CARE HOME ADULTS 18-65
Kynaston Care(80) 80 Kynaston Avenue Thornton Heath Croydon CR7 7BW Lead Inspector
Claire Taylor Unannounced 29 July 2005, 13.00 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. Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Kynaston Care(80) Address 80 Kynaston Care, Thornton Heath, Croydon, Surrey, CR7 7BW 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) 020 8665 4798 020 8665 4798 evemukandi@aol.co.uk Mrs Effidah Smith Mr Alan Ernest Smith Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: A variation has been granted to allow one specified service user over the age of 65 years to continue to live there. Date of last inspection 13 January 2005 Brief Description of the Service: 80 Kynaston Avenue is registered to provide support to three young adults with learning disabilities. The home is set in a quiet residential area in Thornton Heath and 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 and a good size garden available to the service users. Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during lunchtime and afternoon and lasted three and a half hours. Inspection time was spent examining records, touring the building and meeting with one staff member and one of the service users. The other two people who live at the home were not available to comment on this occasion. One service user was away for a family visit and the third was out for the day. The Commission received three comment cards prior to this inspection however of which two were from service users. The registered provider, Mrs Smith also spoke with the inspector on the telephone as the home was found to have been in breach of its registration category. This issue has been discussed under “what the home could do better”. What the service does well: What has improved since the last inspection?
The majority of previous requirements had been met and from a previous total of 29, only three remain outstanding. The provider has dealt with fire safety issues raised at the last inspection. I.e. suitable fire doors have been fitted; the fire policy amended and the premises risk assessed to ensure that the home provides adequate means of escape. The provider has also worked hard to develop administration systems in the home and standards of record keeping have much improved. This ensures that both service users and the staff can access information more easily. Appropriate staff records are now in place including relevant police checks, certificates of training and most of the other necessary documents required by the care homes regulations. The staff on duty, who has recently joined, described her induction to the home and confirmed that she had attended
Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 6 training courses in health and safety and food hygiene. Quality assurance monitoring has begun and the manager’s efforts to improve the quality of care are progressing well. 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) G53 G53 S25805 kynastoncare V192525 290705 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 Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 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 The home has its own assessment plan to ensure that any new service user’s needs are fully assessed prior to their admission and that staff are aware of how to support them. Of serious concern, the home had been in breach of its registration category by accommodating four service users instead of three. Although needs were fully assessed, service users could have been put at unnecessary risk due to living in a premises that has only been registered for three people. EVIDENCE: Since the last inspection, two service users have been admitted to the home one of whom continues to live there. Records were examined in some depth and a serious breach of regulations had occurred. Over a time period of two months, the home had been accommodating four service users when it is only registered for a maximum of three. The registered provider must ensure that only a maximum of three service users reside in the home at any one time. The Commission may consider taking enforcement action if there is such a breach of regulations again and the registered provider was advised accordingly by telephone during this inspection. The home’s registration category only allows for three service users at any one time at present. A needs assessment tool was in place for prospective service users who may be self-funding or placed without a care management assessment. Records indicate that the home undertook a thorough assessment of the new service user’s personal, social and health care needs. Completed by the care manager from the placing Croydon local authority, the assessments were found to be
Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 9 comprehensive and include all the necessary information required. An up to date care plan was also seen for each service user. The registered provider has experience of working with people who have learning disabilities. Two other care staff are currently employed, one of who has only joined recently. There was good evidence that the newest service user had received appropriate support to settle in to the home. A comprehensive admission checklist had been completed that outlined information about key aspects, rules and routines of the home as well as criteria for admission. Kynaston care’s admissions policy covers all the elements of the standard, including clear guidelines about a planned introductory period for service users. Daily notes and other records seen also showed that the service user was well supported to familiarise herself with the home. A six weekly review meeting was held following their admission to the home. Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8 and 9 Individual plans of care are reviewed and revised regularly and service users are fully involved. Service users views are always sought about the home’s operation and they are actively encouraged to participate in its day-to-day running. Service users are provided with the necessary support to take risks so that independence is maximised as far as possible. EVIDENCE: Care plans were viewed and clearly based upon a detailed needs assessment. They identified every aspect of each service user’s individual personal, social and health care needs, as well as detailed guidance for staff, with regard to the support each service user needs to achieve their identified goals and objectives. The service users require minimal support and all lead very independent lifestyles. Needs assessments and care plans confirmed that the service users need assistance with general basic living skills such as cooking, cleaning and laundry. Staff supervise individuals to participate in such skills and service users require very little support with managing their personal care. Plans were being regularly reviewed and up dated. (All completed in September 2004) Detailed daily progress notes are also kept for each individual. Service users are in regular contact with other health and social care professionals, including GP’s, Care Managers, and community based
Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 11 healthcare professionals, who are all able to check that assessed needs are being met. As required previously, service users meetings are regularly held and discussions are geared towards their views. E.g. choice of activities, food and general house issues. Staff appeared committed to ensure that service users are fully involved with the operation of the home and encourage them to contribute. 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) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 12 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) 13,14,15,16 and 17 The home promotes service users’ independence; individuals are encouraged to become part of the local community. Service users are supported to continue education and appropriate activities, so that they can maximise fulfilment and achievement in their lives. Appropriate contact between service users and their families and friends is encouraged to help them maintain relationships. EVIDENCE: Service users are provided with information and advice about community resources through, discussions with the staff and posted leaflets and flyers. The home provides an activity folder that contains information about local community activities and newsletters from “Leisure Link” who circulate details about events and other items of interest for people with learning disabilities. All three service users travel independently and choose to organise their own daytime activities, including regular trips to London and Brighton for two of them. One service user, recently retired, holds a particular interest for trains and can travel about independently to follow his hobby. Care plans seen contained detailed information about each service user’s preferred activities
Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 13 and their likes and dislikes. The registered provider and staff maintain good communication links with the service users’ respective families. Entries in the service users’ daily diary notes and the visitor’s book indicated that family, friends and guests are welcome at the home. Likewise, records indicated that staff respect service users choices and encourage them to exercise their rights around the home. The Commission received one comment card from a relative which gave positive feedback about the home and its care practices. Menus are written in conjunction with the service users and they choose the meals they wish to eat for the forthcoming week. They are also offered an alternative if they don’t like the main choice. Service users are able to eat at times which meet the needs of their social lives and participate in the preparation and serving of food as they so choose. Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 14 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) 19 and 20 Promotion of health is well observed. Service users welfare is closely monitored to ensure that their physical and emotional needs are met. Medication is well managed to maintain maximised good health although staff need to attend formal training on medication practices. EVIDENCE: Service users are registered with a local GP. Healthcare needs are well monitored and the home has “health visit” sheets in place to document any appointments and outcomes. The service users are supported to access other NHS services regularly, including dentist, consultant psychiatrist and hospital outpatient appointments for one service user. Medication is stored in a locked cabinet in the kitchen. “Superdrug” pharmacy supplies the home on a monthly basis. Medication administration records checked on the day of the inspection were up to date and accurate. The provider is required to ensure that staff receive accredited medication training however. Evidence was available that the relevant doctor or consultant undertakes reviews of medication on a regular basis. Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 15 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 The home operates a clear and effective complaints procedure that is available to all the homes service users in a suitable language/format. There are procedures and systems in place regarding the protection of vulnerable adults and prevention of abuse although staff need formal training to maximise protection for the service users. EVIDENCE: The home has a complaints procedure that meets all the elements of this Standard including a minimum response time of less than 28 days, details of how to contact the Commission as well as a detailed form to log any complaints. No formal complaints have been made about the home’s operation in the past twelve months. Service user comment cards confirmed that they were aware of the complaints process. The home has a comprehensive collection of procedures for responding to allegations or suspicion of abuse. The home has a copy of the Croydon local authority Adult Protection Procedure although staff have yet to receive formal training on abuse awareness and this must be addressed. Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 16 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) 24 and 30 The home is clean, hygienic and in a good state of repair which enables service users to live in a safe environment. EVIDENCE: The home is well positioned in Thornton Heath to access local transport, amenities and relevant support services. The layout of this family type house appears to suit the personal and lifestyle needs of the service users who live there. A brief walk round the home was undertaken to check that previous fire safety requirements had been addressed and that there were no health and safety concerns. Since the last inspection, the provider has arranged for new fire doors to be fitted, amended the fire policy and completed a risk assessment for the premises. The home appeared clean, tidy and free from offensive odours. As this is a small family type home there is no separate laundry facility and the washing machine is in the kitchen. Policies and procedures for the prevention and control of infection were in place. Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 17 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 This family type home has a small staff team who have had relevant training to meet the needs of the service users living there. Staff are given the information about what is expected of them and how to do their work properly although they should be provided with a contract of employment. Overall, recruitment practices are well managed to maximise protection for the service users although the provider must ensure that two references are obtained before staff start. EVIDENCE: Together with the registered provider who works most days, two staff are currently employed at Kynaston and as previously required a duty rota is now in place. The care worker on duty explained that she works from Monday to Friday and sleeps in on the premises at night. She stated that another staff worked at the weekends and added that the registered provider was readily available in the event of an emergency. CRB checks were seen for both employees and other staff records required by the care homes regulations were in place apart from only one reference being available for one staff. A requirement is therefore set that the provider ensure two references are obtained for all staff before they commence work. Staff must also be provided with a contract of employment that outlines the terms and conditions of working at the home. Formal staff meetings are now being held and documented. Likewise, training records are being maintained and a training plan for the home has been developed.
Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 18 Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 19 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 has good plans in place to show how they intend to make positive changes and monitor quality of care. The health, safety and welfare of service users is overall promoted and protected although some improvements are needed with record keeping to better safeguard the service users. EVIDENCE: The home has formal systems in place for ascertaining the views of the service users including satisfaction questionnaires and most recent ones offered in May of this year all indicated positive feedback. There was good evidence that Mrs Smith continues to improve the quality of the service and care provided for the service users and maintains compliance with the National Minimum Standards. Significant work has been undertaken to address and meet previous inspection requirements resulting in a notable reduction in the number set at this inspection. Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 20 Record keeping concerning health and safety is in good order. Staff were fully up to date in most areas of health and safety training i.e. moving and handling, food hygiene and first aid. The provider must arrange for staff to receive appropriate training in other health and safety topics however. I.e fire and infection control. Accurate records are kept for accident and incident reporting. Fire drills, fire equipment and system checks are now being carried out at appropriate intervals. Electrical and gas safety certificates to evidence compliance with legislation were in date. Weekly water temperature checks are carried out but only bath temperatures had been documented. The former requirement that water temperature checks are carried out on all hand basins / washing facilities within the premises therefore still stands. Environmental hazards around the home have been risk assessed although these should be expanded upon. I.e. they must specify more clearly what measures are in place to reduce the likelihood of risk, minimise the risk of injury and safeguard the welfare of the service users. Aside from this, the home was found to be safe, and the welfare of service users and staff promoted. Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 21 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 1 3 x Standard No 22 23
ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 x 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x x 3 3 3 3 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
Kynaston Care(80) Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 7(3)(a) 12(1) 23(2)(a) Care Standards Act Part II 14(1)(c) & 24 13(6) 18(1 a & c) 19(5 b) 7(3)(c) 13(6) 18(1 a & c) 19(5 b) 13 ( 4 c) 18(1) sch. 2 & 4(6) 18(4)sch. 4(6 e & f) 9(2b i) 13(5) 18(1a) 19(5b) Requirement The registered provider must ensure that only a maximum of three service users reside in the home at any one time. The Commission may consider taking enforcement action if there is such a breach of regulations again. The registered provider must ensure that staff have received accredited medication training. All staff must receive training on the Protection of Vulnerable Adults, with records to evidence this kept in the home.(Timescale of 30.11.04 and 30.4.05 not met) Two suitable job references must be obtained before staff are appointed and commence duties. All staff must be given a copy of the statement of their terms and conditions.(Timescale of 31.3.05 not met) The provider must arrange for staff to receive appropriate training in health and safety topics however. I.e fire and Timescale for action Immediate and henceforth. 2. 20 30.11.05 3. 23 30.11.05 4. 34 5. 34 From receipt of this report and henceforth 30.11.05 6. 42 30.11.05 Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 23 infection control. 7. 42 13(4) 23(2 j) Water temperature checks must be carried out on a regular basis that includes all hand basins / washing facilities within the premises.(Timescale of immediate from previous inspection not met) From receipt of this report and henceforth 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 42 Good Practice Recommendations Environmental risk assessments should be expanded upon. I.e. they must specify more clearly what measures are in place to reduce the likelihood of risk, minimise the risk of injury and safeguard the welfare of the service users. Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 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
© 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 Kynaston Care(80) G53 G53 S25805 kynastoncare V192525 290705 stage 4.doc Version 1.30 Page 25 - 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!
