Inspection on 20/03/09 for Roy Kinnear House

This inspection was carried out on 20th March 2009.

CSCI found this care home to be providing an Adequate service.

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 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Roy Kinnear House 07/05/08

Roy Kinnear House 26/09/07

Roy Kinnear House 27/06/06

Roy Kinnear House 10/11/05

Roy Kinnear House 30/06/05

Roy Kinnear House 08/12/04

Roy Kinnear House 17/05/04

Roy Kinnear House 11/11/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 10/07/2009.

CARE HOME ADULTS 18-65 Roy Kinnear House 289 Waldegrave Road Twickenham Middlesex TW1 4SU Lead Inspector Sandy Patrick Unannounced Inspection 20 March 2009 10:30 th Roy Kinnear House DS0000038036.V374995.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 Roy Kinnear House DS0000038036.V374995.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. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roy Kinnear House Address 289 Waldegrave Road Twickenham Middlesex TW1 4SU 020 8892 4049 020 8891 6734 roykinnear@btconnect.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) The Roy Kinnear Charitable Foundation Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. On the morning shift/afternoon shift/evening shift there must be: 1 Qualified Nurse 1 Senior Support Worker 4 Support Workers 2 Domestics (20 Hours each) On the nighttime shift there must be: 1 qualified nurse (awake) 1 senior support worker 2 support workers There must be no reduction in the establishments posts which currently stands at 19. 2. 3. Date of last inspection Brief Description of the Service: Roy Kinnear House provides accommodation and personal care for up to eight residents who have severe learning and physical disabilities. The home provides nursing and residential care, where a qualified nurse is on duty at all times. The home is situated in a residential road in Twickenham and is purpose built. Three of the bedrooms have patio doors leading onto an attractive and wellmaintained garden. The lounge also opens onto the garden. The home is situated close to local shops and amenities. Placement fees are calculated according to need and are agreed by the home and the placing authority. The current fees range from £1,635 - £3,077 per week. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of this inspection we made an unannounced visit to the home on the 5th March 2009. We met people who live at the home, staff on duty and the Acting Manager. We looked at records, the environment and how people were being cared for. A Pharmacy Inspector looked at medication management and wrote a report on her findings which is included in Section 4 of this report. We wrote to people who live at the home, their representatives, staff and other professionals and asked them to complete surveys about what they thought of the service. We wrote to the Acting Manager and asked her to complete a quality self assessment. This had not been completed at the time of the inspection. The Registered Manager left the organisation in October 2008, an Acting Manager has been in post since this time. She plans to apply to be the Registered Manager. People who work at the home, other professionals and relatives of people living at the home told us that they felt things had improved over the past year. Some of the things people told us were: ‘People are treated as individuals.’ ‘There is a welcoming atmosphere and it is homely.’ ‘I think Roy Kinnear House is an outstanding place which looks after the residents very professionally in a homely and caring atmosphere.’ ‘I think there are improvements but more could be done.’ ‘I believe my relative is very happy there.’ ‘My relative is well looked after and is relaxed in a place which she feels is her home’. ‘There has been a massive improvement in the last 12 months.’ Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: We felt that although there is better structure and organisation at the home, some of the staff did not seem to know what they were supposed to be doing during our visit and this confusion meant that some people did not get the support they needed. We felt that some of the things the staff did with people were a bit rushed, and people would benefit from staff taking more time when supporting them. Some of the comments staff make about people are not appropriate and do not show respect. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 7 Temporary staff who work at the home need to be given proper directions and information about what they are required to do. People need to get more individual support so that they do things that they want to do and enjoy. The staff need to work in a more person centred way. People need better support to do more activities and different things within the home and outside. The staff need to make sure everyone’s health and personal care needs are always met. The environment needs to be changed so that people have more communal space and proper kitchen facilities. 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. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 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 Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People have the information they need to help them when they move to the home. EVIDENCE: No one has moved to the home since the last inspection. People’s representatives told us that they had enough information to help them make a decision when they moved to there. They said that they were able to visit and spend time there. One person said, ‘mum and dad got all the information about the home and took their time making sure it was the right one for me’. The Acting Manager said the contracts with funding authorities for the people living at the home were not clear and needed to be updated and reviewed. She has started to do this. This is important because it is not clear who pays for different services and equipment for each person. Roy Kinnear House DS0000038036.V374995.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, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The way in which people are supported and their needs are recorded has improved, but they need to be supported to have more control and choice about the life they lead. EVIDENCE: One staff member told us, ‘people are treated as individuals and care is delivered according to a plan’. Some of the staff have had training to help them understand how to plan people’s care around their individual needs. Things have improved in this area however the staff still need to have a more person centred approach so that each person gets an individual service tailor made to their needs and wishes. One relative told us, ‘the staff have personalised bedrooms but do not reflect individual needs in activities or food.’ Everyone has a record (care plan), which tells the staff what they need to do to support them and meet their needs. These care plans are reviewed and Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 11 updated monthly. The plans contain guidelines from other professionals and assessments of risks. We looked at a sample of these. Care plans had been regularly reviewed and gave good details about people’s health and personal care needs. They also clearly recorded who is responsible for supporting people. However, we saw that some information in guidelines from professionals had not been transferred to care plans and different records contradicted each other. We also saw that some changes to care plans were unclear. Care plans contained only brief information on people’s social needs and interests. The staff should make sure more information is recorded in this area and care plans show how people can be supported to meet their individual needs and wishes. Daily care notes are written for each person. These show what tasks have been achieved by staff to meet individual needs but do not record much detail about how the person felt that day or what they did and enjoyed. The records did not talk about the person but referred to a series of tasks or statements. For example, ‘’meds given’, ‘safety maintained’, ‘am swimming, pm walk’ and ‘vocalising and happy’. One person has recently acquired a new communication aid. They were having support to learn how to use this and the staff were being trained so that they can offer the right support and can use the aid to help communicate with this person. The person showed us how they used the device. This will hopefully enhance the person’s life and ability to communicate with others. The Acting Manager has introduced regular meetings for people living at the home to help keep them informed about changes. We saw that some of the staff worked really well with people giving them good support and talking to them. We saw that some staff, although kind and helpful, did not really talk to people when they were supporting them. For example some staff did not talk to people when they were supporting them at mealtimes and some staff did not tell people what they were doing when they moved their wheelchairs from one place to another. Records about people, including care plans, guidelines and medical information are stored in the main lounge. Some of these are kept on the desktop which is accessible to everyone. Others are stored in unlocked cupboards. There are notices to staff, minutes of meetings, a complaints book and other records also stored in the lounge. The staff telephone is located in the lounge and confidential telephone conversations are discussed in communal areas. Roy Kinnear House DS0000038036.V374995.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): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People have been given support to try new activities and spend more time outside of the home. However, they need more support to take part in different social activities and for personal development. EVIDENCE: One relative told us, ‘there are more activities being carried out but day to day life skills are not encouraged. My relative enjoys being involved in preparing food with me, but the staff at the home do not do this.’ Another person said, ‘Some staff do not have the skills and attitude required to support individual social needs, often they leave the TV on children’s television programmes for long periods of time.’ One person said, ‘My relative goes to church and this is positive and they have tried some new activities, but the staff do not always encourage age appropriate activities.’ Another person told us, ‘the activities have improved but the staff are sometimes slow to put music on for my Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 13 relative’. One professional told us, ‘there could be improvements to day to day activities including community based activities that meet individual needs and preferences.’ One member of staff said, ‘there is not enough staff and time for individual activities, to encourage personal development or stimulation’. Since the last inspection people have tried some new activities and the Acting Manager told us that people were more occupied than they were in the past. This is positive and the staff told us that they planned to support people to try even more new things. We saw some examples of appropriate activities which people clearly enjoyed. During our visit some people enjoyed using the garden, some people listened to music and some people used sensory equipment. There is a record of the activities that are planned for each person every day. However, we found that some people were not supported to take part in all the activities which were recorded on their plan. Past records also indicated that people did not always do the things that were planned. People also spent a lot of time not doing any planned activity. On the day of our visit some people spent quite a long time doing nothing. One member of staff told us that it was hard to make sure activities took place because people had high support needs and often needed two members of staff to help them move or with personal care and this meant that people had to do things in large groups rather than individual activities. Visitors told us that they felt welcome and that they were consulted and involved in the care of their relatives. We saw that some people have family members visiting every day. The people living at the home have made contact with friends through college and outside activities, such as Church. One visitor told us, ‘we are always welcomed and it is very homely’. Another person said, ‘relatives are now more involved in planning care’. However, some relatives felt that the communication between staff and themselves could be improved. One relative told us that messages were not always passed on. One person told us, ‘staff always knock when they enter my relatives room which is good’. They also said, ‘I feel that the attitude of some staff does not respect my relative’s dignity, for example I have heard staff make disrespectful comments and one member of staff refers to themselves as uncle which is not appropriate. I have heard some staff call my relative a big baby and this is inappropriate.’ One person told us, ‘I feel the service is starting to respond to the needs of the individual rather than expecting the individual to fit in with a routine.’ Some of the people use Percutaneous Endoscopic Gastrostomy (PEG) feeds. Meals are prepared for the other people in the kitchen area. But there is no cooker or hob top. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 14 Since the last inspection the staff have changed the way they plan menus and prepare food. They have purchased new equipment, including a steamer, and the food they prepare is more varied and healthier. We looked at a sample of menus and saw that these were varied and that staff tried to offer people nutritious and balanced food. One member of staff told us, ‘I wish we had a hob to prepare food instead of a microwave’. One relative told us, ‘There needs to be better meals using fresh produce not ready meals.’ Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 15 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 & 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The way in which people’s medication is managed has improved. The staff work closely with other professionals to keep people healthy. Records do not always evidence if people’s needs have been met. EVIDENCE: People have their health and personal care needs recorded within individual plans. We looked at a sample of records which showed when people had had baths and showers. We saw that some records indicated people had not had regular baths. For example one person’s record showed that they had only had one bath in the month of February, when their care plan stated that they should have daily baths. The staff said that this was a recording error rather than a lack of care. They should make sure records are kept up to date. One relative told us that they felt people did not have daily baths and staff did not always adhere to the care plans. They said that they felt this had impacted on their relative’s health. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 16 We saw one member of staff walking around the home wearing protective gloves which they had used when supporting someone with personal care. All staff should remove and dispose of gloves and other protective clothing immediately after finishing a task to avoid the risk of spreading infection. The staff work closely with other health professionals to make sure people get the support they need. Care plans include guidelines from health professionals and people have regular input from some therapists. One relative told us, ‘advice is sought from specialists, eg the Speech and Language Therapist but I have observed that recommendations and guidelines are not always carried out’. Everyone is registered with a local GP and other health care professionals as needed. The staff have worked hard to build a good relationship with these health care professionals. People told us that the generally felt health care needs were met. One professional told us, ‘the home liaise with the local GP and learning disability team’. One relative said, ‘the staff and manager were brilliant support after a recent hospital admission.’ However one relative told us, ‘It is hard to know whether health care needs are always met.’ There is a record of consultation with health professionals. We looked at a sample of these. For some people, records indicated that they had not seen a dentist for some time. The Acting Manager must make sure people have regular consultations with all health care professionals as required and that there is a record of this. We inspected the recording of receipts, administration and disposal of medication to see if medicines were being given as prescribed. We looked at the storage of medication and noticed that it was now kept in original packs in individual lockable cupboards in resident’s rooms. Stock control was much improved and there was evidence of less excess. No medicines were out of stock. Recording was much improved. Each resident had their own medication folder which contained a medication administration record (MAR), stock control audit sheet, records of disposal, details of any feeding regimens and protocols for managing seizures. We noted that on the current MAR all receipts of stock had been documented together with that brought forward from the previous cycle. It was the second day of the current medication cycle so it was disappointing to note that there was one gap in recording a diuretic on the first day. An audit of the tablets proved that it was given. For another resident on two different strengths of the same tablet, instead of three tablets of each being given as prescribed it seemed that 2 and 4 were given. The home is investigating Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 17 whether there was an error in administration. We looked at all the resident’s medication and all other samples counted could be reconciled with signatures for administration. We also looked at the previous month’ MAR charts and could see no gaps. This means that overall there was evidence that medication was being administered as prescribed. We looked at three care plans and were able to see updated medication profiles for 2 residents. Medication had been reviewed by the GP for these residents as part of a rolling review of all residents. We were able to track dosage changes either to hospital discharge letters or GP notes. Charts for recording seizures were available in the care plans and we noticed that this was completed for one resident. We noticed that there were fluid balance charts. For one resident there were comprehensive care plans with time lines for all nursing care and care provided by support workers. Medication was also included in the former and detailed how medicines were to be given through the feeding tube, the appropriate timing and safe practice in administering medicines for inhalation. We checked whether other requirements made at the inspection in November 2008 had been met .The waste medicines were stored safely and disposed of via a licensed waste carrier and the fridge was locked and temperature recorded. Training was planned for later in March for medication and two sessions planned for enteral feeding. The home had a medication policy but an update with regard to current practice is still outstanding. Overall therefore we were pleased with the progress made in developing safe systems in handling medication. There now needs to be a period of consolidation to embed the changes made, together with continuing audit and training. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 18 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 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are appropriate procedures designed to protect people. Staff have been trained and have information on how to keep people safe. EVIDENCE: There is a complaints procedure and a record of complaints and how these have been resolved. People told us that they knew what to do if they had a concern or complaint. There is a copy of the local authority protection of vulnerable adults procedure and the staff have had training in this. The staff who contacted us demonstrated a good understanding of what to do if they suspected abuse. Some people’s families manage their finances. Some people have their own bank accounts. The home holds small amounts of cash for people and records of expenditure of this. We looked at a sample of records relating to these and found that they were correct. A lot of staff work at the home and have access to this money, however checks on balances are not made every day. One member of staff should be allocated as responsible for people’s money each shift and they should hand this over when the staff on duty change. Balances and records should be checked with each staff handover to minimise the risks of error and financial abuse. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 19 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, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a generally well maintained and clean environment. they do not have enough communal space to live comfortably. EVIDENCE: The house is a detached building set back from the road with a small number of parking spaces. There is a large attractive garden. The home and garden are decorated nicely and the building feels light and airy. There are nice personal touches and sensory ornaments, mirrors and lighting. Bedrooms are highly personalised and attractive. Areas of the building are showing signs of wear and tear and need attention. These include damaged flooring in communal areas. Some of the woodwork was worn and marked. There was a problem with the back door which did not close properly. Some of the baths and sinks had limescale marks and these should be removed. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 20 Although In 2007 the environment was changed to create 3 new bedrooms. The home’s separate kitchen, staff office and laundry rooms were removed. A kitchen area and the staff office were relocated to the lounge. This has made this area smaller and more cluttered. There are no proper cooking facilities, no hob top or oven. The fridges and freezers take up what used to be floor space in the lounge. The kitchen area including worktops and sink take up space in the lounge. The staff office, including cupboards, records, work desks and chairs are all within the lounge. There is no separate area for storing records confidentially. Records and notices for staff were displayed in the lounge. Care plans and confidential information was not held securely. Many of the people who live at the home use wheelchairs and other large equipment. The space in the lounge is not sufficient for people to use this comfortably. The organisation hopes to extend the communal environment. This is important because there is not enough space for people to enjoy different activities at the same time or have some privacy apart from in their own bedrooms. During lunch time on the day of our visit the communal area was very crowded. The Acting Manager told us that the organisation plans to extend the home to create a separate office space for staff and a new kitchen. One person told us, ‘the space is very limited, we need a nurses station, kitchen and privacy, the lounge is too crowded with everyone in it and wheelchairs’. Another person told us, ‘service users spend their time in an open room which has a small kitchen and this is not ideal and there is no privacy or place for quiet activities. The sensory room is used by staff to take their breaks.’ One person said, ‘the staff discuss client related issues in the communal living space because there is not a separate office and they have their breaks in the sensory room so this cannot be used by people living at the home.’ The Manager told us that they plan to buy new sensory audio visual equipment and specialist equipment to help people who live at the home to access the computer. We found that the home was clean and fresh throughout on the day of our visit. People told us that they felt the home was always kept clean and fresh. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 21 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): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People are supported by staff who have clear direction and are trained. There needs to be further staff training and improvements to the way in which staff are recruited to make sure they are suitable. EVIDENCE: Some of the things that people told us about the staff were, ‘some staff do not seem to understand their roles as support workers and focus on care rather than empowerment’ and ‘some of the time staff do not meet the needs of residents, this does not seem to be through lack of respect but through a lack of knowledge.’ The Acting Manager needs to make sure the staff team are able to understand and implement training so that they can support people to meet individual needs. Some of the things the staff team told us were, ‘there is better team work and we have a good working relationship with each other’, ‘for the past few months the systems of the house have improved with team meetings and supervisions’ Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 22 and ‘we have regular team meetings and discuss things about residents and concerns, we also have a communication book which is accessible to all staff’, The Acting Manager has updated information for staff on their roles and responsibilities. She has also updated policies and procedures. Since the last inspection a Deputy Manager has been employed. The Acting Manager said that she has helped to give the staff the support they need to change and improve their work. The Deputy Manager is undertaking a management qualification. The Acting Manager told us that she had also developed the role of senior support staff. We spoke to the senior staff and they said that they were supported to have more responsibility. On the day of our visit a member of staff was off sick and a temporary member of staff was employed to work at the home. This member of staff had not worked at the home before. However, when they arrived on duty no one was allocated to show them basic health and safety, such as the fire procedure or to introduce them to the people who live at the home. They did not read any information about the person they were assigned to work with until two and a half hours after they arrived. They were asked to assist someone with eating a meal shortly after arriving at the home. This person had specific eating and drinking guidelines and a risk assessment about this, however the staff member was not told about these nor did they read them. This could have put the person they were assisting at risk. There needs to be a structured formal procedure for inducting all new and temporary staff to make sure they know basic health and safety procedures as soon as they arrive at the home. They also need to be aware of any guidelines, care plans and risk assessments relating to the people they are supporting with specific activities. They should sign a record to say that they have received and understood this information. The Acting Manager said that all staff are recruited following a formal interview. We looked at a sample of staff recruitment files. Two newly employed members of staff only had evidence of one reference check as part of their recruitment. Communication within the staff team has improved since the last inspection. The Acting Manager has created communication records which staff need to read and sign. There are also regular team meetings and a handover of information each time the staff on duty change over. We saw records of these. The instructions given to staff about how to manage their daily tasks have improved and there is more structure to the way support and activities are planned. We saw that this had made a positive difference to the experiences of people who live at the home. However, on the day of the inspection we saw that some staff were confused about what they were doing and who should be doing certain tasks. This had an impact on the way they worked. For example Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 23 one person who was being supported at lunch time had three different people supporting them. The staff spoke to each other over the person’s head and changed over who was giving support without explaining what was happening to the person. The Acting Manager has organised for the staff team to take part in a range of training. There are clear records to show what training people have undertaken and when this needs to be updated. We saw that the staff had been trained in key areas or were due to attend essential training. Four members of staff have completed NVQs. Six staff are undertaking NVQ Level 2 and three senior staff are undertaking NVQ Level 3. The Acting Manager told us that the local Primary Care Trust provide training for the nursing staff. One member of staff said, ‘we have done mandatory training but not much else’. The Acting Manager has a plan of scheduled supervision meetings with all staff. These are recorded. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 24 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, 38, 39, 41 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a well managed home where clear systems and structures are being developed so that things run smoothly and efficiently. EVIDENCE: The Registered Manager left her post in October 2008. An Acting Manager has been in post since this time. She told us that she is hoping to stay in the post on a permanent basis. She must make an application to be registered with the Care Quality Commission (the new regulators of social care). The Acting Manager is an experienced manager and has a background in human resources. She has worked in social care settings but she needs to undertake a relevant qualification to enhance her knowledge and skills. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 25 Some of the things people told us about the Acting Manager were, ‘the present manager is trying to address many of the issues we have raised with some success, eg better meal preparation, finding more age appropriate activities and supporting people to take part in activities away from the home’, ‘the current manager is well organised, experienced and effective in her role, she works hard and has a excellent relationship with staff’, ‘things are getting so much better with the present manager’ and ‘my present manager is very good and discusses everything with me and gives me support’. One member of staff said that they did not feel supported and encouraged by the manager. However, other staff working at the home said that they liked the Acting Manager and that she had introduced some positive changes. One member of staff said, ‘there have been some good changes and the Acting Manager is very supportive, she is always at the end of a phone or here. We are happy and everyone feels relaxed’. The Acting Manager reports to the Trustees and gives them a report on progress and developments at the home each month. The organisation is fundraising by holding a number of events with the aim of raising money to improve the building. We asked the provider to complete an annual quality assurance assessment (AQAA). They did not do this within the timescale we asked them and had not completed it at the time of the inspection. The Acting Manager has created a number of records, systems and checks to help plan the day to day management of the home. These have improved the structure and organisation of the home and have helped make sure people get the support they need. The Acting Manager has set up systems to make sure there are regular checks on health and safety and fire safety. We looked at evidence of these. The staff make daily checks of fridge and freezer temperatures. However, there are 2 fridges and 2 freezers and it is not clear which record relates to which appliance. The checks show that one fridge had been running at temperatures between –2 and -5ºC for over two months. This is well below the recommended temperature of 5ºC. We checked the temperature of fridges and found that one of them was -4ºC on the day of our visit. The staff need to make sure they take appropriate action to remedy and faults or problems they find when making health and safety checks, so that the same problems do not continue to occur. Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 26 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 2 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 3 2 X 3 2 X Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 YA5 Regulation 5 Timescale for action The Manager must make sure 30/09/09 the contracts for each person accurately reflect the terms and conditions of residency, what services and facilities are provided and who is responsible for providing these. The Manager must make sure 31/07/09 that a person-centred approach is implemented at the service, and that this is used to enhance the care planning and record-keeping. Previous requirement partly met 31/07/08 The Manager must make sure 31/05/09 care plans include information from health care professionals and records are consistent and accurate. The Registered Person must 31/07/09 make sure everyone has information in their care plan about their social needs, interests and hobbies and how they can be supported to meet these. The Manager must make sure 30/06/09 records with information about DS0000038036.V374995.R01.S.doc Version 5.2 Page 28 Requirement 2. YA6 12 15 3. YA6 15 4. YA6 15 5. YA10 12 Roy Kinnear House residents are stored securely and confidentially. Previous requirement partly met – 30/05/08 The Manager must make sure 31/07/09 each resident participates in a range of leisure, educational and therapeutic opportunities which meet their needs and interests and that they have full and varied lives. Previous requirement partly met – 31/07/08 The Manager must make sure 30/04/09 the staff treat residents with respect and dignity when supporting them. Previous requirement partly met – 15/05/08 The Registered Person needs to 30/04/09 make sure the staff supporting people tell them what is happening at all times and talk to them. The Registered Person should make sure staff supporting an individual with a task do not change over unnecessarily. If a member of staff supporting someone has to leave and be replaced they should explain this to the person being supported. The Registered Person must 30/04/09 make sure the staff remove protective clothing as soon as they have finished supporting someone. The Registered Person must 30/04/09 make sure people have the personal care support they need as recorded in their care plans. DS0000038036.V374995.R01.S.doc Version 5.2 Page 29 6. YA14 16 7. YA16 12 8. YA14 12 9. YA18 13 10. YA18 12 Roy Kinnear House 11. YA19 12 12. YA20 13 13. YA20 13 14. YA23 13 15. YA24 23 The Registered Person must make sure everyone has regular consultations with all health care professionals as required and that there is a record of this. The Registered Person must make sure robust auditing processes must continue to ensure that medicines are administered as required and recorded accurately. The Registered Person must make sure policies and Procedures are reviewed to include all the current safe practices. The Registered Person must make sure there are suitable procedures to protect money belonging to the people who live at the home. These should include a designated person responsible for this each shift and a handover of balances and records. The Registered Person needs to make sure the flooring in communal areas is repaired or replaced. The Registered Person should make sure limescale marks are removed. 30/04/09 30/04/09 01/06/09 30/04/09 31/07/09 16. 17. YA24 YA34 13 19 The Registered Person should make sure damaged and marked woodwork is repainted and repaired where necessary. The Registered Person must 30/04/09 make sure the back door closes properly. The Manager must make sure 31/07/09 staff recruitment records evidence thorough checks on their suitability. Previous requirement partly Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 30 met 31/07/08 18. YA31 18 The Registered Person must make sure all temporary staff receive a basic induction to the home and read and understand guidelines, care plans and risk assessments which they need for supporting people with specific activities. There should be a record of this induction. The Manager must submit an application to be registered with the CSCI. The Registered Person must make sure staff identify problems and take the appropriate action to remedy these when making checks on health and safety. The Registered Person must make sure fridge temperatures are within the recommended range for storing food. The Registered Person must make sure the AQAA is completed and returned to the CSCI within agreed timescales. The organisation must review the current arrangements for food preparation and staff office work to make sure residents have enough communal space, that privacy is respected and different methods of prepared food are available. The review should be recorded and the organisation should record the actions they plan to take to solve the problems presented by the current arrangements 30/04/09 19. 20. YA37 YA42 9 13 31/05/09 30/04/09 21. YA42 13 30/04/09 22. YA39 24 31/03/10 23. YA28 23 31/07/09 24. YA17 12 16 Previous requirement partly met 31/07/08 The Manager must make sure 30/04/09 people are given choices about the food they eat and that they are given opportunities to DS0000038036.V374995.R01.S.doc Version 5.2 Page 31 Roy Kinnear House 25. YA16 12 participate in meal preparation. Food must be nutritious and freshly prepared. The Registered Person must 30/04/09 make sure staff do not use inappropriate terminology and language when speaking to or about people who live at the home. They must show people respect at all times. 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 YA6 YA18 YA32 Good Practice Recommendations Staff should try to include information on what each person did and how they felt about this in their daily care notes. The staff should make sure they keep all records up to date for example bathing records. The staff should try to make sure they are organised and are clear about who is attending to each task before they start supporting people so that people have clear and consistent support at all times. The organisation should consider installing a hob and oven. The organisation should make sure there is sufficient storage space. The organisation should consider re-situating the nurse station to ensure confidentiality. 3. 4. 5. YA28 YA24 YA24 Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. Extracts may not be used or reproduced without the express permission of CSCI Roy Kinnear House DS0000038036.V374995.R01.S.doc Version 5.2 Page 33 - 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. 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