CARE HOMES FOR OLDER PEOPLE
Kyffin Taylor House Deyes Lane Maghull Liverpool Merseyside L31 6DJ Lead Inspector
Mrs Trish Thomas Key Unannounced Inspection 15th December 2006 11:00 X10015.doc Version 1.40 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 Kyffin Taylor House DS0000005416.V295384.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 Older People. 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. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kyffin Taylor House Address Deyes Lane Maghull Liverpool Merseyside L31 6DJ 0151 527 2822 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) Parkhaven Trust Mrs Joan Quinn Care Home 20 Category(ies) of Dementia (7), Dementia - over 65 years of age registration, with number (7), Old age, not falling within any other of places category (20) Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. 20/01/06 Date of last inspection Brief Description of the Service: Kyffin Taylor House is a care home, which is owned by Parkhaven Trust and the manager is Mrs. Joan Quinn. The home is registered for 20 older people (including 7 dementia respite beds), situated on a private estate on Deyes Lane Maghull. All bedrooms are for single occupancy, there being ten bedrooms on the ground floor and ten on the first floor. Communal areas include two lounges and a dining room. There are good views from the windows of the surrounding gardens, which are well maintained and secure, and include a patio with seating and extensive flower garden at the rear. There is a visitors and staff car park at the front of the building. There is level access to the rear exterior for residents who have poor mobility. The home has a passenger lift and call facilities to summon staff, are available throughout the building. The home is staffed throughout the day and night and staff receive mandatory training and undertake NVQ from levels 2 to 4. The home employs a chef, meals are home cooked and special diets are catered for as necessary. The home is situated close to bus routes and local shops and amenities. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An un announced visit was carried out to Kyffin Taylor and discussion took place with residents, the manager Mrs. Joan Quinn, and staff on duty. Records maintained in the home regarding care, health & safety and staffing were seen and a tour of the premises was carried out. What the service does well: What has improved since the last inspection?
The following requirement and recommendations from the last inspection have been met. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 6 Regulation 23(4). Regular fire drills have been carried out since the inspection of January 06. A fire drill was due at the time of visit. Un-used prescribed dressings are now returned to the surgery and not retained for stock. The kitchen base units which were wooden, have been replaced. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 4 Quality in this outcome area is good. Residents are admitted to the home on the basis of a full assessment of need carried out by people who are trained to do so. The registration certificate does not reflect the correct numbers of residents whose needs fall into the category of dementia. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Reference was made to the care files of two residents, which contained assessments by social workers and by staff from Kyffin Taylor. Reference was made to admissions and discharge records and discussion took place with the manager, Mrs. Quinn. There are a high number of admissions
Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 9 and discharges to and from the home, by residents who use the dementia respite service. The home has a system for reviewing respite residents’ progress three days after admission. On discharge, a letter is sent to the resident’s family/representatives summarising their progress and general condition during their stay in Kyffin Taylor. The social services department who contracts the service is also updated on respite residents’ progress. For permanent residents, their care plans are reviewed monthly or more frequently if necessary if there is a deterioration/improvement in the individual’s general condition. The home is in a transition period regarding the registered category. Following consultation with residents/representatives, it is intended that residential/elderly beds will be phased out, and the home will be fully registered in the category of dementia/elderly. A number of residents, who do not have dementia, chose to continue to live in Kyffin Taylor at the time the dementia respite service was registered, and their wishes have been respected. At the time of this visit, the manager, Mrs. Quinn said that four permanent residents’ needs are now within the category of dementia / residential. A requirement is given that application be made for a variation to increase the numbers of registered dementia beds in the home and that the residents and their representatives are informed. Kyffin Taylor does not provide an intermediate care service and was not assessed against Standard 6. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10. Quality in this outcome area is good. The home has established satisfactory systems for maintaining relevant records and making arrangements for residents’ health, personal and social care needs to be met. The home was meeting the needs of residents whose care plans were seen and those who were spoken with. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were thirteen permanent residents and four residents receiving respite care at the time of inspection. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 11 The care plans of three residents were seen, one was that of a permanent resident and two of residents of the respite service, and the residents were spoken with. Care files follow a standard format and contained records of assessments of need, action plans and reviews. Records of assessed needs were cross checked with action plans and there were care plans in place to meet areas of need which had been assessed, including those for dementia, safety, mobility, personal and social care. To support the actions to be taken to meet residents’ needs, risk assessments and reviews had been carried out. All permanent residents are registered with local G.P.s and there are arrangements for residents of the respite service, who do not live permanently in the area, to receive the services of an on-call doctor if needed. There were records of arrangements for clinic / hospital appointments and of medical / paramedical referrals and treatments. The home has a procedure for managing residents prescribed medication, including one for residents’ of the respite service, to ensure that a supply of their medication is available on admission. Medication is stored in a locked and secured trolley and administration records were satisfactorily maintained. The records of the three residents previously referred to were checked and there were adequate stocks held of their prescribed drugs. The manager and staff on duty confirmed that staff have received relevant training in administering residents’ medication. A recommendation from the last inspection regarding returns of unused prescribed dressings to the pharmacy, had been met. The home has a policy on privacy/ confidentiality and files and records are stored securely in the office. Residents who were spoken with expressed no concerns regarding respect for their privacy and dignity. They have single accommodation and one resident said he/she has a bedroom door key. Three residents who were asked, said they receive their mail unopened and that staff do not become involved in their personal business. Bedroom and bathroom doors were seen to remain closed during the visit and staff on duty expressed awareness in conversation and in practice, of the home’s policies on privacy, dignity and confidentiality. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15. Quality in this outcome area is good. Day space has been organised to meet the needs of permanent and respite residents and the service, lifestyle and culture on offer in Kyffin Taylor appear to be meeting their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five residents who commented and said things were going well for them. They were having a sing-along in the lounge. One resident said, “They are very good here, the staff, nothing is too much trouble.” Residents in the respite lounge were doing a jigsaw. One resident loves knitting and sewing, she said, “I like to keep busy and there are things going
Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 13 on to keep us occupied.” Staff appeared competent in involving residents who have dementia in activities and progressing at a pace which suits them. Individual activities logs are held on residents’ files. An activities co-ordinator is employed, who visits the home four times a week for about three hours each session and there is also a visiting hairdresser. The manager said that residents who live permanently in Kyffin Taylor were becoming used to having a respite service being run from their home, and make welcome the new residents who are admitted each week. One resident said, “People come and go, they are all very pleasant and don’t interfere with me. The staff are good, they are there if we need them.” The respite service supports the residents, and their families who care for them at home, by providing regular respite breaks. The service enables them to remain in the wider community and provides ongoing assessment of needs. Some residents are admitted in emergency/crisis situations. All residents are encouraged to have regular visitors and their beliefs are recorded in care plans and supported. Residents who commented on food said they had no complaints and there are choices and alternatives available. The menus were satisfactory and record a balanced and varied diet with variety of fresh vegetables, fruit, meat and desserts. There were in stock choices of cereals, bread, hot and cold drinks and fresh fruit and vegetables. A resident said, “We get plenty to eat and they are always bringing drinks round.” The dining room is very well presented, light and airy with adequate seating for the residents and good views of the garden. From reading records and observation it is evident that residents’ rights exercise choice and control over their lives, is subject to risk assessment and risk management. Residents who are assessed with dementia receive high levels of supervision and remain in the lounge during the day, others who are not at risk, spend time in their bedrooms during the day, reading or watching television. Residents are allocated key workers and social histories and personal preferences are recorded on their files to ensure that as far as is possible, the lifestyle in Kyffin Taylor meets their expectations. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 18 Quality in this outcome area is good. The home has a complaints procedure which is made available to residents and their representatives on admission. Service users are protected from abuse through the home’s procedures, staff vetting and training programmes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure and a copy is provided to each resident and/or their representative on admission to the home. The procedure is also posted on the residents’ notice board. There have been no complaints about Kyffin Taylor made to CSCI in the past twelve months. Three residents when they were asked, said they would tell a member of staff if anything was troubling them. The home has “whistle-blowing” and adult protection procedures and staff have received the relevant training. The home’s recruitment procedures include vetting of staff to ensure they are fit to work with elderly and vulnerable people.
Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 15 Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,26. Quality in this outcome area is good. The home is well maintained and homely in a peaceful setting. Some areas are in need of decoration. The home is maintained to very good standards of hygiene. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Kyffin Taylor was in good order and well maintained at the time of the visit. The home has a pleasant atmosphere and bedrooms and communal areas have good views of the grounds and have been furnished in domestic style. The gardens are extensive and well maintained and there is a patio for residents’ use in warm weather.
Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 17 Communal areas and some bedrooms are due to be upgraded in a proposed refurbishment of the home. Residents said they were comfortable, two who were seated in the lounge who commented said, “It is lovely and comfortable and the dining room is very pleasant.” “My bedroom is very nice and cosy.” The home employs domestic staff and was clean and odour free during this visit. Residents had no complaints about the condition of the home. Those who commented said it was always the same, clean and tidy, and staff work hard to keep it that way. The kitchen and food stores were clean and well organised. The wooden kitchen base units have been replaced since the last inspection. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 Quality in this outcome area is good. Staffing levels in the home are meeting residents needs and the home’s recruitment procedures and appraisal and training programmes are aimed at protecting residents’ welfare and best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rosters were seen and were satisfactorily maintained. The manager said there were no staff vacancies at the time of the visit and that formal supervision sessions (one-to-ones) and staff appraisals were up to date. About 50 of staff are qualified to a minimum of NVQ2 and staff receive mandatory and service specific training. Staff training records gave evidence of training undertaken including, First Aid, Moving and Handling, Protection of Vulnerable Adults, Food Hygiene, Dementia Awareness, Infection Control, Health and Safety and Medication Administration. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 19 Staff said they receive formal supervision and that the training on offer is in keeping with their job roles. Staff files for three staff members were seen and were satisfactorily maintained. The recruitment procedures followed includes interviewing candidates, taking up references and police clearances. On commencing employment in the home, staff are issued with job descriptions and contracts of employment. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,38 Quality in this outcome area is good. The home is run in residents’ best interests and their welfare is safeguarded through procedures and practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs. Quinn is a qualified and experienced manager and is registered with CSCI. There are clear lines of responsibility in the home there being a deputy and senior staff who are designated specific areas of responsibility.
Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 21 The home has a quality assurance system. Questionnaires are distributed to residents and their representatives and the outcomes of the exercise are monitored and acted upon. The home has systems for regular consultation with residents and their families through residents’ meetings, ongoing reviews and an open door policy. The manager confirmed that the home does not become involved in residents’ personal finances. Residents without family/representatives have access to advocacy services. Records are maintained of monies held on behalf of residents in safe keeping for their day- to- day use. Residents who commented said they had no concerns about their money, one lady said, “My daughter takes care of everything for me, I have no worries at all and I have all I need.” Health and Safety certification was up to date : Gas Certificate 27/2/06, Five Yearly Electrical Certificate 30/1/2002, Chubb Alarms Jan 06, Lift 8/11/06, Hoist 27/11/06, Portable Appliance Tests 25/1/06. The fire book had been satisfactorily maintained and fire equipment and alarm systems had been tested. There had been three fire drills since the previous inspection Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 23 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 OP4 Regulation 14(1)(d) Requirement “The registered person has confirmed in writing to the service user, that having regard to the assessment, the care home is suitable for the purpose of meeting the service users’ needs in respect of his health and welfare.” The registered person must, following professional assessment of the residents concerned, arrange for the home’s registration certificate to be amended to reflect numbers of residents who have dementia and who are accommodated. The residents and their representatives must be informed of the actions taken. Timescale for action 18/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 24 No. 1. Refer to Standard OP19 Good Practice Recommendations The manager should arrange for a programme of decoration to include communal areas and bedrooms as necessary. Kyffin Taylor House DS0000005416.V295384.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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