CARE HOME ADULTS 18-65
Radnor House 139 Canterbury Road Hawkinge Folkestone Kent CT18 7AX Lead Inspector
Lois Tozer Announced Inspection 14th November 2005 09:30 Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 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 Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 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. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Radnor House Address 139 Canterbury Road Hawkinge Folkestone Kent CT18 7AX 01303 894693 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) Caretech Community Services Limited Mrs Toni Frances Zinzan Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th April 2005 Brief Description of the Service: Radnor House is owned and operated by CareTech Community Services Ltd, is managed on a day to day basis by Mrs Toni Zin Zan and is registered to provide accomodation and personal care to a maximum of 6 persons within the age range 18 to 65 who have learning disabilities. It was first registered in October 2004 under the Care Standards Act 2000. It is a detached propertey situated in the centre of the village of Hawkinge, Kent. The home comprises of four single bedrooms situated in the main house and two semi-independent flatletts that are accessed via the main front door. The flatletts have individual front doors within the main building that are fittled with a key code entry panel. All bedrooms have ensuite facilities and the flats have full bathing facilities plus kitchenette. There are two bathrooms with wc facilities and one separate wc. The layout of the home is not suitable for persons using wheelchairs for internal mobility. Residents benefit from a large ‘L’ shaped lounge / diner that opens onto the secluded rear garden (access is currently limited by a key pad system). A small room off the lounge is available, this is used as a quiet and recreational area but can be used as a separate dining room if required. There is a central kitchen for the preperation of all main meals. A shingle covered carpark to the front of the premises allows parking for aproximatly 8 vehicles. There is an administration office for the secure storage of information and a dedicated medication room. A cellar is available for storage, however is not in day to day use. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory announced inspection took place on 14th November 2005 between 09:30 and 17:00. The manager, Mrs Toni Zin Zan was available throughout the inspection and offered assistance wherever required. Additional support was given by the Area Director, Deputy Manager, staff team, with thanks. There were 6 people living at the home, three gave some verbal or signed feedback. All sent back comment cards, and these helped gain an impression of life in the home, which was quite mixed, but clearly indicated that involvement and activities were improving and people were offered a greater say in the running of the home. Service user comments included- ‘I like the staff, I think I want to move to be closer to [my family], but this is good for now’. ‘We went swimming today, and that was fun’. Signed communication indicated that the activities taken place during the day (picnic and walk in local country park) had been good. Cheerful banter existed between staff and residents, and staff made efforts to use signed communication, although, due to limited training, the repertoire was limited. One residents relatives / friend returned a comment card. Comments included; ‘X is basically happy. Staff are good, but agency use can be quite high.’ One care manager commented that they were satisfied with the overall care provided in the home. As well as speaking to residents and staff, records of activities, medication, communication plans, physical intervention plans, pre-inspection questionnaire, quality assurance, and were inspected. Individual plans were briefly seen, but these are under review to improve and simplify. What the service does well:
The service provides a fairly spacious environment that enables people living there to move around freely. There is an easygoing atmosphere and the staff team have established good rapports with most of the people living in the home. The range of external activities is extensive and has been established from direct consultation with the individuals. Lots of opportunity to fulfil personal interests, through days out as well as projects in the home, is taking place. Food is mainly home cooked and fresh. All residents seen during the visit said that they enjoyed it. Residents are linked into, and involved, in many more domestic and household chores with the staff supporting them. Staff feel well supported by the manager and enjoy their work.
Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 6 The staffing ratio’s have been based on individual needs and the provision of vehicles to get out and about is good. The home is well furnished and offers two individual flatletts to meet specific needs The manager has identified the need to maintain a log of restrains and plans to implement this immediately. What has improved since the last inspection? What they could do better:
Some residents use Makaton, sign and symbol language, but the packages used were not obtained at the pre admissions stage. This is clearly an essential area, as it is the way service users have a voice and can express themselves, not just have their very basic needs met. Three quarters of the staff team have had a one-day signing session, but this is not sufficient to support and understand the service users fast repertoire. Aspirations would be difficult to ascertain without a good level of signing knowledge. Greater input from professionals, such as the Community Learning Disability Team (local or via the individuals funding authority) to establish strong communication and behavioural guidelines that are right for each person are needed. Individual plans are being reviewed, and these will benefit from being developed in a truly person centred style, with a strong emphasis on communication.
Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 7 Medication management procedures need further tightening to ensure the health and safety of all service users. Locked doors to the fenced, secluded, garden need to be risk assessed, as this limits the unsupported freedom of service users to make a decision to go outside. Most staff have up to date BILD accredited restraint training, but several have not been refreshed within the companies own time scale of 9 months, and two have not received training in respect of this service user group. 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. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 8 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 Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 9 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): 2, 3 Pre admissions assessments need reviewing to become more effective and collect the level of information required. The staff team has insufficient communication training so does not support service users using sign language in a way that self-determination through appropriate communication can be expressed. EVIDENCE: Prospective service users have an initial assessment by a company representative who then passes information to the home manager. Several service users use Makaton sign language, but no communication package or programme had been obtained from their previous young person placement. The manager had made efforts to create a communication package, but this was not based on previous communication systems (as absent) and could not be used for rapid, day-to-day communication. This level of information must be obtained prior to admission, and a review of the pre-admissions information / incorporation into support plan is required. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 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 the following standard(s): 6, 7, 8, 9, 10 Individual plans are under review. Good efforts to enable decision-making have been made. Service user participation and inclusion has improved. Obtaining support from specialist professionals would be beneficial. Generally, risk management to enable individual’s freedom with participation is good, but some restrictions need greater risk assessment, and action after incidents needs assessment and action taken to reduce reoccurrence. Storage of information is secure. EVIDENCE: In discussion with the area and home manager, individual plans are being reviewed to have a more person centred approach. As outlined in standard 2, pre-admission assessment information is central to a meaningful plan, and the depth and accuracy of information must improve. Challenging behaviour would benefit from a functional analysis by a professional psychologist, to ensure that staff were supporting the individual in the most effective way, rather than relying on their common sense. Despite having a big gap in individual plans relating to communication, the manager, and team have devised an effective system for each individual to make decision in the home for menu planning. Staff have excellent ideas and enthusiasm to aid communication and learning, a pictorial shift planner is in
Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 11 place, and discussion about consultation with a speech and language therapist is strongly recommended to save reinvention of ideas (and to use systems that individuals have been brought up with). Good efforts to devise pictorial task analysis to encourage participation in day-to-day chores such as tea making and laundry are in place. Risk assessments for activities and physical interventions are in place. Environmentally, access to the enclosed rear garden is limited, as a number-coded keypad has been fitted, which needs risk assessing with a view to reducing its use. Described in standard 26, risks posed by furniture need assessment. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 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 the following standard(s): 11, 12, 13, 14, 15, 16, 17 Opportunities for service users to develop skills through activities has improved, but access to specialist services to support work being undertaken is essential, especially for communication. Community access is well supported, and service users enjoy fun and leisure opportunities in the community. Friends and family are welcome to visit. Daily routines and service user inclusion has improved. Menu planning and the range of foodstuffs has improved. EVIDENCE: Personal development is much improved, with service users being included within the day-to-day shift planner. Improvement and professional involvement with communication and behavioural support strategies would enhance progress made so far. The activities plans are hugely improved, with structured events built in, including college for several residents. Each week, consultation for fun activities takes place, so it can be planned in advance. One person has a highly personalised service, where activities are chosen on a frequent basis, led by the individual. The majority of service users go out and about in the wider community each day. Fun and leisure activities are a regular feature throughout the week. Families are welcomed into the home,
Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 13 and service users are supported to maintain friendships. Shift planning ensures that service users have a say in their daily routines, and staff know what activity or events are scheduled for the day. The range of foodstuffs and accessibility to fresh fruit and vegetables has improved. Clarification is being pursued regarding an individual’s dietary need through the GP. Service users are well supported to choose what goes on the menu through a picture and symbol system. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 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 the following standard(s): 20 Medication management has improved, but some shortfalls were identified that need addressing to ensure the system is safe and secure. EVIDENCE: Medication storage was clean and tidy, and requirements from the last inspection had been addressed. Most staff who administer medication have received training from a pharmacist, however two have not. An internal competency assessment is in place, but shortfalls were identified, highlighting the importance of staff receiving this training without further delay, and that a robust auditing system must be implemented. Directions on the MAR sheets were not specific, and some were misleading, indicating that ‘as required’ medication should be given on a regular basis. Medication packs signed out for social leave was not signed back in again. Records of refusal of medication did not have follow up action. Full written feedback was given during the inspection. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 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 the following standard(s): 22 The service user complaints procedure has been made available. Complaints are handled promptly and have enabled service review and improvement. EVIDENCE: Two complaints received have highlighted a service issue shortfall hitherto unknown by the manager. Responses to the complaint have been rapid and have had a positive outcome for all concerned. Service users have access to a pictorial complaints process. Greater staff Makaton communication training would benefit service users to express themselves more freely. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 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 the following standard(s): 24, 25, 26, 27, 28, 29, 30 The home is safe, homely and comfortable, but restrictions on access require assessing and minimising where possible. Individuals bedrooms are highly personalised, but the safety of furniture following incidents needs assessing. There are many toilets and bathrooms. Specialist equipment has been purchased and installed as needed. The home is generally clean and hygienic, but some attention is needed in en-suite facilities to improve conditions. EVIDENCE: The home has a warm and friendly atmosphere, and sufficient communal space to enable service users relaxation and enjoyment at mealtimes and when doing activities. Bedrooms are spacious, all have en-suite facilities (one of which has a problem that needs attending to ensure the standard of hygiene is maintained). No individual en-suites have mirrors, and it is recommended that each person be offered one. A flashing light has been installed to enable a deaf service user to know when someone is knocking at the door. A problem with damp exists in the basement (never used by service users), which is being investigated by the maintenance team. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 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 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): 35 Staff training has improved, but an ongoing programme to educate staff to the level required by the service users is essential. EVIDENCE: Nine of the 12 staff have received a one day Makaton taster day. At present, basic needs are being met, and one staff member who has good skills is coaching the other staff. Efforts are being made to encourage staff to practice skills with ‘Makaton sentence of the week’. As the home accommodates several service users who are able, fast, Makaton signers, and have recently left formal education using this language, it is essential that the staff team be supported to obtain the level of skill needed to fully communicate. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 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): 39 The quality assurance system has been centrally reviewed to better reflect outcomes to service users, but has not yet been tested in the home. EVIDENCE: What appears to be a comprehensive QA system has been developed, and this is next due to take place in December 2005. A greater focus on the NMS and the outcomes to the service users has been incorporated. Families are actively encouraged to give feedback at any time, and formally at each review. Service user 1:1 talk time is recommended to be used to feed directly to the QA outcomes. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 19 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 2 2 X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 2 2 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 2 3 3 3 2 LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Radnor House Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X X X DS0000061367.V250923.R01.S.doc Version 5.0 Page 20 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 YA2 Regulation 14 Requirement Previous requirement, timescale of 1/6/05 unmet; Needs assessment form a supportive, informative initial service user plan. Focus on individual communication needs, and how the home will meet them to be improved. Previous requirement, timescale of 01/07/05 unmet; Support plan to describe individual strengths & needs, detailing specific areas as required. Must be accessible and easy for staff to use to offer developmental support and link to relevant risk assessments. Risk assess and reduce the limitation for service users to freely access the rear garden from the lounge area. Risk assess and secure individual wardrobe. Make entry and exit safer to individual room. Previous requirement, timescale of 01/07/05 partly met; Staff who administer medication must have training from a qualified source that will give them the skills to meet the
DS0000061367.V250923.R01.S.doc Timescale for action 01/04/06 2 YA6 YA9 YA18 15 (1; 2,b) 01/04/06 3 YA9 17 (1,a) 01/01/06 4 5 YA9YA26 YA20 YA35 13 (4,c) 13(2)18 (1,a,c[i]) 01/02/06 01/01/06 Radnor House Version 5.0 Page 21 needs of the service. 6 7 8 YA20 YA20 YA20 13 (2) 13 (2) 13 (2) Medication administration directions must be specific; any ambiguity must be clarified. Establish the preferred way of individuals taking medication and record their consent to do so. Actions completed by staff (refusals, meds returned to the home) are clearly recorded, and follow the correct procedures. Ask and where accepted, support individuals to purchase personal mirrors. Make named service users ensuite facility surface impermeable. Communication training to be in sufficient depth to enable staff to explore service users aspirations and work with them to achieve them. Staff to have BILD accredited restraint training specific to the service needs before using any restraint techniques. 01/01/06 01/01/06 01/01/06 9 10 11 YA26 YA30 YA35 16 (2, d) 13 (3) 18 (1 – 2) 01/02/06 01/02/05 01/02/06 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 YA20 YA24 YA37 Good Practice Recommendations Individual front cover sheet for medication with individuals specific and exact needs and preferences stated. A picture be displayed on this sheet. Reduce vibration of washing machine above lounge. Submit action plan to address damp problem in basement. Manager and deputy would benefit from accredited training specific to person centred planning and the needs of the service user group. Radnor House DS0000061367.V250923.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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