Inspection on 18/12/06 for Mckechnie House

This inspection was carried out on 18th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mckechnie House 12/02/09

Mckechnie House 24/01/06

Mckechnie House 06/10/05

Mckechnie House 09/03/05

Mckechnie House 16/08/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Mckechnie House 104 Mill Road Mile End Colchester Essex CO4 5LJ Lead Inspector Pauline Dean Key Unannounced Inspection 18th December 2006 14:25 Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 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 Mckechnie House DS0000017880.V322874.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 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. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mckechnie House Address 104 Mill Road Mile End Colchester Essex CO4 5LJ 01206 751463 01206 843367 broadhzn@aol.com 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) Broad Horizons Limited Mrs Jean Brown Fleming Revelle Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 2 persons) 24th January 2006 Date of last inspection Brief Description of the Service: McKechnie House is an established small care home, first registered in October 2001 for two younger adults with learning disabilities. The registered provider is Broad Horizons Ltd, with Mrs Jean Revelle as the responsible individual/ registered manager. McKechnie House is one of three small care homes, with the same proprietor, located in Mill Road and as they are in close proximity there is interaction between service users and staff. The home is found in a residential area of Colchester, located close to Colchester General Hospital. Close by there are local shops and facilities, with the main town centre offering shopping and leisure facilities a short bus ride away. Accommodation for the two service users is on the first floor, both having single rooms with a wash hand basin fitted. There is a bathroom with bathing and shower facilities and toilet. An office/staff bedroom is also found on the first floor. On the ground floor there is a front lounge and a kitchen/dining area. The property is semi-detached and has gardens to the front and rear. There is some off-road parking in the front garden. The rear garden is enclosed with a paved patio area, decking and a lawn. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection, covering the key National Minimum Standards, took into consideration all recent records relating to the service, including information sent to the Commission by the Providers. A record of inspection was collated prior and during the inspection process. It also included a site visit to the home on 18/12/06, which lasted approximately 8 hours over the three Broad Horizon Care Homes. At this visit, the inspector was unable to speak with the two service users, as they went not at the home. Discussion did take place with care staff on duty and the registered manager. A tour of premises was completed and there was observation of care practice and the sampling of records. Where possible, the site visits focussed on the experience of the two service users, a process known as case tracking. Of the twenty-three National Minimum Standards inspected on this occasion, sixteen were met and seven nearly met. One of which was a repeat requirement. Whilst it is recognised that there has been an increase in requirements, from three to seven, it should be noted that more Standards were inspected at this inspection. At the time of this inspection there were three service users living at McKechnie House. Current fees are £550 - £575 per week. Hairdressing, papers, magazines, clothing, personal activities and college fees are not covered by the fees and are charged at cost. What the service does well: What has improved since the last inspection? Disappointedly there has been little improvement since the last inspection. Five of the judgement outcomes were found to be good, with the remaining three judged as adequate. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 6 One requirement relating to quality assurance has been completed since the last inspection and survey work has been conducted. Mrs Revelle said this work had been considered and used to inform working practices in the home. 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. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 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 Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Documentation ensures that service users move into the home knowing that their needs will be met. EVIDENCE: There are two service users living at McKechnie House. One of these service users was admitted in September 2006 and had been admitted following a lengthy and detailed admission process by both the placing authority and the care home. A ‘Passport’ book, which had been completed by and for the service user had assisted with this process for it clearly detailed previous placements and history of the service user in an easily readable format for the service user. Prior to moving in the service user had been able to visit the home staying overnight and for a weekend. Following the ‘settling in’ period, the service user had been offered a permanent placement and this had been agreed with them and their placing authority. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 9 Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning documents detailed health, personal and social care needs and records evidenced all aspects of care required. Service users are enabled to a degree to make decisions through risk assessments and risk management. EVIDENCE: The care plan for the most recent admission was sampled and inspected at the site visit. It was seen to detail nine care plan objectives and aims, which had been reviewed and revised since the service user’s admission. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 11 The inspector was unable to evidence that service users are able make decisions and choices in their daily life through discussion with service users, as they were not present during the site visit. However, care planning and record keeping evidenced that service user did make decisions such as outings, meals and activities in the home. Whilst there was evidence of some risk assessments being introduced in the care planning file of the most recent admission to the home, the registered manager acknowledged that there is a need to conduct a review of all care plans to ascertain whether risk assessments and risk management needs to be introduced. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support and assist service users to participate in educational, training and community activities, as they are able. Staff support service users to maintain family links & friendships. Service users rights are respected and responsibilities are recognised. EVIDENCE: Neither of the two service users living at McKechnie House have employment or attend college courses. One service user goes horse riding and the other service user is considering this as an activity. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 13 Both service users within the home had completed surveys produced by the Commission for Social Care Inspection (CSCI). Both spoke of being able to make choices in what they could do. Both service users are encouraged and supported to access community facilities. They enjoy visits to a local pub for a meal, shopping and bowling. One service user enjoys trips into Colchester town centre by bus. Both service users have friends in the other Broad Horizon homes and often visit each other in their homes. Both service users maintain links with their families and they enjoy visits and outings with their parents. The home liaises and arranges visits to their family as they wish. At this site visit, none of the service users were in the home, however, from record keeping and care planning it was evident that both service users are encouraged to undertake individual activities within the home or outside. Individual nutrition records of meals eaten were seen for both service users. Management and care staff said that neither of the service users had special diets, but were able to choose their meals from the food in stock or when they were out shopping. Takeaway meals and meals out are enjoyed by both service users. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s arrangements for supporting the healthcare of service users were satisfactory, with the record keeping and medication administration well managed. EVIDENCE: It was evident from discussion with the registered manager and care staff that service users were able to get up and go to bed as they wished. Record keeping detailed this. In addition, the care staff member on duty was able to give examples of flexibility around mealtimes and activities to accommodate the wishes of the two service users. Within McKechnie House there is a predominance of male care workers as the current resident group is male only. Both service users are registered at a local GP surgery. Mrs Revelle said that the most recent admission to McKechnie House had transferred to the same Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 15 surgery. There is access to local healthcare facilities such as the dentist, which has moved from the centre of Colchester to the immediate locality. Links with a consultant psychiatrist and the outreach team are encouraged and service users are supported by the home and their relatives to attend regular review appointments. Medication administration was not sampled and inspected in detail at this inspection. It was sampled in detail at another of the three Broad Horizons care homes. The medication for the two service users is held by the care home with appropriate record keeping and storage in place. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, service users were well treated and listened to, with complaints and adult protection procedures in place. EVIDENCE: McKechnie House has a complaints procedure, which has been devised using a care home consultancy company. This was found in the home’s policies and procedure file and in a service user’s file. This procedure made reference to raising complaints with the Commission and states that complaints should be raised with “registered director of our Inspectorate.” Mrs Revelle, the registered manager was advised of the need to review this procedure for there are inaccuracies. In addition, clarification is required as to the role of Commission for Social Care Inspection (CSCI). It should be noted that the Commission is not a ‘complaints agency’ and does not have statutory powers to investigate complaints. The Commission will use their powers of inspection to undertake enquiry so that we can make a judgement as to whether the provider is complying with the regulations. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 17 An adult protection procedure was found in the home’s policies and procedures file. This had a variety of documents entitled ‘Preventing Abuse of a Person in our Care’, ‘Signs of Abuse’ and ‘Suspicion of Abuse.’ Whilst these documents had reference to the Essex County Council Protection of Vulnerable Adults (POVA) referral and the Department of Health document – ‘No Secrets’, the need to review and revise these documents was evident for reference was found to the previous Commission –National Care Standards Commission (NCSC) in the latter document. Mrs Revelle was advised of the need to review these documents making the changes as required. The inspector was informed that the home has the Essex CD training package on abuse and Mrs Revelle said that she plans to use this as a training tool. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, the home provides a safe, well-maintained environment that is accessible to service users, homely and meets individual needs. EVIDENCE: Overall, McKechnie House continues to offer a bright, clean and a homely environment. The premises are of a domestic type and are in keeping with the local community in a residential area. The communal areas of the lounge and the kitchen/dining room were in good decorative order with good quality furnishings and fittings. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 19 This home as with the other two homes managed by Broad Horizons Limited is having a loft extension offering additional bedroom accommodation. This was ongoing at the time of the site visit and as would have been expected this had caused some disruption in the care home. Some damage had also been caused by the building work. On the day of the site visit, the two service users were out of the home, for the new staircase was being fitted and the noise level was high. General decoration and maintenance are required following the completion of the building work notably in the service user’s bedroom and in the bathroom were a replacement shower is required. Mrs Revelle said that these are all planned projects on completion of the building work. Laundry facilities comprise of a washer and dryer, which are domestic in character. The washer is sited in the kitchen, with the dryer in the garden shed. Consideration is given to the management of laundry to ensure that soiled items do not come in contact with food preparation and eating. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. McKechnie House’s recruitment policy did not meet requirements and therefore does not support and protect service users. There was not sufficient evidence to demonstrate that staff were adequately supervised, trained or supported in their roles. EVIDENCE: Staffing levels and staff rotas were sampled and inspected on the site visit. With just two male service users at McKechnie House, one carer is considered sufficient to meet the assessed needs of the service users. Staffing levels are flexible, with both service users and carers meeting up in the three Broad Horizons Homes and activities and outings arranged across the three homes. The file of one staff member was sampled and inspected at this site visit and this was found to be in good order. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 21 Whilst there was some evidence of some basic training courses completed in the past, as with other staff files seen at the Broad Horizons Homes there was no evidence of individual training and development assessments and profiles. These clearly need to be developed to ensure that there is a staff training and development programme, which meets Sector Skills Council workforce training targets. Within the staff file inspected there was some evidence of supervisions. Two had taken place in 2006. It was acknowledged by the registered manager that a thorough review of this practice must be completed to ensure that staff and service users are well supported by management. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a competent and experienced manager to run the home. The home has to review and develop a quality assurance and quality monitoring system to help ensure that the home is run in the best interests of the service users. Safe working practices are promoted through ongoing training. Health and safety certification promotes a safe working environment. EVIDENCE: Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 23 Mrs Revelle said that she has completed the National Vocational Qualification (NVQ) level 4 in Management and is looking to complete the Health and Social Care section in 2007. She said that she is also planning to complete a NVQ level 5 in Care in that year. Since the last inspection service users, relatives and staff have completed quality assurance survey work. An analysis of the outcome of the survey work has been completed and these have been circulated and used to improve practice within the home. Copies of completed survey forms were found on service user’s files. Safe working practices are ensured through basic training courses and some evidence of this was seen on staff files and from discussion with staff and management. Mrs Revelle said that basic training courses in food hygiene and health and safety are planned in 2007. Safety certification and health and safety policies and procedures were not sampled and inspected at this site visit. Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 24 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 3 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 25 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 YA9 Regulation 13 (4)(b)(c) 14(2) Requirement Timescale for action 20/02/07 2. YA22 22 3. YA23 13(6) 21 4. YA24 23 The registered person must ensure that staff enable service users to take responsible risks, ensuring that they have good information on which to base decisions within the individual service users’ care plan, risk assessment and risk management strategies. The registered person must 20/02/07 ensure that there is a clear and effective complaints procedure, which includes the stages of, and time scales, for the process, and that service users know how to complain. The registered person must 20/02/07 ensure that service users are protected from abuse, neglect and self-harm. This is with regard to the adult protection policy and procedure. The registered person must 20/02/07 ensure that the home has a planned maintenance and renewal programme for the fabric and decoration of the premises with records kept. This is with regard to maintenance and decoration following DS0000017880.V322874.R01.S.doc Version 5.2 Mckechnie House Page 26 5. YA35 18(1)(c) 6. YA36 12 (5), 18 (2) completion of the loft conversion. The registered person must ensure that there is a staff training and development programme, which meets Sector Skills Council workforce training targets. The registered person must ensure that staff receive support and supervision to carry out the job as detailed in the National Minimum Standards for Care Homes for Adults (18 - 65). (This is a repeat requirement. Previous timescale of 10/02/06 was not met.) 20/02/07 20/02/07 7. YA37 9 The registered manager must ensure that they have the required level 4 qualifications in care by 2007. 31/12/07 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 Mckechnie House DS0000017880.V322874.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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