Inspection on 30/06/05 for Roy Kinnear House

This inspection was carried out on 30th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 12 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 27/06/06

Roy Kinnear House 10/11/05

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 30 June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Roy Kinnear House Address 289 Waldegrave Road Twickenham Middlesex TW1 4SU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8892 4049 020 8891 6734 The Roy Kinnear Foundation Care Home 5 Category(ies) of 5 Learning Disability registration, with number 5 Physical Disability of places Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1.Nursing care: no more than three service users requiring nursing care at any one time. 2. Management: One full time manager 39 hours per week. One senior day nurse 39 hours per week. 3. 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. 4. Ancillary Staff: one domestic worker 20 hours per week. 5. 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 apropriate 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 8th December 2005 Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 5 Brief Description of the Service: Roy Kinnear House provides accommodation and personal care to up to five service users.The home is registered to accommodate service users who have a severe learning and physical disabilities. The home is registered to provide nursing care to up to three service users and residential care to up to two service users. A qualified nurse is on duty at all times. The home is situated in a residential road in Twickenham and is purpose built. All service user 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. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on 30th June 2005 and was unannounced. The Inspection Team consisted of a Regulation Inspector and a Pharmacy Inspector. The findings of the Pharmacy Inspector are recorded under Section 4 of this report – Personal and Healthcare Support. The Inspection Team met with service users, staff on duty and the Manager and was made welcome by all. The Inspectors observed positive interactions between staff and service users which indicated mutual trust and respect. Throughout the inspection service users were seen to pursue a range of activities. Service users presented as happy and relaxed in their environment and the staff approach was caring and demonstrated a good knowledge of individual needs. The home is currently registered for five service users. The organisation plan to create three new bedrooms and apply to increase the registered numbers. The plans also include developing a sensory garden, relocating the office and kitchen and building a sensory room. The planned changes to the building are complex, but the organisation has developed a plan which they feel will minimise disruption for the service users. The organisation needs to submit an application for variation to the Commission for Social Care Inspection. The Registered Person will then be able to discuss these plans with an allocated Inspector. The Manager has applied for registration with the Commission for Social Care Inspection. Shortly before the inspection, she had an interview as part of the registration process. Since the last inspection there has been a new member of the Board of Trustees. This person has been successfully registered as the organisation’s Responsible Individual with the Commission for Social Care Inspection. What the service does well: Roy Kinnear House offers a specialist service for people who have a learning disability and a physical disability or nursing needs, including young adults (16-18). The environment meets this need and is attractive, imaginatively decorated and well equipped. The staff at the home work alongside health care professionals to ensure that the complex needs of service users are being met. The home has good links with the local community, a local college and church. These links have helped to provide a positive community image for the service users and helped raised awareness of their needs. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 7 The staff work closely with families and friends of service users. There is evidence of open communication with families and a selection of photographs showed how service users were able to invite their relatives and friends to parties and other celebrations at the home. All service users receive individual support from staff throughout the day and are able to pursue activities designed to meet their needs and wishes. What has improved since the last inspection? What they could do better: Although significant work to develop the service and to look at future developments have taken place, the majority of requirements made at the last inspection visit have not been fully met. The Manager was able to demonstrate some work which had taken place in these areas, however further work is required. Failure to comply with some of the outstanding requirements Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 8 puts service users at risk of harm or abuse and work to meet these requirements must be prioritised. Failure to do so may lead to enforcement action being taken by the Commission for Social Care Inspection. The home needs to issue all service users with terms and conditions of residency. Assessments of risk need to be made, recorded and kept under regular review for all service users. Failure to comply may put service users at risk. This work must be prioritised. One service user does not have independent financial or advocate representatives. The Registered Person must liaise with the placing authority to arrange for this. Failure to comply puts the service user and the organisation at risk. This work must be prioritised. More thorough checks need to take place and be evidenced for all staff and volunteers who work at the home. Failure to comply puts service users at risk. This work must be prioritised. All staff must receive regular individual supervision and must participate in regular team meetings. The staff, and where applicable volunteers, at the home must be offered a wide range of training relevant to their role. In particular all staff must receive training in protection of children and vulnerable adults, first aid, food hygiene, fire safety and any other training relevant to their role. Failure to comply puts service users at risk. This work must be prioritised. The Registered Person must ensure that monthly unannounced visits of the home take place to monitor quality and that reports of these visits are forwarded to the Commission for Social Care Inspection. The Manager is the most senior member of staff employed within the organisation. She has budgetary responsibilities and has taken on the responsibilities of the Chief Executive who left the organisation earlier in the year. The Manager does not have supervision and is not line managed by anyone. There is no expertise or experience in the field outside that of the Manager and staff employed at the home. This situation puts considerable responsibility on the Manager and is not good practice. The impact of this is that the home does not have suitable monitoring, supervision, support and guidance. The role of managing the home is a full time responsibility and additional duties may be detrimental to this role. Staff supervisions, meetings and training have been extremely periodic and the Manager’s current responsibilities take time away from these essential areas of management. The Inspector accepts that the employment of a new Deputy Manager and the possible involvement of another care provider will be helpful in some of the areas mentioned. However, the organisation should recognise the risks Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 9 created by the current situation and should be proactive in seeking appropriate support and supervision for the Manager and the employment of a suitably qualified individual who can monitor quality and service provision at the home. 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 G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 & 5 There is no service user guide for the home and work to produce a suitable guide needs to take place, so that potential service users and their families have accessible information to make a decision about moving to the home. There are thorough procedures for the assessment and admission of service users and the staff work closely with the service user, friends, families and other professionals to support service users to familiarise themselves with the home. The home offers a specialist service to service users with a learning disability, physical and nursing needs. Close work with health care professionals, a suitable environment and individual support is helpful in meeting these needs. Further staff training and support are required to ensure that they have a full understanding of how to meet needs. Placement contracts have been developed for all but one service user. The Manager has been unable to gain a copy of the contract with the placing authority for this service user. Some contractual agreement needs to be developed, so that all parties are clear of the terms and conditions of residency. EVIDENCE: There is a comprehensive Statement of Purpose for the home. This includes a copy of the home’s Aims and Objectives and the Mission Statement. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 12 There is currently no Service User Guide. The Manager has discussed with staff, other professionals, friends and family of service users ideas of how best to produce this document. Consideration has been given to the use of photographs and a DVD of the home. This would be more informative than written text or symbols for many of the service users who live at the home. The Foundation has produced a leaflet guide to accompany the Statement of Purpose. The Inspector recognises the difficulties of producing a full Service User Guide, which will be accessible to all service users. However, some form of Service User Guide should be created making use of written, visual and recorded information. The requirement made at previous inspections is restated. This work is particularly important giving consideration to the proposed extension of registered places, when potential service users will need as much accessible information as possible so that they can be supported to make an informed choice about whether they want to move to the home. There is a thorough assessment procedure and once potential service users have made a decision to move to the home, comprehensive work to support them with this move takes place. The Manager reported that one service user who was due to move to the home later in the year had visited Roy Kinnear House and had met with other service users and staff. They had been invited for meals and were due to spend a night at the home shortly after the inspection. In addition staff from the home had visited the service user in their current home and had met with friends, families, teachers and other carers. The Manager and keyworker had attended reviews at the service user’s current placement and have received written information from a variety of other professionals and current carers, which were shown to the Inspector. The Manager reported that staff had taken photographs of the service user’s current home to help organise their bedroom in a familiar and pleasing way at Roy Kinnear House. Photographs had also been given to the service user to remind them of their new home. The Manager reported that this work would continue during the transition. Assessments of need are made by the Manager during the period of transition and by the placing authority. These are complemented by information from other professionals and the family. The Manager reported that families and current carers were invited to complete information on a provisional care plan which would be used to help support the service user during the period of transition and during their initial stay at the home. All service users are admitted on a six week trial stay. At the end of this period a review meeting with the service user and their representatives is held to decide whether the placement is appropriate and should continue. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 13 The Manager reported that the home hopes to offer a fully staffed day care service to potential service users in the future as part of the admission and assessment procedure. This will help new service users familiarised themselves with staff and the home and will provide information on individual needs which can be translated into a plan of care when the service user moves to the home. The home offers a service to people who have a range of complex needs. Nursing staff are employed throughout the day and night to meet individual nursing needs. The home works closely with dieticians, physiotherapists and other health care professionals. The Manager reported that the physiotherapist was meeting the new service user during their next visit to the home and would be assessing their needs and advising on equipment at this time. Guidelines from health care professionals and evidence of meetings and assessments were seen within service user plans. There is evidence of close work with families and friends to ensure that they can be involved with care and are appropriately informed. Service users have various communication needs and verbal communication is limited. Therefore the home has used different methods to support better communication and understanding. The Inspector saw use of a communication book between staff and the parents of one service user. The Manager reported that photographs are commonly used to support service users to show their families what they have been doing. The staff reported that they support service users to express themselves through drama, music and art work. On the day of they inspection the Inspector saw staff and service users using various communicating techniques, including signs understood by both parties. The Manager reported that some service users enjoy using the computer and the Inspector saw one service user expressing themselves through painting. The environment is equipped with lighting and other sensory equipment and plans to create a sensory garden were being discussed at the time of the inspection. The Foundation plans to redevelop areas of the building and to increase the registered numbers. An application to vary the registration must be made to the Commission for Social Care Inspection. Staffing levels must be increased to reflect this and should reflect individual assessments of need. The Manager reported that contracts of care are in place for all but one of the service users. She reported that a contract had already been agreed for the new service user. However, she stated that the placing authority for one service user were refusing to issue a contract. The home, as the provider, must ensure that contractual arrangements including terms and conditions of residency are in place for all service users. Refer to Requirements 1 & 2 Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 14 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 & 10 Individual needs are identified and recorded within service user plans. There is evidence that plans are followed and these needs are met. Representatives of the service users have been consulted and have agreed with individual plans of care. There is no finance or advocate representative for one service user, other than staff at the home. Representatives of the Roy Kinnear Foundation must not act as finance agents or representatives to this service user, in order to safeguard the interests of the service user and the organisation. Assessments of risk are not in place for individual service users where there is a perceived risk or where restrictions are in place. Therefore there is no evidence of the decision making process for judgements made within service user plans and restrictions. EVIDENCE: Individual service user plans are in place for all service users. The Manager reported that families have been involved in the development and review of these. Service user plans had been signed by a representative of the service user. The Inspector examined two service user plans, which were written in Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 15 the first person. Plans were a clear design and information was appropriately presented. These plans were comprehensive and included detailed information on social, health, personal, cultural and emotional needs. Daily care notes are made and indicate that service user plans are followed appropriately. Service user plans indicate choices and known preferences of the service user. Information and guidelines from health care professionals was appropriately translated into service user plans. There was evidence of monthly reviews of service user plans and changes in need were recorded. There was a small amount of conflicting information in one service user plan. Where a service user had experienced a change in need, both old and newer guidelines were in place and some of this information was contradictory. The Manager must ensure that all information within the service user plan is current and older information is appropriately archived. Service users at the home have various communication needs and some have difficulties expressing choices and preferences. Service user plans indicated that known choices and preferences were recorded and that the staff had consulted with representatives of service users to gain information in relation to this. Where service users are able to indicate choice, this was recorded and staff are expected to use guidance to offer choices. One service user’s representatives are due to be moving out of the country and this service user does not have an advocate. There is also a need to change the appointee to manage this service user’s finances. The Registered Person should contact the placing authority for this service user and must ensure that a representative external to the home undertakes the role of Appointee. The Manager or staff at the home must not be the service user’s appointee. The Registered Person should also seek independent advocate support for this service user and should liaise with the placing authority about the most suitable party to undertake this role. The service users at Roy Kinnear House have a variety of communication needs and are not always able to express their choices and preferences on the running of the home. The Manager should ensure that where possible service users and their representatives are consulted about changes in procedure and service delivery. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 16 General risk assessments in respect of procedures and the health and safety of the environment have been developed. However, assessments regarding individual needs of service users, particularly where service users are able to move around the home independently are not in place. Assessments of risk must also be recorded, and agreed by representatives, where restraining devices, such as adjustable bedsides and wheelchair belts, are in place. One service user plan indicated that the kitchen door should be closed at times because a service user was at risk if they accessed the room independently, however no assessment was in place to evidence the decision to restrict the service user. There is an appropriate procedure regarding confidentiality. stored securely, was accurate and appropriately presented. demonstrated an understanding of confidentiality issues. Information is Staff on duty Refer to requirements 3 & 4 and Good Practice Recommendation 1. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 17 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16 & 17 Service users are offered individual support to meet their needs. They are supported to access the community and participate in a wide range of educational and social activities. Service users are supported to maintain contact with their families and friends. Staff demonstrated that they treated service users with respect. There is a balanced and varied menu, which has been approved by a Dietician who visits the home regularly. EVIDENCE: Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 18 Service users at the home are supported to participate in a range of activities, on an individual basis and in groups. Each service user is allocated one member of staff throughout the day to support them. Service users attend local places of worship and have links with colleges and social groups. Service users access local colleges, have therapeutic input and make use of leisure facilities. Throughout the home, there is a range of sensory equipment. Individual activities are organised for service users, according to needs and known preferences. These include attending college, use of hydrotherapy pools and sensory rooms, reflexology and music therapy. Staff on duty reported that service users accessed the local community, making use of leisure facilities, shops and other local resources. This is evidenced in service user plans and daily notes. There is a variety of television, video and music equipment in communal and private areas. There is also a computer in the main lounge. Staff on duty reported that some service users enjoying using this. There is a wide range of sensory and leisure equipment. Service users are offered music therapy, reflexology and aromatherapy on a regular basis. The Manager reported that a volunteer has been offering drama therapy support over the summer. She also explained that a local college was working in partnership with the home to offer students placements providing drama therapy support. The programme of support will be designed by staff at the home and the college to meet service users’ needs. This is an exciting piece of work and the Inspector is keen to seen how it will develop. The Registered Person must ensure that appropriate checks have been made on all students working with the service users. Refer to Sections 5 & 7. There is a flexible visitors procedure. The Manager reported that staff work closely with visitors. There was evidence of good communication between staff and families, including communication books and photographic records. Staff were observed to interact appropriately with service users and use appropriate forms of address. The atmosphere at the home was relaxed and peaceful. Staff were observed to treat service users with respect. Adjustable bedsides are in place at the home. Assessments of risk must be made and service user plans must record where any restricting equipment is used. Refer to Section 2 of this report. The home caters for a variety of dietary needs. The Manager reported that staff work closely with a local dietician, who offers advice and support with menu planning and monitoring of needs. Records of food eaten by service users 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. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 & 21 Personal and health care needs are appropriately recorded and monitored within service user plans. The home liaises with health care professionals and their guidance is included within service user plans. The home has arrangements for the ordering, storage, recording, administration and auditing of medication and has access to a pharmacist for advice. Omissions and errors in recording were found that had no direct affect on the health and welfare of service users. The staff at the home offered support to the family and friends of a service user who died earlier in the year. There is no procedure to be followed in event of death of a service user and therefore staff may not have accessible information on what they need to do if this should occur. EVIDENCE: Personal care needs are recorded within service user plans. Staff on duty were seen to attend to individual needs discreetly and appropriately. Staff on duty reported that same gender carers supported service users with intimate personal care. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 20 The service users at the home have a range of complex health needs. The home works closely with health care professionals, and this is evidenced in service user plans. All service users are registered with local GPs. The home is registered to provide nursing care to three service users. A registered nurse is on duty throughout the day and night. Health care needs are appropriately recorded in service user plans and include information from health care professionals. There is a record of all accidents and incidents. The Manager has developed guidelines for staff on supporting service users with epilepsy. These guidelines are informative and well designed. The Manager reported that she hopes to develop further guidance regarding other health care and nursing needs. The written policies and procedures were found to be adequate on a previous inspection and were not reviewed on this visit. All medications administered by staff along with the records relating to receipt, storage, administration and disposal of medication were examined. The Manager and nurse charge were interviewed and two service users medications not supplied in the monitored dosage system counted and compared to the records of receipt and administration. From these discussion and observations one service user had missing entries indicating administration/non-administration of medication. The medication had been supplied in a Dosett container and had been administered. The administration record for one service user did not record accurately the dose of medication given for two medications. Separate written guidelines were in place detailing the dose to be given and at what time. From discussion with the nurse in charge the medication is being administered as directed. The allergy section on the administration records was not completed for two service users on the current administration record. The allergy section had been completed for all service users on the previous months records. A record was seen of monthly checks on expiry dates of medication. Random checks are made of medications and records. No record was seen detailing these checks. All medication was stored securely. Where medication had not been administered as directed by the prescriber a clear reason had been recorded. There are records in place of visits by the pharmacist. Issues identified on the last visit had been addressed. Since the last inspection, one service user sadly passed away. The Manager and staff on duty told the Inspector of the work that had taken place around this time to organise a memorial and to support friends and family. The staff are commended for their work to celebrate and commemorate the life of the service user. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 21 There is an appropriate procedure for care of ill and dying service users. There was no procedure to be followed in event of death of a service user. A procedure for staff to follow must be put in place. There must be recorded information on a specific individual wishes or preferences in this area. Refer to Requirements 5 & 6 and Good Practice Recommendation 2. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 22 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 There is an appropriate complaints procedure. Procedures are in place to protect service users. However, staff have not been appropriately trained as to what constitutes abuse and how to report suspect abuse. Therefore service users are at risk and are not adequately protected. Criminal record checks and written references were not in place for staff and volunteers who work with service users. Therefore the Registered Person cannot guarantee the suitability of these people and service users may be at risk of harm or abuse. EVIDENCE: There is an appropriate complaints procedure, including time scales and contact details for the Commission for Social Care Inspection. There have been no complaints since the last inspection of the service. The home has adopted the London Borough of Richmond Protection of Vulnerable Adults Procedure and has its own procedures on abuse and whistle blowing. The home has information on Child Protection Procedures from the London Borough of Richmond. The Manager must ensure that any updates on policy and procedure are available at the home. The majority of staff have not received training on protection of vulnerable adults or children. This training is essential for staff to understand what constitutes as abuse and the procedures to be followed in the case of suspected abuse. The service users at Roy Kinnear House are vulnerable and have communication needs, therefore it staff must have a clear understanding of these issues and how they can protect service users from harm or abuse. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 23 This training has been outstanding and has been the subject of requirements made at the last two inspections. The Registered Person must recognise the importance of this training for staff and must ensure that training is arranged for all staff as soon as practicable. Refer to Requirement 7. The Registered Person must liaise with the placing authority to organise an independent financial representative for one service user. Refer also to Section 2. Criminal record checks were not in place for all staff and volunteers who were on the rota to work at the home during July 2005. It is essential that thorough checks, including criminal record checks are made on all staff and volunteers before they undertake work with the vulnerable service users who live at the home. Refer to Section 7 and Requirement 8. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 24 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 & 30 The environment is spacious, clean and well maintained. The home is attractively decorated throughout and staff are commended for their work to personalise rooms. The environment meets the needs of the current service user group. EVIDENCE: The accommodation is purpose built and is suitable to meet the needs of service users. All accommodation accessed by service users is on the ground floor. There is a large, mature and attractive garden to the rear. The home is attractively decorated throughout, with many areas, including bedrooms and communal areas, redecorated over the past year. There are plans to redevelop areas of the building creating three new bedrooms, a new kitchen area, office, sensory room and a sensory garden. All bedrooms and communal space meet or exceed the size requirements of the National Minimum Standards. Bedrooms are highly personalised and reflect individual tastes and personalities. Three bedrooms have patio doors Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 25 leading to the garden. The lounge/diner is large and patio doors lead to the garden. There are two bathrooms available for service users, one with a specialist bath, the other with a shower facility. The Manager reported that there are plans to refurbish one bathroom. The home is well equipped with sensory equipment throughout and this gives opportunities for stimulation and relaxation for service users. The Manager reported that the new bathroom will be a sensory environment, with sound and lighting to enhance relaxation. Suitable adaptations have been made to the environment and individual equipment is provided for service users as required. The Manager reported that the physiotherapist and occupational therapist have regular input into the home. The home is spacious and the environment well maintained. It is important that the home continues to meet National Minimum Standards size requirements for communal space following the refurbishment, so that service users have enough room to meet their needs. Storage at the home can be problematic and service users have large and numerous pieces of equipment necessary to meet their needs. The Manager reported that additional storage facilities were planned. The home was clean and well maintained throughout. Appropriate procedures are in place for the laundering of clothes, infection control and control of substances hazardous to health (COSHH). Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 26 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 & 36 There are sufficient numbers of staff on duty and the staffing structure is appropriately organised. The staffing levels must be reviewed when new service users are admitted. There is information for staff on their roles and responsibilities. The home has not made thorough checks on all staff and volunteers and service users are placed at risk. Staff have not undertaken essential training and therefore may lack the necessary skills and knowledge to ensure the health and wellbeing of service users. Staff have not received regular support through individual or team meetings. EVIDENCE: Individual job descriptions are in place for all roles within the home. There are systems for appropriate communication and additional guidelines and information for staff on their roles and responsibilities. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 27 One member of staff told the Inspector that the staff team were very positive and happy at the moment. The Manager reported that a new staffing rota had been developed and this was due for implementation in July 2005. Some of the staff on duty stated that they often worked long days (12 hour) and that this could be tiring. The Manager stated that the new rota was designed to reduce the number of 12 hour shifts worked. The Manager should keep the rota under review consulting with the staff team about the best way to organise their hours. Working longer hours may affect staff performance and concentration and there must be sufficient breaks and time off. Since the last inspection the Deputy Manager left the home. A new Deputy Manager has been appointed from the existing staff team and was due to undertake their new role shortly after the inspection. The staff on duty commented that since the last Deputy Manager left there had been limited management support working directly with them. The Manager reported that the new Deputy Manager would work directly with the staff and not be based in the office. Two staff files were examined. One file did not contain any identification or references. There was no copy of the job description or contract. The other file held more information and copies of interview questions and answers were seen. However the file only contained one requested reference which stated that the referee felt they were not appropriate because they had only known the staff member a short time. The other references on file were standard references to ‘whom it may concern’ and had not be requested by the home in relation to the actual job description. Both staff files contained criminal record checks and the original application form. Staff records must be complete. It is essential that two written references are requested and received prior to the staff member commencing work at the home. Failure to do so puts service users at risk by employing staff who may not be suitable. The home makes use of volunteers to offer additional support for service users. Reference checks and criminal record checks were not in place for all these volunteers and must be. The Manager reported that the home proposes to use volunteers from a local college to offer drama therapy support. Criminal record checks must also be made on these volunteers. None of the staff currently have NVQ qualifications nor are any staff undertaking these. Staff at the home have a range of experiences and some staff are qualified nurses. However, the organisation must be proactive in supporting unqualified staff to achieve relevant NVQs. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 28 The organisation has produced induction and foundation training packages. These cover the required areas and staff are expected to complete work books relating to their training. At the end of a member of staff’s probationary period, they and their supervisor complete an appraisal of their work. An example of a completed appraisal was seen to cover ability top perform duties, philosophy of care and any specific needs. The Manager has started to develop new information sheets for staff about aspects of their role and specific health care needs. She reported that she is hoping to build up a resource pack for staff. Staff on duty reported that they had only had training in moving and handling and in food hygiene. Training records for all staff were examined. Nine staff had applied for places on a basic first aid course in September. There was no record of rectal diazepam training, protection of vulnerable adults and children or fire safety. One staff member had been on training in menu planning and food and nutrition. This training would be useful for all staff. The Manager must ensure that all staff are appropriately trained to ensure the health and wellbeing of service users. Consideration should be given to accessing training from health care professionals who visits service users in addition to external training courses, as they are a useful resource and have direct knowledge of the home and service users. The Manager is qualified to offer manual handling training and to assess staff in the workplace. Staff on duty reported that they had not received individual supervision or team meetings since January 2005. There was no records of more frequent team meetings. It is essential that staff receive this support both individually and as a team. The Manager reported that senior staff met on a regular basis. The Manager reported that a new system to monitor individual supervision was being set up. Individual supervisions and team meetings must be arranged on a regular basis for all staff. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 40, 41, 42 & 43 The Manager is appropriately experienced and is in the process of being registered with the Commission for Social Care Inspection. The board of Trustees does not have the relevant experience to offer support and supervision to the Manager and are not undertaking the required quality monitoring checks of the home. Procedures are in place to check health and safety at the home. EVIDENCE: The Manager is a qualified nurse. She reported that she plans to undertake an NVQ Level 4. She has additional qualifications in theology. The Manager has been in post since July 2003. She has applied to be registered with the Commission for Social Care Inspection. This application was being processed at the time of the inspection. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 30 The organisation has undergone some restructuring and the Manager’s role has expanded. These changes continue and the organisation is planning to develop and extend services. The Registered Person must ensure that the Manager is appropriately supported through and after any changes within the organisation. The trustees do not have professional backgrounds or experience relevant to the service. Consideration should be given to the employment of a suitable qualified person to offer professional support and supervision to the Manager. The Foundation has made contact with another care provider and they are considering working in partnership with each other. The Registered Person is required to organise for unannounced monthly visits of the service to monitor the quality of service delivery. Reports form these visits must be forwarded to the Commission for Social Care Inspection. There was no evidence of such visits. The Manager reported that she is working closely with the trustees, meeting monthly and providing quarterly reports. This is positive but the unannounced visits must be organised. There is a range of policies and procedure at the home and evidence of regular review. The Registered Person must ensure that a procedure to be followed in event of death of a service user is developed. See Section 4 of this report. Checks on health and safety, fire safety, water temperatures, first aid, electrical and gas safety were seen. The Manager works closely with the Trustees to develop and monitor the budget. There is an appropriate business plan which includes proposed costs of the changes to the environment and projected income for the five registered place and the proposed additional places. The home has appropriate insurance. Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 4 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 2 3 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 4 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 3 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Roy Kinnear House Score 3 3 2 2 Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 3 3 3 G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 32 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. YA1 5(1) The Registered Person must compile information to produce a Service User Guide, which is made available to service users. Previous requirement - timescale 31/03/05 2. YA5 5(1) The Registered Person must 31/10/05 ensure that contracts of care are in place for all service users and that copies are held at the home, available for inspection. Previous requirement - timescale 31/03/05 3. YA7 12(2) & (3) 20(3) The Registered Person must work with the placing authority of one service user, who does not have an external representative, to ensure that they have an advocate and financial representative independent from the Foundation. Previous requirement - timescale 31/03/05 Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 33 Standard Regulation Requirement Timescale for action 31/10/05 30/09/05 4. YA9 13(4), (6) & (7) The Registered Person must ensure that individual risk assessments are in place for all service users who are at risk and where any restrictions are in place. Previous requirement - timescale 28/02/05 5. YA20 13(2) The Registered Person must 1. Ensure that the administration/nonadministration of all medication is recorded accurately and reflects the actual dose of medication administered. 2. Ensure that the allergy section on the administration record is completed for all service users. 6. 12(1) NMS YA21 The Registered Person must: 1. Develop a procedure to be followed in event of death of a service user. 2. Ensure that individual wishes and preferences are recorded. Previous requirement - timescale 31/03/05 7. 13(6) 19(1)(a) YA23 The Registered Person must ensure that all staff receive training in recognising and reporting abuse (protection of vulnerable adults and children). Previous requirement - timescale 31/07/05 Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 34 31/08/05 01/07/05 30/09/05 31/10/05 This must be prioritised and training must be organised to take place by the timescale for action. 8. 13(4) & (6) 19(1)(a) Schedule 2 YA34 The Registered Person must ensure that thorough checks are made on all staff and volunteers. These must include two written references and criminal record checks recieved prior to the commencement of employment. Staff files must be complete and missing information for existing staff and volunteers must be requested. 9. 18(1)(a) & (c) 19(1)(a) 10. 18(1)(a) & (c) YA35 The Registered organisation must ensure that: 1. All staff, including temporary staff must be trained in first aid, food hygiene, manual handling, abuse awareness, fire safety and administration of rectal diazepam. 2. Permanent staff must receive training in care planning and other areas relevant to their roles. Previous requirement - timescale 31/03/05 11. 12(5) 18(2)(a) 1. All staff receive regular Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 35 31/08/05 30/09/05 YA32 The Registered Person must proactively support staff to undertake NVQs. 31/12/05 31/10/05 YA36 The Registered Person must ensure that: 31/08/05 individual supervision with their line manager. 2. Regualr team meetings are held. 12. 26 YA39 The Registered Organisation must ensure 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. 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. YA6 The Registered Person must ensure that only current information is held within service user plans and that old information is appropriately archived. It is recommended that records be made of any audit or random check made on medication and medication records. Consider the employment of a suitably qualified person to offer professional supervision and support to the Manager. Refer to Standard Good Practice Recommendations 2. YA20 3. YA38 Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 36 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Roy Kinnear House G54-G04 S38036 Roy Kinnear Hse V227905 300605 Stage 4.doc Version 1.40 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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