, access to the local and wider community and friendships and family relationships. There is a healthy diet that meets the cultural and nutritional needs of each service user. EVIDENCE: Service users are involved in a variety of daytime activities; these include attending day centres, college courses and one-to-one activities with staff. An aromatherapist and masseuse also visit one service user at home on a regular basis. One service user said, I cook at college and bring the food home to eat every week, but we are having a break from college at the moment for the summer holidays. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 15 There is a house vehicle and a member of the support team is employed as a support worker/driver. There are many outings to places of interest. Recent trips have included Hampton Court and Kew gardens. There have also been trips to the disco, cinema, swimming, bowling, museums and local shops, cafes, restaurants and parks. One service user enjoys dictating letters to staff to send to famous television personalities. Service user can maintain their friendships and relationships whilst living in the home, with visits, telephone calls and letters. A service user said, My sister phones in the evening because she knows I will be back home then. The service user also visits her sister regularly and proudly showed photographs of a recent family wedding that she had attended. Another service user was recently escorted to visit her mother in a residential care home for older persons. One service user had recently had a barbeque birthday party that was reported to have been a great success. There is a television and music centre in the communal lounge and arts and crafts materials are available. The cultural and spiritual needs of individual service users are recorded and steps are taken to meet these needs. For example one service user regularly attends church and culturally appropriate meals are prepared and served for one service user who is Italian. Staff were observed to interact well with service user and to readily engage in conversation. A recent placing authority review recommends that staff communicate more using signed communication for adults with a learning disability and staff training in effective communication is recommended. (See recommendation 4) Meals are served in the dining area of the communal lounge. Records indicate that a range of meals are served in accordance with individual needs, such as wheat free, dairy free, meals suitable for someone with diabetes and culturally appropriate meal choices. Individual likes and dislikes are also recorded. One service user requires support with eating meals and with ensuring that food is cut up properly. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 16 A relative has queried the arrangements for paying for food when a service user stays with a relative for a period of time. These arrangements should be clarified and appropriate steps taken to reimburse relatives when appropriate. (See recommendation 5) Kirkstall Lodge DS0000053104.V305382.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in the way they prefer and require and health care needs are addressed promptly. However, plans are not in place to address all healthcare needs. This is essential to enable pro-active healthcare. Medication is generally handled well although administration instructions are not in place in some cases and staff training must be assessed to ensure that staff are fully trained and competent. EVIDENCE: Service users require varying levels of support with maintaining their personal hygiene from full support to verbal prompting. Personal support is provided in private, either in bedrooms or in bathrooms and each service user has a written personal care guideline detailing the nature of support required. There are currently two male service users and two female service users. There are both male and female staff available to provide personal care, but same sex personal care cannot always be provided. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 18 There is a designated key worker system in place and on occasions when additional staff are required they are supplied via a bank system from other home run by the registered provider in the area. There is evidence that appropriate advice is taken in regard to specialist support from physiotherapists, occupational therapists and speech therapists and necessary adaptations and equipment are in place. There is evidence in records that the healthcare needs are well met. However, records are replicated in many areas in this is confusing for staff who are completing several different sets of records. Staff should have a whole picture of each persons healthcare readily available. (See recommendation 6) Records of health appointments show that service users have regular input from the GP, dentist and other health professionals. A health needs assessment is completed for each service user, and each service user has specific health goals, for example, exercise and healthy eating plans in place to aid weight reduction. Lambeth SLAM NHS Trust Health Action Plans are completed for each service user. Most identified health needs have associated care plans. There is a need to ensure that all health issues have associated health care plans. (See requirement 8) Although Health Action Plans specifically for adults with a learning disability are in place, it is not clear whether these plans have been shared with each service users GP as required. (See recommendation 7) Medical, health and progress notes show evidence of effective health monitoring, for example, one service user had painful joints, they saw the GP quickly and the GPs recommendations are documented. A GP from the local group practice, involved in the care of the service users, confirmed: • Staff from the home communicate clearly and work in partnership with the group practice • Senior staff are available to confer with • Consultations are held in private • Staff demonstrate a clear understanding of the care needs of service users • Specialist health advice is incorporated into plans • Medication is managed appropriately • Managers and staff make appropriate decisions when they can no longer manage the care needs of service users • No complaints have been received about the home • Satisfaction with the overall care provided to service user within the home Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 19 All service users are taking their prescribed medicines regularly and no prescribed medication is out of stock at the time of this inspection. The supplying pharmacist conducts regular audits. The four reports of these inspections provide evidence that any comments made in the reports are addressed, for example, obtaining lockable storage for medication stored in the fridge. There are no outstanding issues. Medical device alerts have been printed off and actioned where necessary. A district nurse visits one service user each day to administer insulin. Each visit is recorded, and MAR (Medication Administration Records) are signed to record the injection has been given. The date that the insulin is opened is recorded. There is a written risk assessment and guideline for what to do if the service user goes into a diabetic coma and there is adequate information available to enable staff to prepare suitable meals. The variable dose of insulin administered by the District Nurse should be recorded on the MAR chart. (See recommendation 8) The use of external products (such as creams) is recorded. Service users are given their medication when they are away from the home, for example, on holiday or when they out for the day. Some prescribed items do not have full instructions on the MAR chart, for example, some entries state to be used As Required only. There is a need to ensure that the prescription from the GP has full instructions, and that the Pharmacist adds the full instructions to the MAR chart. (See requirement 9) Quantities of PRN medicines are not added to MAR charts. This must be done to enable effective stock checking. (See requirement 10) All staff administering medicines receive training. Certificates are available in staff training records. The pharmacist provides some training and staff also attend a three hour workshop. There must be a system for assessing competence and ensuring that the training is adequate and covers all of the required areas, for example, handling of refusals and errors, side effects, and what the medicines are used for. (See requirement 11) Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure in place, although care must be taken to ensure that procedures for recording complaints are suitable to the needs of the service users. Adult protection procedures are in place, but the service has failed to notify the CSCI and placing authorities of significant events and injuries in some cases and measures to ensure that service users are protected from financial abuse are inadequate. EVIDENCE: There is a complaints procedure in place. The record of complaints shows that there have been no complaints made in the last 12 months. There are regular opportunities for service users to discuss issues during regular key work and house meetings. Given that the service users are not able to make formal written complaints it is essential that a record be kept of any complaint made verbally, and that such complaints/concerns are listened to acted upon accordingly. (See recommendation 9) Procedures are in place for responding to suspicion or evidence of abuse or neglect (including whistle-blowing) to ensure the safety and protection of service users. There are adult protection procedures in place that include dealing with aggression and service users finances held in safekeeping. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 21 However, the procedures in regard to the safeguarding of valuables and finances have not been followed and there are valuable documents, bank account books, pin numbers and cash cards readily available to all staff with no record of safekeeping or checks in place. This does not provide service users with adequate protection from financial abuse. (See requirement 12) Staff on duty on the day of the inspection demonstrated an understanding of possible reasons for aggressive behaviour and evidence suggests that they have been pro-active in responding to issues of deteriorating mental health and self-care. The regional manager is aware of the need to ensure that staff, awaiting full enhanced criminal record checks, are subject to satisfactory POVA first clearance before working in the home and the need for staff with only POVA first clearance to be supervised whilst working. The regional manager has taken appropriate action and notified appropriate authorities about a recent incident with adult protection implications. Staff have not yet all been trained in adult protection and abuse awareness. Failure to make correct notifications and appropriate staff training was the subject of a previous requirement that is not met. (See requirement 13) Records examined during this inspection show that staff complete body charts when a service user sustains an injury of any sort. These records show that one service user sustains occasional bruising and scratches. These injuries may be self-inflicted in some cases, but placing authorities and the CSCI must be notified of any injury. The placing authority and CSCI were not notified of the two small but unexplained bruises in June 2006. (See requirement 14) The regional manager is taking appropriate action to safeguard one service user whose care is currently subject to an adult protection investigation. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 22 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, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is comfortable and clean but some communal areas are not accessible to a service ser with mobility needs. EVIDENCE: The small home is clean, comfortably furnished and well decorated. All bedrooms are single occupancy. There are two ground floor bedrooms, one with en-suite bathroom facilities. There is a ground floor wet shower room that is in the final stages of refurbishment and a separate toilet. The ground floor has a communal lounge with a dining area, a small kitchen and patio access to a small rear garden. There is also a small office area within the communal area and another small office is in the garden. The first floor has four bedrooms, one of which has en-suite bathroom facilities. There is a bathroom with a toilet and a small laundry room. One bedroom is currently used for staff that are sleeping-in at night. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 23 All bedrooms are well decorated and furnished attractively, although not all contained the fixtures and fittings listed in the national minimum standard, for example, lockable areas and a second comfortable chair. (See recommendation 10) One bedroom door lock is missing and staff explained that the lock had been removed after a service user had locked himself in his bedroom by accident. Service users who wish to must be given a key to the home and to their individual bedrooms. To ensure safety, staff must have access to a master key of some sort to enable access in an emergency. (See requirement 15) The rear garden is not accessible to one of the service users who has mobility problems. The garden path is comprised of both slabs and gravel and is an uneven surface to walk on. The garden chairs are not appropriate to the needs of this service user and staff are fearful that the service user may injure herself. These issues must be addressed with advice from an occupational therapist. (See requirements 16 & 17) One service user refuses to sleep in a bed and prefers to sleep in a reclining chair instead. Advice must be sought from a qualified occupational therapist as to the appropriateness of the chair recently purchased. (See requirement 18) Bathrooms and toilets are fitted with appropriate privacy locks and hot water is regulated to within safe temperature limits. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 24 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 & 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are not thorough enough and staff have not been effectively inducted or supervised. Staff training must be increased and more staff must attain a vocational qualification. EVIDENCE: There is high staff turnover and this has affected staff continuity and staff training plans. There are currently seven members of staff regularly working in the home, three senior support workers and four support workers. The majority of staff began working in the home in 2005. One member of the care team has attained an NVQ at level 3 and 5 members of staff are currently working towards and NVQ at level 2. Progress in attaining a satisfactory percentage of vocationally trained staff will be examined during the next inspection visit. The following training has taken place: • Health and safety Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 25 • • • • • • • • • • Food hygiene First aid Fire safety (only 2 staff have recent training however) Infection control LADF Autism Assessment and Intervention: Mental health and learning disability Medication competence Person centred planning POVA Manual handling Not all staff have attended each training session and some require refresher courses, some of which are scheduled for July, August and September 2006. There is also a need to ensure that all staff receive specific training in meeting the needs of the current service users. Training should include: • Communicating with adults with a learning disability • Signed communication • Epilepsy • Diabetes • Equal opportunities • Capacity to consent • Risk assessment (See recommendation 11) Individual files are kept of each member of staffs recruitment. This includes application form, self-declaration of health and criminal records and references. However, one member of staff has not completed the selfdeclaration of criminal record although it has been signed and professional references for other staff have not been authenticated in some cases. Each member of staff has an enhanced criminal record bureau check in place. (See requirement 19) On occasions bank staff have also covered shifts in the home. These are care staff who work in other registered homes that the registered provider operates. Staff records indicate that staff have not received a structured and evidenced induction to working in the home. (See requirement 20) Staff records indicate that staff have not been supervised with the required frequency. (See requirement 21) Kirkstall Lodge DS0000053104.V305382.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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is no registered manager and there are unmet requirements from previous inspection reports. Quality assurance systems based on the views of service user are not in place. EVIDENCE: There has not been a registered manager in post in the home for many months. Interim management arrangements have been in place as an interim measure. The regional manager has also resigned recently, the new regional manager, who facilitated this inspection, has been in post for three weeks at the time of this inspection. This has been difficult for staff and may have contributed to the significant number of requirements in this report. Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 27 A new manager has been recruited and is due to commence in post once satisfactory checks are completed. An application for the post of registered care manager must be completed as soon as possible. (See requirement 22) A representative of the registered provider conducts monthly inspection visits to the service, in accordance with regulation. Copies of the reports of these visits are available in the home and have been supplied to the CSCI. Quality monitoring systems are not fully developed and do not include stakeholder audits. (See requirement 23) Fire evacuation procedures and a building floor plan are displayed. Fire evacuation drills are held regularly and the outcome of the drill recorded. Fire detection equipment is tested each week, and the fire fighting and detection equipment is also professionally tested on a regular basis. Records are kept of fridge and freezer temperatures and hot water temperatures are tested and recorded. Records show that temperatures are maintained to within safe limits. Building and equipment safety certificates seen show that: • The gas appliances were tested on 09/05/06 • The mains electrical system was tested on 03/11/03 • Small electrical appliances were tested in 05/06 • Legionella tests were conducted on 10/03/06 A food hygiene inspection as carried out by the local authority on 29/03/06. The report of this inspection comments that the food preparation and kitchen environment are satisfactory and there is good monitoring. Kirkstall Lodge DS0000053104.V305382.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 3 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 2 28 2 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 1 X 1 X X 3 X Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 4 5 Requirement The registered person must supply the CSCI Southwark office with copies of the revised statement of purpose and service users guide. Current service users must be consulted about any significant changes. The registered person must ensure that pre-admission and trial placement assessment documents and all records of care delivered to service users on trial placement are retained for inspection. The registered person must ensure that contracts with service users contain the National Minimum Standard of information. This must include the rooms to be occupied under the agreement. The registered person must ensure that care plans and goals are dated to evidence recent review. The registered person must review and assess the risks posed to each individual service user. The registered person must DS0000053104.V305382.R01.S.doc Timescale for action 31/10/06 2. YA2 14 15/09/06 3. YA5 12(5) 15/09/06 4. YA6 15(2) 15/09/06 5. YA9 13 15/09/06 6. YA7 20 15/09/06 Page 30 Kirkstall Lodge Version 5.2 7. YA7 12 8. YA19 12 9. YA20 13(2) 10. YA20 13(2) 11. YA20 13(2) 12. YA23 12 13(6) 13. YA23 13(6) ensure that the management and support service users receive to help with management of their finances is transparent and that individual accounts held by service users are retained at the home. The previous timescale of 30/11/05 is not met. The registered person must ensure that service users are consulted about decisions such as moving bedrooms and must ensure that such decisions are made only in a service users best interest or as a result of specific request. The registered person must ensure that there are plans in place to address all healthcare needs of each service user. The registered person must ensure that there are detailed instructions in place for the administration of all prescribed medications. The registered person must ensure that medication administration records detail quantities of As required medication in stock. The registered person must supply the CSCI Southwark office with evidence that staff training in medication is appropriate to the needs of the service and contains an element of competence assessment. The registered person must ensure that systems, records and checks are in place to provide service users with adequate protection from any financial abuse. The registered person must ensure that staff are provided with adult protection training. Placement social workers to be DS0000053104.V305382.R01.S.doc 15/09/06 15/09/06 15/09/06 15/09/06 13/10/06 15/09/06 15/09/06 Kirkstall Lodge Version 5.2 Page 31 14. YA23 37 15. YA26 12 16. YA28 12 16 23 17. YA28 23 18. YA29 12 19. YA34 13 19 notified immediately of any unexplained injury sustained. The previous timescale of 30/12/05 is not met. The registered person must ensure that the CSCI Southwark office is notified of any event in the care home that adversely affects the health, safety or well being of any service user. The registered person must ensure that service users who wish to are able to lock their bedroom doors and retain the key. Keys to the front door must also be provided unless there are specific and demonstrable risks for not doing so. Bedroom door locks fitted must be of a type that will allow staff access in an emergency. The registered person must ensure that the rear garden is suitable to meet the needs of all service users (the uneven surface must be repaired or replaced). The previous timescale of 30/12/05 is not met. The registered person must ensure that a range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. This must include full access to the garden area for a service user with a mobility need. The registered person must seek the advice of an occupational therapist as to the appropriateness of a reclining chair (recently purchased for a service user who has a mobility need) to sleep in at night on a regular basis. The registered person must ensure that essential information DS0000053104.V305382.R01.S.doc 31/08/06 15/09/06 31/10/06 31/10/06 15/09/06 31/08/06 Kirkstall Lodge Version 5.2 Page 32 20. YA35 18 21. 22. YA36 YA37 18(2) 8 23. YA39 24 is available for all new staff before they commence employment. Professional references must be authentic and verified. The registered person must ensure that all staff receive a structured induction to the home and induction training in accordance with Sector Skills Council workforce training targets. The registered person must ensure that staff are given appropriate levels of supervision. The registered person must submit an application for the post of registered manager to the CSCI. The registered person must ensure that an annual development plan is formulated, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users. Previous timescales of 27/05/05 and 30/11/05 not met. 31/08/06 31/08/06 31/10/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 YA5 Good Practice Recommendations The registered persons should revise the service users guide and service user contracts to ensure that the additional information required by changes in legislation (coming into force on 1st September 2006) are added. The registered person should ensure that care files are weeded of out of date information so that staff can easily access current care plans and risk assessments. Out of date information should be kept in a separate file. DS0000053104.V305382.R01.S.doc Version 5.2 Page 33 2. YA6 Kirkstall Lodge 3. YA9 4. 5. YA11 YA32 YA17 6. 7. 8. 9. 10. YA19 YA19 YA20 YA22 YA26 11. YA32 The registered person should develop a risk audit tool that enables staff to methodically assess risks posed to service users and tracks current risk assessments and review dates. The registered person should train staff in effective communication specifically for adults with a learning disability and communication needs. The registered person should clarify the financial arrangements for the cost of food consumed by service users when away from the home, at either a day service or when staying with relatives or friends. The registered person should ensure that records relating to healthcare are easily accessible and that each resident has a single record for healthcare. The registered person should ensure that individual health action plans are discussed and agreed with each service users GP. The registered persons should record the variable dose of insulin administered by a district nurse to one service user with diabetes. The registered person should ensure that verbal complaints made by service user are listened to, recorded and acted upon. The registered person should ensure that service users bedrooms contain all items listed in national minimum standard 26.2. Where a service user expressly refuses a particular item a record of this decision should be kept in the persons individual plan. The registered person should ensure that staff are trained in meeting the specific needs of the current service users. Training should include: • Communicating with adults with a learning disability • Signed communication • Epilepsy • Diabetes • Equal opportunities/disability focus • Capacity to consent • Risk assessment • Abuse awareness Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. Extracts may not be used or reproduced without the express permission of CSCI Kirkstall Lodge DS0000053104.V305382.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!