Inspection on 27/06/06 for Roy Kinnear House

This inspection was carried out on 27th June 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Roy Kinnear House 20/03/09

Roy Kinnear House 07/05/08

Roy Kinnear House 26/09/07

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 09/07/2008.

CARE HOME ADULTS 18-65 Roy Kinnear House 289 Waldegrave Road Twickenham Middlesex TW1 4SU Lead Inspector Sandy Patrick Unannounced Inspection 27th June 2006 10:30 Roy Kinnear House DS0000038036.V300878.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.V300878.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.V300878.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 Francesca Keating Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Nursing Care No more than three service users requiring nursing care at any one time. Management One full time manager 39 hours per week. One senior day nurse 39 hours per week. Staffing There must be an appropriately qualified nurse on duty at all times. Apart from limited periods of time e.g. emergencies, this person must be in addition to the registered manager. On the morning/early afternoon shift there must be, in addition to the qualified nurse, three support workers. On the afternoon/evening shift there must be, in addition to the qualified nurse, three support workers. There must be one waking night duty qualified nurse and one support worker. There must be no reduction in the establishment posts, which currently stands at 16, including the manager, without prior consultation with the CSCI. Ancillary Staff One domestic worker 20 hours per week. General The organisation must ensure that the above minimum staffing levels remain under review and that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. The number and distribution of nurses, support staff and ancillary staff must be reviewed at regular intervals. If at any time, the evidence indicates that there are insufficient staff of any category available to meet the assessed needs of service users, the CSCI will require additional staffing as appropriate. Date of last inspection 10th November 2005 4. 5. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 5 Brief Description of the Service: Roy Kinnear House provides accommodation and personal care to up to five residents. The home is registered to accommodate residents who have a severe learning and physical disabilities. The home is registered to provide nursing care to up to four residents (one named resident) and residential care for one resident. A qualified nurse is on duty at all times. The home is situated in a residential road in Twickenham and is purpose built. All resident accommodation is situated on the ground floor. Three of the five bedrooms have patio doors leading onto an attractive and well maintained 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 £800 - £2,000 per week. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over two days, 27th June and the 10th July 2006. The second visit was conducted by the Pharmacy Inspector. A report of his findings is recorded within Section 4 (Personal and Healthcare support). The first visit was conducted by two Regulation Inspectors. The Inspectors were made welcome at the home and had the opportunity to meet with residents, staff on duty and the Manager. The Inspectors spoke with the Manager and staff, made observations of care practices and looked at records. Before the inspection, the CSCI contacted relatives of residents and professionals involved with the home to ask for their views on the service. The residents who live at Roy Kinnear House are not able to communicate verbally and would not be able to understand and answer the questions on the surveys. However, relatives were asked to give their views on what they believed the residents felt about the service. Two resident questionnaires were completed by relatives, three relative and visitor questionnaires and nine health care professionals questionnaires were returned. Relatives completing surveys said that they were happy with the service and that they felt staff provided excellent personal care and supported residents to develop skills and individuality. One relative wrote, ‘this is a lovely happy comfortable home’. The comments from other professionals were generally positive but also had some suggestions for further improvements. One person wrote that the staff had a caring approach. Another person wrote that staff were dedicated. Professionals said that the staff generally communicated with them well and that they had a good relationship with residents. One person wrote that the home was calm, relaxed and cheerful. One of the professionals said that they felt the Manager had too many external tasks and that this sometimes affected their availability at the home. One team of professionals who work closely with the home spoke about the improvements in many areas, complimenting the hard work of staff. They highlighted that sometimes communication with their team could be better and also said that further training in specific areas was necessary for staff. They raised concerns about the manual handling training and knowledge of staff. What the service does well: The home is a relaxed and comfortable environment where residents seem happy and at ease. The relatives of residents are happy with the home and believe that residents are well cared for. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 7 Residents receive individual care and attention from staff and pursue activities which they enjoy and benefit from. The home is generally well maintained and there is a wide range of sensory equipment and decorations. Improvements to the garden have taken place over the last year and further improvements to the main house and outbuildings in the garden are planned for the near future. The home has built up good links with local organisations, the Church and a local college. Residents benefit directly from the support of these organisations. The Manager and staff have demonstrated a good knowledge of the needs of residents and have been committed to finding individual activities to meet their needs. The Manager and staff speak about residents with genuine affection and respect. The service works towards a person centred approach. What has improved since the last inspection? Over the past two years the service has steadily improved and improvements continue. Improvements to the care of residents, cleanliness of the house, maintenance of equipment, record keeping and the recruitment and support of staff have all directly benefited the residents. The home has also worked more proactively as part of a multidisciplinary team, which is really important in making sure all the needs of residents are met. The Manager and staff are commended for their hard work to improve the service. The Registered Persons have produced a new Statement of Purpose and are working on the production of a DVD guide to the home. These will help potential residents and their families have a better understanding of the facilities and services the home offers. The staff regularly look for new activities and interests which the residents can try and the Manager and staff have made good links with outside agencies. Improvement has been made in the recording and auditing of medication, although some records were not up to date. The staff have participated in a range of training opportunities and training records have improved. Recruitment practices and staff records have improved. However, the Registered Person must make sure all the required checks are made on new staff as one staff record did not evidence a full enhanced criminal record check. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 8 The Board of Trustees has become more directly involved in the management of the service and has supported changes and continuous improvement. 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. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 9 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.V300878.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, 4 & 5 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Potential residents are able to visit and spend time at the home and the transition period is designed to meet their individual needs. The Registered Persons have started to produce information for potential residents and their families to help them to understand about the home’s services and facilities. The needs of the current residents are met and there has been continuous improvement of the service over the past two years. The staff work closely with other health care professionals and this has a positive influence on the care of residents. EVIDENCE: Since the last inspection a new Statement of Purpose has been produced. This is a well laid out and attractive guide to the home. The guide includes photographs and key details about the service. The Statement of Purpose contains information about the home’s aims and objectives. The home is commended for its hard work to produce this document. A DVD guide to the home is being created and this will serve as a Service User Guide, and will be shown to potential residents and their families to help them to have a better understanding of the services offered at the home. A copy of Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 11 the finished DVD should be forwarded to the Commission for Social Care Inspection. The home currently offers places to five residents and additional day care services to two service users. The Roy Kinnear Foundation plans to make changes to the property and to create three new bedrooms. Two of these bedrooms will be offered as long term places and one bedroom will be used to short breaks. The organisation needs to apply for a variation of the registration categories in order for these rooms to be used. The day care service offered to two people is a valuable resource for them and their families and is staffed independently from the residential service. This service has been the subject of discussion between the Registered Persons and the CSCI. It is important that the home does not offer further day care services except as part of the admission and assessment process for potential residents, as the communal space and facilities are limited. The registration of three new bedrooms will mean that communal space and facilities are limited further. The Registered Persons must keep the situation under review and must prioritise the needs of the residents as this is their home. The Registered Persons must notify the CSCI of any changes to the current arrangements. The needs of the residents are generally well met at the home. The home is designed to accommodate people with multiple needs. Training for staff has improved, although there are still some areas where further staff training is needed. The home has worked closely with other health care professionals to make sure the needs of the residents are met. Licence agreements are in place for all residents. The assessments for potential residents are thorough and include opportunities for the resident to spend time at the home during the day and over night stays. Once the new bedrooms are registered, potential residents will be able to spend as much time at the home as they need to make their transition easier and for the staff to be able to get to know their needs. Assessments include information from care managers, health care professionals and the residents’ schools, colleges and any residential places. The home has started to gather information on people who have expressed an interest in the new bedrooms. The registration categories and conditions of registration need to be reviewed by the CSCI and Registered Persons. The Inspector and Manager agreed that this review should take place as part of the variation application when the new bedrooms have been built. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 12 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 & 9 The quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. Residents have their individual needs recorded within care plans. These are designed so that staff can understand them and are regularly reviewed. Some of the risks which residents experienced have not been fully assessed and need to be so that there is a clear record of how risks are to be minimised and evidence of why any restrictions are made. EVIDENCE: Individual care plans are in place for all residents. These are written in the first person and are reviewed monthly. Information is clearly recorded and in There is evidence that families and health care professionals have been involved in the development of plans. All plans have been regularly reviewed. Daily care notes are made by staff. Residents at the home have various communication needs and some have difficulties expressing choices and preferences. Care plans indicated that known choices and preferences were recorded and that the staff had consulted Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 13 with families. Where residents are able to indicate choice, this was recorded and staff are expected to use guidance to offer choices. Care plans indicate that there are risks however there is no recorded assessment for some of these risks. Some residents are able to move around the home, open doors and get out of bed on their own. Assessments of risk must be developed, recorded, and agreed by representatives wherever there is a potential risk for a resident and also where restraining devices, such as adjustable bedsides and wheelchair belts, are in place. The requirement made at the last two inspection is restated. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 14 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 The quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The staff make sure residents are offered a range of individual and group activities which they enjoy and find stimulating. Residents make good use of the local community and are supported to spend time with their friends and families. The staff treat residents with respect and offer choices where possible. Some of the terminology used by staff is not appropriate and they need to make sure they show appropriate respect when addressing residents. There is a wide range of well prepared food which is made for individuals. Staff must be seated with residents they are supporting at mealtimes. EVIDENCE: The residents at Roy Kinnear House cannot communicate verbally and understanding their needs can be difficult. However the staff have worked closely with families and have built up a picture of interests and needs. As the Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 15 staff get to know the residents well they are able to interpret how residents are feeling and a great deal of effort has been put into creating stimulating activities which meet individual needs. For example one resident who enjoys classical music is given the opportunity to hear new pieces of music and to spend time appreciating this. Residents who are able to move about independently are given the freedom to do this so that they can express themselves. On the morning of the inspection the majority of residents were at home. The staff spend time with people individually. Music was playing and there was a lively atmosphere throughout the home. Residents and staff sat in the garden over lunchtime and staff were careful to make sure residents were comfortable. The staff made good use of sensory equipment including different smells and sounds and residents appeared happy and calm. Some of the residents watched Wimbledon tennis on the television for a short period. All the residents went out in the afternoon and some of them went swimming. The staff on duty spoke about some of the activities which residents participated in. They said that they used local facilities and resources and enjoyed attending a range of local events and festivals. Residents go swimming each week and visit local parks. A music therapist and physiotherapist visit the home weekly and offer support for the group and individuals. Residents attend events at the local college and are attend church services and other religious celebrations if this is the family’s wish. There is a wide range of sensory equipment available at the home. Residents have televisions and music equipment in their rooms as well as communal areas. There is a computer in the lounge which residents are able to use. A building in the garden is due to be used as a sensory room with a range of sensory equipment. The home has special events and celebrations throughout the year. Each resident’s birthday is celebrated with a party and parties are organised for other special events. Families and friends participate in these special events and photographs are displayed throughout the home. Staff spoke about a recent Jamaican day which they organised to support one resident to celebrate their culture and heritage. The staff said that they were planning to hold more ‘international’ days where the residents would have the opportunity to sample music, decorations, food and other aspects of a particular country. Interactions between staff and residents were good, with staff showing respect and kindness and, in general, using appropriate forms of address. Although several members of staff were overheard saying, ‘good boy’ to one of the residents. This is inappropriate and the staff should be aware that speaking to residents in this way is not acceptable. The Manager should help the staff to think of more appropriate ways for them to praise residents. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 16 The Manager said that staff work closely with families and consult them about the care of residents. This is important particularly where residents cannot always communicate their needs. The families who completed surveys for the CSCI, and those who have met with the Inspector, said that they were well informed. They said that they were made welcome at the home. Two of the residents have family members on the Board of Trustees. A website where relatives and friends can view photographs and have updates on events and activities at the home has been set up. Some residents use Percutaneous Endoscopic Gastrostomy (PEG) feeds. The other residents have a variety of dietary needs. The staff said that they work closely with a local dietician, who offers advice and support with menu planning and monitoring of needs. Records of food eaten by residents is appropriately recorded and monitored. Menus at the home indicated choice and variety. The kitchen was well stocked with fresh food on the day of the inspection. Food was generally labelled and dated appropriately. A bowl of stewed fruit was labelled with 20/06/06, six days before the inspection and should have been discarded. The Manager must make sure staff make regular checks on the food stored so that food is used or discarded in a timely manner. One member of staff who was a support a resident during their meal was standing next to the resident. Staff supporting residents at mealtimes must be seated next to the resident. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 The overall quality in this outcome group is adequate. This judgement has been made using evidence including a visit to the service. Residents generally have their personal and health care needs met and the staff work closely with other health care professionals. However staff do not always follow the safest and most appropriate manual handling procedures. Some nursing practices are not always recorded appropriately. The overall quality of the medication standard is poor. Inaccuracies in recording, and poor administration and disposal of medication practice were found that could put the health and welfare of residents at risk. EVIDENCE: Personal care needs are appropriately recorded. Bathing and support with personal care are recognised as important, and staff spoke about ways in which they make these activities a positive and enjoyable experience for residents. The residents at the home have a range of complex health needs. The home works closely with health care professionals, and this is evidenced in care plans. All residents are registered with local GPs. The home is registered to Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 18 provide nursing care to three service users. throughout the day and night. A registered nurse is on duty The procedures for some nursing practices are not recorded and risk assessments associated with these are not in place and must be. Some monitoring of health and nursing care was periodically recorded and records did not always indicate that appropriate checks had been made. The Manager said that all staff had received training and support regarding manual handling techniques. The Manager is a qualified manual handling instructor and the physiotherapist and occupational therapist also work closely with staff to look at techniques and practice. The Inspectors witnessed some disorganised and some poor manual handling practices. In one instance three staff attempted to support a resident to move position. The staff could not decide on the best techniques and the whole procedure was unnecessarily muddled. The staff did not follow guidance in the care plan. In another case a mattress where a resident was lying was pulled towards a hoist rather than the hoist being taken to the resident. These manual handling practices are potentially hazardous to residents and staff and may cause unnecessary distress. The care plan of one resident included recommendations from the physiotherapist for the use of a particular piece of equipment, which was not being used by staff. The Manager must work with the other health care professionals to further look at manual handling practices so that the staff follow correct procedures. Staff must be retrained as necessary. The staff on duty said that they felt that in general the health of residents had improved and that they worked closely with health care professionals who offered advice and support. All records relating to receipt, storage, administration and disposal of current medication were examined. One staff member and the manager were interviewed. The current medication in stock was compared to the current records and medication was counted and compared to the records to check that medication had been given correctly. Care records were checked for two residents. All current medication was stored securely in individual resident’s rooms. Extra medication is kept in a locked cupboard. All medication was stored under appropriate conditions. Most medication is given from a compliance aid container that is filled and dispensed by the pharmacist. Staff are able to check if medication has been given or not. When medication is not supplied in the container there is a clear audit trail to check whether medication has been given correctly. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 19 Detailed care notes are written to help staff make sure medication and feeds that are given by a PEG tube are given correctly. The care notes for two residents did not match the current medication regime. This could lead to confusion of what medication is supposed to be given and how. Staff stated that they would up date the information on the day of the visit. Detailed information is available to help staff monitor seizures in residents and to ensure appropriate treatment is given. Records showed that appropriate action had been taken. The information about allergies on the administration record did not agree with the information in the care notes for one resident. All other medication administration records had been completed accurately. It was not possible to check if one resident had been given their medication correctly as the receipt of all the current medication had not been recorded. Three items of medication had been removed from their original container and placed in the resident’s room. There were no directions for administration on the medications. From discussion with the nurse on duty the administration records are not taken in to the resident’s room when giving the medication. This means there is no way to check the current dose of medication against the records at the time of giving the medication. Although the nurse on duty knows the residents and the dose of medication this is not considered safe practice by the nursing professional body or The Royal Pharmaceutical Society of Great Britain. It was agreed on the day that medication would be administered from the labelled container and administration record would be available in residents’ rooms. All other medication was labelled with directions for administration and from the amount of medication in stock compared to the records all medication had been given as directed. There are no arrangements for the safe disposal of medicines by a licensed waste disposal company. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 20 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 & 23 The overall quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. There are appropriate procedures regarding complaints and protection of vulnerable adults and these are designed to safeguard the service users. EVIDENCE: There is a suitable complaints procedure detailing timescales and how to contact the Commission for Social Care Inspection. There have been no complaints since the last inspection. Residents’ families are aware of the complaints procedure and who to contact if they are unhappy about any aspect of the service. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults Procedure. All the staff have recently attended training in this area. The staff on duty were able to tell the Inspector their responsibilities under the Whistle Blowing procedure. The Registered Person recently worked with a multidisciplinary team in a Protection of Vulnerable Adults investigation. The Registered Person followed procedures appropriately and worked closely with other agencies to make sure the safety of service users was maintained. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 21 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 quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The residents live in a pleasant, homely environment and have enough space to live comfortably. The home is decorated and furnished appropriately. The plans to change the home and register more places are appropriate for the service. EVIDENCE: The home is purpose built. The bedrooms, bathrooms and communal spaces are large and suitably equipped to meet the residents’ needs. Bedrooms have been personalised and the home is attractively decorated throughout. There is an accessible garden which has been specially designed for the residents. The garden has a range of smells, textures, colours and special feature to appeal to residents through a range of senses, and is a highly commendable asset to the home. The staff and residents spent time in the garden on the day of the inspection. Two chalet style buildings have been built in the garden. One of these is to be used as an office and the other as a sensory room. These rooms were not Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 22 functioning at the time of the inspection but work to make them ready to use was taking place. A new garden swing seat had been purchased and the Inspector was able to view videos of residents enjoying the use of this. The organisation plans to redevelop parts of the building to create three additional bedrooms. The plans include a change of purpose for the current kitchen. A smaller catering areas will be set up as part of the lounge and is designed to meet the needs of residents. A number of the residents have PEG feeds and the others have specialist diets which do not require a fully equipped kitchen to prepare. The current kitchen is looking old and worn and if for any reason the plans for the building change and the kitchen is not relocated then the Registered Person must look at refurbishment of this room. The home was clean throughout and there is a regime of cleaning in place to maintain a good standard of cleanliness. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 23 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): 31, 32, 33, 34, 35 & 36 The quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The recruitment procedures are suitable to safeguard residents, although the Manager must make sure that enhanced criminal record checks are made on staff. The staff have undertaken a range of relevant training and records of training have improved so it is easier for the Manager to monitor where additional training is needed. The staff say that they feel supported and there has been more frequent individual meetings with staff. The Manager should make sure there are formal opportunities for the staff to meet on a regular basis so that knowledge is shared and there is a consistent approach. EVIDENCE: The home is appropriately staffed, and staffing is reviewed as the needs of residents change. The day care service is staffed separately from the residential service. The staffing rota includes a large amount of long (up to 12 hour) shifts for some staff on a regular basis. The Manager must keep this situation under Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 24 review as long working hours can affect adversely performance. Staff working long hours must be given sufficient time off and should receive regular supervision to make sure they can work effectively under these conditions. The recruitment procedure includes a formal interview, which is recorded and held on file. Candidates who successfully passed the interview are then invited to spend some time working at the home alongside experienced staff as part of the selection process. Staff files contained evidence of appropriate checks on the suitability of staff, except in the case of one staff member who had a standard and not an enhanced criminal record check. The Manager has since contacted the CSCI to state that an enhanced check has now been received on this member of staff. The Registered Person must make sure an enhanced disclosure is requested on all staff. The staff on duty spoke about their work at the home. They said that they enjoyed their work and supported each other well. They said that the Deputy Manager worked directly with them and one of the new members of staff spoke about their induction, saying that they had received good support during this. Two members of staff started shortly before the inspection. The Manager said that both staff members had completed their induction and were working well with the residents. Both members of staff had had training in first aid and Protection of Vulnerable adults. Some of the staff were attending training on the day of the inspection. Over the past six months the Registered Persons have shown a commitment to staff training and have arranged for all staff to have Protection of Vulnerable Adults training. Training records have improved and there was a clear record of individual staff training. This improvement is positive and will help the Manager monitor training needs. There has been some good work with other organisations to offer training for staff and this has been designed to look at the individual needs of residents. The training records indicated that the staff had participated in a range of different training events. The Manager must make sure these records are kept up to date and that training needs are regularly reviewed. The new members of staff did not participate in some of the recent training events which took place before they started. The Manager must make sure they undertake all relevant training as soon as possible. The Manager said that she is investigating the possibility of a local college providing training in holistic massage, aromatherapy, music therapy and other alternative therapies. The staff would be able to use learnt techniques at the home. The Manager hopes that staff would be able to start this training in September 2006. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 25 The Manager said that staff supervisions were taking place more regularly than they had in the past and that the Deputy Manager had become more involved in giving supervision. It is important that individual supervision meetings take place on a regular basis to offer support to staff and to help them develop and learn. There have been only periodic staff meetings and these should be arranged more often. The Manager said that informal communication is good between staff members and this is important. However, regular formal meetings for information sharing, in house training and for staff to offer their views on the service are essential for the continuous improvement of the service. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 26 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): 31, 38, 39, 40 & 42 The quality in this outcome group is good. This judgement has been made using evidence including a visit to the service. The service is appropriately managed, although the Manager’s strategic role takes time away from the day to day management of the home and this may adversely affect the service if her strategic role grows further. There are systems for quality monitoring although these are not always followed. The Registered Persons should also look at further ways in which they can monitor quality and outcomes for the residents. There are suitable checks on healthy and safety and these are recorded. EVIDENCE: The Manager is a qualified nurse. She reported that she plans to undertake an NVQ Level 4, and must make plans to do this. She has additional qualifications in theology. The Manager has been in post since July 2003 and was registered with the CSCI in 2005. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 27 The Manager said that over the past year she has felt more supported by the Board of Trustees and they have offered valuable advice and input into the service. One of the Trustees is a medical professional, one works for another larger care organisation and the Chair of the Trustees has shown a commitment and interest in the development of the service. The Manager still does not have any direct line management support, although she reports to the Board on a regular basis. The advice and support of other professionals has been very valuable, however regular supervision and opportunities for the Manager to meet on an individual basis with an appropriate professional would be beneficial. The Manager’s role includes strategic and organisational development and this takes time away from the direct management of the home. The organisation has plans for further expansion and development. The Registered Person must make sure the Manager is appropriately supported so that strategic work does not adversely effect the day to day management of the home. The supervision of staff and daily input of the Manager has not always been available because of her other responsibilities. The organisation should consider how best to manage its development and expansion whilst maintaining a commitment to continuous improvement at the home. The Registered Persons have produced a Business Plan for the coming year which outlines the history of the organisation, Mission Statement, aims and objectives, structure and plans for development. The Manager has been involved in local groups organised by the London Borough of Richmond to look at how quality is measured within the service. The Chair of the Trustees visits the home regularly but is required to make monthly inspections of the service and produce a report on this which needs to be forwarded to the CSCI. There have only been a small number of these reports and the Registered Person must make sure he conducts monthly quality monitoring visits and reports to the CSCI on these. Record keeping at the home has improved and the home’s Administrator has set up good systems to audit and check records. There is evidence of regular checks on health and safety, including fire safety. The Manager spoke about plans to make sure residents and staff are kept safe during the building works at the home. A risk assessment should be drawn up and should be reviewed if there are changes to the planned work. The Registered Person should make sure the risks to residents and staff during the proposed building works are formally identified and an assessment is recorded. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 28 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 4 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 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 3 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 3 3 2 3 X 3 X Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 29 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 YA9 Regulation Requirement Timescale for action 13(4), (6) & (7) The Registered Person must 31/08/06 make sure that individual risk assessments are in place for all residents who are at risk and where any restrictions are in place. Previous timescale 31/08/05 requirement 28/02/05, & 31/12/05 This must be prioritised and be completed by the timescale for action. Evidence must be forwarded to the Commission for Social Care Inspection. Failure to comply may lead to enforcement action being taken. 2. YA16 12(4) The Registered Person must 31/07/06 make sure staff do not use inappropriate terms when speaking to or about residents. The Registered Person must Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 30 make sure staff supporting residents during mealtimes are seated next to them. 3. YA19 12(1) 13(4) (6) The Registered Person must 31/07/06 make sure procedures and risk assessments are in place for all nursing interventions and that appropriate monitoring is recorded. The Registered Person must 31/07/06 make sure staff follow correct manual handling equipment and use equipment recommended by health care professionals. Staff must be retrained as necessary. The Registered Person must 24/07/06 make sure: 1. All medication is administered appropriately in accordance with good practice guidelines. 2. All records relating to medication are current and up to date. 3. The receipt of all medication is recorded appropriately. 4. There are appropriate arrangements for the safe disposal of medication. (01/09/06) YA34 Roy Kinnear House 4. YA19 12(1) 13(4) (5) (6) 5. YA20 13(2) 13 The Registered Person must 31/07/06 DS0000038036.V300878.R01.S.doc Version 5.2 Page 31 6. 19(1)(a)Sch2 make sure that there have an enhanced criminal record check for all members of staff. The Registered Person must 31/12/06 make sure regular team meetings are held. Previous timescale 31/12/06 requirement 31/08/05 & 7. YA36 12(5)18(2) 8. YA39 26 The Registered Organisation 31/07/06 must make sure that a representative conducts unannounced inspections of the service each month. They must produce a report of their findings and forward a copy of this to the Commission for Social Care Inspection. Previous timescale 31/12/05 requirement 31/08/05 & RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations The Registered Person must make sure perishable food is disposed of in a timely manner. The Registered Person should make sure that staff working DS0000038036.V300878.R01.S.doc Version 5.2 Page 32 2. YA31 Roy Kinnear House long shifts as given appropriate time off work and that their performance is closely supervised. 3. YA38 Consider the employment of a suitably qualified person to offer professional supervision and support to the Manager. 4. YA39 The Registered Person should make sure the risks to residents and staff during the proposed building works are formally identified and an assessment is recorded. Roy Kinnear House DS0000038036.V300878.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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