CARE HOME ADULTS 18-65
Klair House 236 Wroxham Road Sprowston Norwich NR7 8BE Lead Inspector
Hilary Shephard Announced 27 June 2005 9:30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Klair House Address 236 Wroxham Road Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01603 417617 01603 400038 parneil@tiscali.co.uk Klair House Ltd Mr Robert Ian Arneil Care Home 10 Category(ies) of Learning disability (1), Mental disorder, registration, with number excluding learning disability or dementia (9) of places Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Nine (9) Service Users of either sex may be accomodated who are aged between 18 and 65 and have a mental disorder (in the category MD) One (1) Service User may be accomodated who has a learning difficulty and who shall be named in the Commissions records (in the category LD) The total number of service users accomodated shall not exceed ten (10)) Date of last inspection 15th February 2005 Brief Description of the Service: Klair House offers care for up to ten adults with mental heath needs. It is a domestic style detached house situated in a residential area on the outskirts of Norwich and the home blends extremely well into its surroundings. The bedroom accommodation is situated on both ground and first floors. There is good car parking space at the front of the house and a well maintained garden area at the rear. Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was carried out over 7 ½ hours, three of the ten residents and one member of staff were spoken with and their views are reflected in the report. Information was obtained from residents, staff, the manager, staff and resident files, nine comment cards from residents and three from relatives. Feedback was given to the manager and residents. What the service does well: What has improved since the last inspection? What they could do better:
The home has developed a good care plan structure, but care plans need to be updated to reflect the residents changing needs. Care plans also need to include better and clearer guidelines to enable staff to provide care, which meets the identified needs of the residents. The home manages medication well, but could improve on this by ensuring all medication received into the home is checked and booked in. Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 6 The home needs to improve its recruitment practice to protect residents from potential harm, and must ensure that two written references and checks on the Protection of Vulnerable Adult (POVA) register are obtained prior to commencement of new staff. 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. Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 4 Residents are enabled to make a choice about where they wish to live and are confident that the home is capable of meeting their needs. EVIDENCE: One resident had been admitted recently, and the manger advised that this person had visited the home on numerous occasions to ensure she was happy the staff would be able to meet her needs. Admissions are planned with the involvement of the residents’ social workers, and residents have plenty of opportunity to meet the staff and residents in the home before deciding to move in. Residents’ needs are assessed prior to admission, and the home has a good structure ensuring all areas of their health are looked at. Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 The home has developed a good care plan structure but care plans have not been updated or amended to reflect changes and do not reflect residents current needs. Residents lead their care with good staff support and are consulted with regarding planned changes within the home. EVIDENCE: Four care plans were looked at which all had a good structure for assessing residents’ needs, and planning their care. Care plans aim to be focussed on the individual residents needs and goals, which are identified by both the resident and their key worker. Recorded information about care needs was basic, and in some cases out of date. The home uses an assessment format, followed by a person centred care plan, with risk assessments and records of reviews. The assessed needs were not always reflected in the care plan, and in most cases the review contained information that should be recorded in the care plan. Care plans need to follow assessed needs providing guidelines for staff in how to meet these needs and must be updated as needs change. A recommendation has been made. Residents advised that they participated in meetings, were well aware of any changes planned for the home, and were involved with their care planning.
Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 10 Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 The food provided is fresh, well prepared, healthy and is enjoyed by the residents. EVIDENCE: The residents are asked to complete a weekly menu, advising staff of the meals they would like for the coming week and if they don’t like any of the options, they can choose off the menu if they wish. Food is bought in fresh and meals are prepared from fresh ingredients. The menu also offers a healthy option, which is often chosen by the residents. Residents advised that special diets are catered for, and the home makes an effort to prepare food they like. Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Residents are involved with their care programme, they are enabled by staff to choose how they are looked after, and the home is proactive about addressing health issues. Medication is administered, stored and recorded safely. EVIDENCE: Residents gave examples of how their health needs are monitored and advised that staff work with them to manage their mental and physical health, and also provide any adaptations needed to make their lives easier. Residents said the staff and manager were very good, and lots of positive interaction was seen during the day. Residents also receive support from their GP, Psychiatrist and other healthcare professionals. The manager and staff demonstrated a good understanding of the residents’ health needs and were quick to act when one resident became unwell. Medication was checked, and was found to be managed well. The home does not routinely book the medication into the home, and is recommended to do so. Medication is administered by staff who have undergone training with Boots. Currently none of the residents are self-administering their medication, and they advised that this was their choice, but they might consider this in the future. Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Residents feel safe, and are confident that concerns raised are listened to and dealt with. EVIDENCE: Residents advised that any concerns would be raised with the staff, and gave examples of where this had happened, and said that staff were very good at dealing with issues. They all said the manager was available and often helped them with problems. The home has very good policies and procedures regarding the management of complaints and adult protection. Staff are provided with a copy of the Norfolk Adult Protection protocol, and the homes policy has been written in line with this. The manager demonstrated a good understanding of reporting issues to the Adult Protection Unit. Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not assessed at this inspection. EVIDENCE: Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35 Residents are currently well supported by adequate numbers of experienced and trained staff, but by not following proper recruitment practices, residents’ safety is compromised. EVIDENCE: Staffing levels are provided to meet the needs of the residents, and usually one member of staff plus the manager are on duty during the day. The residents are not often all in the home together so staffing levels are increased depending on the number of residents in the home, and their level of support required. Residents said they were satisfied with the amount of staff on duty, and advised that they were good staff. One relatives comment card advised that the care and treatment provided was excellent. The manager lives close by and provides on call backup. Staff have undergone induction training, and some have obtained NVQ level 2 and have commenced NVQ level 3. Files of newly appointed staff were checked. One staff member had commenced prior to the home receiving two written references and checks made against the Protection of Vulnerable Adults (POVA) register. A requirement has been made regarding proper recruitment checks. Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 16 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39 and 42 The home constantly monitors and measures the quality of service provided, and is good at providing residents with a safe and well-maintained environment. EVIDENCE: The manager undertakes a yearly quality survey with residents and staff and formulates a report of the findings. The manager carries out regular audits against the National Minimum Standards, residents’ care is reviewed and issues within the home are discussed at residents meetings. The manager regularly reviews and updates the homes policies and procedures. The home is well maintained, and the manager has plans to develop the service further to meet the changing needs of the residents. Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 3 x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x x 3 Standard No 31 32 33 34 35 36 Score x x 3 2 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Klair House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 3 x v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 18 None 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 34 Regulation 19 Requirement The Registered person must ensure that two satisfactory written references and a clear POVA check is obtained prior to staff commencement. Staff must also work under supervision from a named supervisor whilst waiting for the CRB check. Timescale for action 11/07/05 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. Refer to Standard 6 Good Practice Recommendations The Registered person is recommended to update all care plans and risk assesssments and to provide clearer guidelines enabling staff to understand the identified care needs of the residents. The Registered person is recommended to check and book in all medication received into the home. 2. 20 Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF 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 Klair House v227501 i55 s55729 klairhouse v227501 110705 stage 4.doc Version 1.30 Page 20 - 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!
