CARE HOME ADULTS 18-65
Kynaston Care(80) 80 Kynaston Avenue Thornton Heath Croydon Surrey CR7 7BW Lead Inspector
Claire Taylor Unannounced Inspection 15th December 2005 1:30pm Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kynaston Care(80) Address 80 Kynaston Avenue Thornton Heath Croydon Surrey CR7 7BW 0208 665 4798 0208 665 4798 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) Mrs Efilidah Smith Mr Alan Ernest Smith Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow one specified service user over the age of 65 years to be accommodated subject to: (1) A minimum annual review of the service user’s health needs (2) All staff having the necessary skills and training to meet the service user’s needs (3) Should the service user become too physically or mentally frail and/or require nursing care, they will need to move to alternative accommodation. 29th July 2005 Date of last inspection Brief Description of the Service: 80 Kynaston Avenue is registered to provide support to three young adults with learning disabilities with a variation granted to allow one person over the age of 65years to live there. The home is owned and managed by Mr and Mrs Smith and is run as a small family type service. Located in a quiet residential area in Thornton Heath, there are accessible transport links within easy reach, including buses and trains. There is a ground floor bedroom and two bedrooms on the first floor with a staff sleep in room situated in a loft extension. Communal areas include a lounge, kitchen / dining area, bathroom / toilet and a good size garden available to the service users. Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s second inspection for the year, was unannounced and took place over an afternoon. All three service users were consulted about the services provided in the home. Time was also spent talking to one staff and the homeowner Mrs Eve Smith who arrived at 2.00pm and facilitated most of the inspection. Various records were checked and a brief walk round the premises took place. One service user’s bedroom was viewed with their permission. There have been no new admissions to the home and the registered provider reported that there have been no significant changes since the last inspection. All those who contributed to the inspection process are thanked for their time and for sharing their views about the home. A selection of standards was assessed on this occasion. Other key standards were assessed at the home’s previous inspection in July 2005 and the reader is therefore referred to that report should they require any further information. What the service does well: What has improved since the last inspection?
The registered provider, Mrs Smith has shown commitment and dedication to improve standards in the home and this is reflected by the significant reduction in the number of requirements and recommendations over the last twelve months. Six of the previous seven requirements have been addressed. Staff have now completed training on the protection of vulnerable adults meaning that they have a better understanding of adult protection issues and what action must be taken to keep service users safe. Staff files now contain all the necessary documentation to comply with regulations and show that staff are vetted correctly for their suitability to work with vulnerable adults. Training on person centred planning has also been achieved which focuses more on the
Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 6 needs of the service user as an individual. Having completed such training, the provider plans to further develop the service users care plans into a more person centred format which is seen as good practice. The health, safety and welfare of people living and working in the home are better safeguarded. Staff have completed or updated their training in health and safety, fire safety and infection control as previously required and temperature checks are now being carried out on all hot water facilities. At the last inspection, a concern was identified that the home had been in a breach of regulations i.e. a fourth service user had been staying in an unregistered bedroom for a period of time. The provider has taken this matter seriously and there was no evidence to suggest that the home had been in breach of its registration category. 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. Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 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 Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 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): X None of these standards were assessed on this occasion. Standard 2 was assessed as met at the July 2005 inspection. EVIDENCE: Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 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 the following standard(s): 6, 7 and 9 Service users’ plans of care clearly identify their needs and how they are supported to achieve their planned goals. Individual plans are frequently reviewed and reflect any changing needs. Overall, service users are consulted about, and can influence, how the home operates although meetings should be held more frequently to show how their choices and decisions are respected. EVIDENCE: All of the service users have a plan of care that is generated from a comprehensive needs assessment undertaken by each person’s placing authority. Needs assessments identified that the service users require minimal support and all lead very independent lifestyles. The plans contained details of the key needs of each service user and how staff would be expected to provide appropriate support e.g. with general basic living skills such as cooking, cleaning and laundry. Records indicated that service users are fully involved in their individual planning meetings and supported to achieve their personal goals and aspirations. In addition, service users relatives are very much included. Daily records are also kept which highlight progress; achievements and any activities participated in. Plans were being regularly reviewed and up dated. One service user confirmed that she had recently met with her care
Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 10 manager and staff at the home to discuss her future hopes and plans. The service user explained that she is hoping to move and live with her sister. Records showed that she was being supported by the home to achieve her goal. Meetings are held for service users although records showed the last one was held in July of this year. Discussions should be held more frequently to ensure that service users are regularly consulted about the home’s operation and show that their choices are respected and carried out. Service users are supported to take ‘responsible’ risks as appropriate. Relevant risk assessments, matched to individual needs are in place for all the service users. e.g. personal hygiene, use of the kitchen and accessing the home / wider community. Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 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 the following standard(s): 12 and 15 Planned around their needs and preferences, service users benefit from a choice of recreational activities and fulfilling lifestyle both within the home and local community. Service users are supported to uphold relations with friends and family. Standards 13, 16 and 17 were assessed as met at the July 2005 inspection. EVIDENCE: Care plans contained detailed information about each service user’s preferred activities and their likes and dislikes. All three service users are very independent and choose to organise their own daytime activities, including regular trips to London and Brighton for two of them. One service user holds a particular interest for trains and can travel about independently to follow his hobby. It was clear, from records and from service users’ feedback, that individuals are supported to stay in touch with family and friends, through visits, letters, and phone calls. One service user confirmed that she maintains regular contact with her family member and that they can visit the home at any time. Service users are provided with information and advice about community resources e.g. Leaflets and flyers about social events and college courses are made available as well as an information folder on leisure activities.
Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 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 the following standard(s): 18, 19 and 20 Service users welfare is closely monitored and suitable arrangements are in place to ensure that their physical, health and emotional needs are met. Medication is well managed to maintain maximised good health although staff still need to attend formal training to keep their knowledge and skills up to date. EVIDENCE: The service users require minimal support with their personal care needs and this was reflected in their respective care plans. Healthcare needs are well monitored and all visits to healthcare services are carefully documented in the service user plans. “Health visit sheets” are used to record any appointments and outcomes. Service users’ plans include details of GP involvement as well as consultant psychiatrist, dentist, outpatient clinics and optician. Records showed that one service user has made significant progress since moving to the home and as a result, their medication treatment had been discontinued, due to alleviation of anxiety episodes. Medication profiles and accurate administration record sheets were seen in those records sampled. Medication is stored appropriately within a locked cabinet in the kitchen. Service users have lockable spaces for safe storage of medication in their rooms. A previous requirement identified the need for staff to receive accredited medication training. The registered provider stated that as both she and the care staff employed are registered nurses, they have completed
Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 13 training on safe administration of medication. This is acknowledged but staff must keep their knowledge and skills up to date periodically. Trained nurses are expected to attend relevant training and this requirement is therefore repeated. Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Staff have now completed training on adult protection issues meaning that they have a better understanding of preventing abuse and service users are more fully protected. Standard 22 was assessed as met at the July 2005 inspection. EVIDENCE: There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. Since the last inspection, the provider and one care staff have received training in Adult Protection/ Abuse Awareness. Plans are in place for the provider’s husband to attend such training. Service users spoken to expressed the view that they felt they were living in a safe environment and that their welfare and rights are respected. Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 15 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, 26 and 30 The home is maintained, decorated and furnished suitably to provide service users with safe, clean and comfortable surroundings in which to live. Service users’ bedrooms provide privacy and reflect individual interests and preferences. EVIDENCE: The communal areas, bathroom / toilet facilities were viewed and one of the bedrooms, with the service user’s permission. The standard of the décor, furnishings and fittings in the home are maintained to a good standard. There is a lounge with comfortable seating and entertainment facilities including television, video and radio. Prior to this inspection, the Commission received a report from the local fire authority (10 November 2005) that highlighted some fire regulations were being contravened. I.e. The fire doors did not conform to the required British Safety Standards and there was unsuitable fastenings fitted to the rear fire exit door. The provider had taken action to address the required actions and during this visit, work was being carried out to adjust the doors so that they comply with fire regulations. One service user kindly showed the inspector their room, which they had personalised according to their preferences. The room was furnished to a good standard and clearly reflected the occupant’s individuality and personal choice. Good hygiene practices are observed and the home once again, appeared clean, tidy and free from offensive odours.
Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 16 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 and 35 This family type home has a small staff team who have been provided with appropriate training and guidance to meet the needs of the people living there. Training for staff has improved since the last inspection resulting in a more skilled workforce to meet the service users’ needs and home’s aims and objectives. Procedures for the recruitment of staff are robust and provide safeguards for people living in the home. EVIDENCE: The home has a small, but stable workforce. The registered provider, her husband and one care assistant currently provide all staffing in the home. Mrs Smith advised that she plans to recruit one more staff. The care worker on duty lives in at the premises from Monday to Friday and the registered provider and her husband cover weekends. These staffing arrangements appear satisfactory to meet the current needs of the service users. Needs assessments and care plans confirmed that the service users require minimal support and all lead very independent lifestyles. They are supported to carry out general living skills such as cooking, cleaning and laundry. As previously required, further progress has been made with regards to staff training and records confirmed that appropriate checks have been carried out i.e. two references were seen on file for the care staff employed. The staff member had also been provided with a contract of employment. Certificates showed that training undertaken since the last inspection has included person centred planning, infection control, health and safety, adult protection and fire safety.
Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 17 Although no new staff have been appointed, records showed that the induction process and orientation to the home is well organised. Learning topics include the particular needs of each individual, the worker’s role in the home and general principles of care. Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 18 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 and 42 Service users benefit from clear staff communication and good management processes. Good safe working practices ensure that the home aims to promote and protect the health and welfare of service users at all times. Standard 39 was assessed as met at the July 2005 inspection. EVIDENCE: Mrs Smith, the registered provider, has a nursing background and has experience of working with people with learning disabilities. Her husband is currently registered as the manager but Mrs Smith takes main responsibility for the day-to-day running of the home. She is clearly familiar with the needs of the service users and continues to demonstrate good management practice. Certificates of training were seen for both the owner and manager. Mrs Smith advised that she is a member of the “learning disabilities provider forum group” in Croydon and therefore keeps up to date with current practice and significant social care issues. Record keeping concerning health and safety continues to be well managed. Fire drills are organised and fire alarms and
Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 19 equipment are checked at regular intervals. Professional checks for the gas system and electrical appliances were up-to-date. Other maintenance and servicing records were not examined on this occasion, as they were checked at the last inspection and valid. Accurate records are kept for accident and incident reporting. Previous requirements had been addressed. I.e. Hot water temperature checks were being carried out on all hand basins / washing facilities within the premises and training for staff has been achieved in fire safety and infection control. Kynaston Care(80) DS0000025805.V260697.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 Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X X X X 3 X Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes- 1 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 YA7 Regulation 12(2 & 3) Requirement Meetings for service users need to be held more frequently to ensure that they are regularly consulted about the home’s operation and that show that their choices are respected. The registered provider must ensure that all staff attend accredited medication training. (Timescale of 30/11/05 not met from last inspection.) Timescale for action 31/01/06 2. YA20 18(1a&c) 19(5b) 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kynaston Care(80) DS0000025805.V260697.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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