CARE HOMES FOR OLDER PEOPLE
Kyffin Taylor House Deyes Lane Maghull Liverpool Merseyside L31 6DJ Lead Inspector
Mrs Trish Thomas Unannounced Inspection 30th January 2006 13:30 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.V282611.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V282611.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kyffin Taylor House Address Deyes Lane Maghull Liverpool Merseyside L31 6DJ 0151 526 4133 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.V282611.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should employ a suitably qualified and experienced Manager who is registered with the CSCI. 24/08/05 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.V282611.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The methods used during this un announced inspection were, discussion with residents and the manager and a care assistant, direct observation and reading care and health & safety records. Requirements from the last inspection of August 05 were checked and outstanding standards assessed. What the service does well: What has improved since the last inspection?
The standard of professional assessments for service users admitted to Kyffin Taylor dementia respite service, has improved since the last inspection. Those which were read, provided sufficient information for the manager to make the decision as to whether the home can meet the prospective resident’s needs, prior to admission.
Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 6 The manager said that staffing levels have been reviewed and there are sufficient numbers of staff on duty to meet residents assessed needs. As the home provides a respite service, there are extra demands on staff on admission and discharge days. In the sample of care plans for residents of the dementia respite service, behavioural strategies and proof that specific programmes had been carried out were included. Risk assessments have been carried out and the home’s missing persons policy provided to staff under the organisation’s “see and sign” procedure. 50 of staff have achieved NVQ qualifications. A course in Positive Dementia, has been attended by staff, and mandatory training is ongoing. A structured programme of activities has been arranged and in addition, the activities co-ordinator has input three times a week. Activities records are maintained and outings are arranged every month for residents. The way in which the service is managed for permanent and respite residents has been reviewed, and the respite and permanent lounges have been exchanged in consultation with residents. Permanent residents were consulted prior to the home being registered for dementia respite. They were offered alternative accommodation and have chosen to remain in Kyffin Taylor. In order to support them and increase their understanding and tolerance of respite residents who may present challenging behaviour, the manager has arranged for staff from a local dementia day hospital to visit Kyffin Taylor. A presentation will be given for permanent residents, to explain the definitions of dementia and associated behaviour. What they could do better:
In order to protect residents from the risk of fire and ensure that staff are competent to follow correct fire safety procedures, the manager must arrange for a fire drill, and for ongoing fire drills to be carried out at suitable intervals. The last recorded drill was July 05. The manager should arrange for unused prescribed dressings to be returned to the pharmacy. As with medication, dressings must only be used for the person for whom they were prescribed. The manager should arrange for communal areas (and bedrooms as necessary) to be decorated. The wooden base units in the kitchen were recommended for replacement by the Environmental Health Officer and this recommendation is repeated from the last CSCI inspection. Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 8 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.V282611.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Assessments for residents of the respite service contain sufficient information to establish their levels of dependency and support needs. EVIDENCE: The manager said that since the last inspection, the standard of assessments for residents admitted for dementia respite services, has improved. Prospective respite residents are often admitted at short notice and their levels of need and capacity are unknown to the home. Initial assessments for these residents, are faxed to the home by social services and updated if necessary. Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 The revised care plan format is satisfactory in planning the means by which residents’ mental/physical health and personal care needs will be met. All permanent residents are registered with a G.P. and respite residents have access to a G.P. whilst living in Kyffin Taylor. Residents’ health care needs are recorded on each individual’s care plans. The home has a medication policy and there are procedures in place for recording, storing and auditing medication brought into the home. EVIDENCE: All residents have a care plan and a sample of three was read. The careplanning format has recently been changed to one, which is more concise. The manager, Mrs. Quinn, said that the revised format is an improvement and is workable and that six- monthly reviews for permanent residents had been completed. For residents receiving the dementia respite service, their assessments are faxed to the home from social services. Assessment of need continues, post admission by home’s staff, and each care plan is reviewed and updated as needed. Care files, which were read, had been satisfactorily
Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 11 maintained in accordance with the presenting needs of the individuals, and contained risk assessments. Permanent residents are registered with local GPs. If respite residents, become ill whilst staying in the home, they attended by a locum GP. Care files included records of G.P. and professional visits. All residents have access to paramedical services and are supported in attending appointments at local hospitals and clinics. The home has a system for managing residents’ prescribed medication. The respite service generates regular admissions and discharges. Medication brought in for these residents is checked and signed by two members of staff. For storing medication, there is a locked/secured trolley and locked metal cupboard. Medication records were satisfactorily maintained and the storage areas were secure. A number of redundant dressings were observed in store and a requirement is made that all unwanted prescribed dressings are returned to the pharmacy, as these must not be stock piled. Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 The home has an activities programme, which is relevant to the preferences of those in residence. Permanent residents have maintained contact with family and friends. The majority of respite residents return to their own homes on discharge from Kyffin Taylor. EVIDENCE: During the inspection I met a group of residents of the dementia respite service, in the lounge. They were drawing and colouring, supervised by a member of staff. One of the permanent residents, who enjoys knitting and sewing, was doing a jig-saw. She said she has started to knit another cardigan. The second lounge was quiet and residents were reading or watching television. I spoke with three residents of the respite service, who responded briefly. The member of staff was effective in motivating residents to become involved in the day’s activities, including a resident who had difficulty in concentrating. Residents appeared to be moving freely in the communal areas of the home and appeared relaxed. The manager said that an activities log has been started. Outings are arranged once a month (afternoon tea at a restaurant had been scheduled for the following week) and a trip to
Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 13 Chester was planned. The manager said that the in-house activities coordinator visits the home three times a week and arranges a range of crafts, quizzes and gatherings for residents. I spoke with a permanent resident, who said things were going well for her. She was not taking part in group activities. She had been in contact with relatives, who do not live in the area. She said that staff are very good and help her to get to her hospital appointments. For residents who are receiving a dementia service, Kyffin Taylor is not their permanent home and they usually return to their own homes on discharge. The dementia service provided in Kyffin Taylor provides respite to residents and their carers. This support system enables family carers to take a holiday or break, and the service users to remain with their families/carers in the community. Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 There are systems in place to protect residents from abuse. EVIDENCE: Reference was made to the home’s Adult Protection and “Whistle Blowing” procedures. The manager said that some staff have received training in Protection of Vulnerable Adults and further training in this is arranged through Sefton Social Services training unit. Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 The home is generally well-maintained and comfortably furnished. The gardens are extensive, well planted and accessible for residents. Some areas are in need of decoration. The building is maintained to good standards of hygiene and there are systems in place for infection control. EVIDENCE: From direct observation, the exterior of the home looks well-maintained, the gardens are secure, well planted and attractive with pathways, flowers beds and a patio. There is a car park for the use of visitors and staff. The manager said that a ramp is to be fitted at the front of the building. There is level access to the patio from the dining room. The lounges, though comfortable, were looking “tired “ and in need of decoration. The dining room is light and airy with views of the garden. The dining tables were clean and wellpresented .The home is furnished in domestic style and residents’ bedrooms are personalised and well-equipped.
Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 16 The home was clean, pleasant and hygienic, in the areas which were visited. Domestic staff are employed and provided with protective clothing and training. A cleaning schedule is in place and systems for infection control and COSHH (control of substances hazardous to health). A resident who commented said she likes the layout of the home and her bedroom is very comfortable and to her liking. She said the dining room is beautiful and very bright. She said that staff work hard to keep the home clean but they are always pleasant and friendly. Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The home has an appraisal system, and staff are trained and competent to do their jobs. EVIDENCE: The training plan was read. The manager said that training is planned two months in advance. Training planned or undertaken in recent months includes Emergency Aid, Moving and Handling, Protection of Vulnerable Adults, Fire Awareness, Basic Food Hygiene. Staff have received Positive Dementia training through a local college. Over 50 of staff have an NVQ qualification. Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 38 There is a quality monitoring system in place and residents’ financial interests are safeguarded. Health and Safety Certification is up to date. EVIDENCE: An annual quality monitoring exercise is carried out by an external agency. The manager said she is in the process of setting up a quality assurance file. There are regular residents’ meetings and they are encouraged to become involved in decision-making. There is ongoing consultation regarding a review menus on offer, and residents have expressed satisfaction with the changes. The home does not become involved in residents’ personal finances. In instances where personal allowances are held on behalf of residents, records are maintained of all transactions and receipts retained for purchases. All transactions have double signatures. The home has a revised procedure for handling money.
Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 19 The home has a policy, which prohibits smoking in the building. Since the last inspection, risk assessments have been reviewed and updated. COSHH assessments have been reviewed and were up to date. Health & Safety certification, gas and electricity certificates and fire safety tests were up to date. A fire drill is due as the last fire drill was recorded as July 05. Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 20 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 23(4)(e) Requirement The manager must arrange for a fire drill to be carried out in the home. Timescale for action 06/03/06 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. 2. 3. Refer to Standard OP9 OP19 OP19 Good Practice Recommendations The manager should ensure that all unused prescribed dressings are returned to the pharmacist. The manager should arrange for a programme of decoration to include communal areas and bedrooms as necessary. The manager should arrange for the wooden base units in the kitchen to be replaced (in accordance with the Environment Health officer’s recommendations). Kyffin Taylor House DS0000005416.V282611.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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