Inspection on 07/05/08 for Roy Kinnear House

This inspection was carried out on 7th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 25 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Roy Kinnear House 20/03/09

Roy Kinnear House 26/09/07

Roy Kinnear House 27/06/06

Roy Kinnear House 10/11/05

Roy Kinnear House 30/06/05

Roy Kinnear House 08/12/04

Roy Kinnear House 17/05/04

Roy Kinnear House 11/11/03

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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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 28/09/2008.

CARE HOME ADULTS 18-65 Roy Kinnear House 289 Waldegrave Road Twickenham Middlesex TW1 4SU Lead Inspector Sandy Patrick Unannounced Inspection 7th May 2008 10:30 Roy Kinnear House DS0000038036.V363696.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.V363696.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.V363696.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roy Kinnear House Address 289 Waldegrave Road Twickenham Middlesex TW1 4SU 020 8892 4049 020 8891 6734 roykinnear@btconnect.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Roy Kinnear Charitable Foundation Care Home 8 Category(ies) of Learning disability (8), Physical disability (8) registration, with number of places Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. On the morning shift/afternoon shift/evening shift there must be: 1 Qualified Nurse 1 Senior Support Worker 4 Support Workers 2 Domestics (20 Hours each) On the nighttime shift there must be: 1 qualified nurse (awake) 1 senior support worker 2 support workers There must be no reduction in the establishments posts which currently stands at 19. 2. 3. Date of last inspection Brief Description of the Service: Roy Kinnear House provides accommodation and personal care for up to eight residents who have severe learning and physical disabilities. The home provides nursing and residential care, where a qualified nurse is on duty at all times. The home is situated in a residential road in Twickenham and is purpose built. Three of the bedrooms have patio doors leading onto an attractive and wellmaintained garden. The lounge also opens onto the garden. The home is situated close to local shops and amenities. Placement fees are calculated according to need and are agreed by the home and the placing authority. The current fees range from £800 - £2,000 per week. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of this inspection we made an unannounced visit to the home on the 7th May 2008. We met the people who live there, staff, the Manager and visitors. We looked at the environment and records. We also wrote to the residents, their families, staff and other visitors asking them to complete surveys about their experiences. Four residents, two relatives, four professional visitors and four members of staff responded. We asked the organisation to complete a quality self assessment about the service. They were unable to do this by the completion of the report. We looked at all the information we had received about the home since the last key inspection. This included a visit we made to the home in January 2008 to see if they were doing the things we asked them to last time. Everyone at the home made us welcome. Most people told us that they were happy living and working at the home. The relatives and other visitors felt that there was a welcoming atmosphere. People at the home are healthy and well cared for. However, some people felt that there were problems communicating with staff. People also felt that there were not enough opportunities to try different activities. Some of the things people told us were: ‘The quality of care in terms of keeping my relative well and very presentable is terrific. It’s a jolly homely atmosphere and of late seems less chaotic. It is a very friendly clean and welcoming place’. ‘Homely atmosphere in happy environment.’ ‘Friendly welcoming atmosphere.’ ‘Staff are caring towards and interact positively with service users.’ What the service does well: People are happy living at the home. The staff are kind and friendly to the people living at the home. The building and garden are attractive and well maintained. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 6 There is a welcoming atmosphere. Bedrooms are personalised. What has improved since the last inspection? What they could do better: Care plans need to be improved and the staff need to support everyone to have a person centred plan. Risk assessments need to be clearly recorded. Confidential information needs to be stored appropriately and discussed in private. Staff need to support people to try more new activities. Staff need to give better support to people when they are helping them at mealtimes. The staff need to make sure they always follow guidelines to keep people healthy. There needs to be some improvement to the way medication is managed to make sure everyone always gets their right medication. Staff need to make sure they keep residents safe at all times. There needs to be changes to the environment to create more space and storage and to make sure everyone is safe. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 7 The staff need to have training in some areas including manual handling techniques. The Manager needs to make sure all staff have regular planned supervision meetings. All the staff must have sufficient written and verbal English communication skills to do their jobs and keep the residents safe. Record keeping needs to improve to make sure information is clear and up to date. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents have their needs assessed to make sure these can be met at the home. EVIDENCE: People told us that they were given information about the home to help them decide to move there. One person has moved to the home since the last inspection. We saw evidence that their needs had been assessed by staff at the home and other professionals and that a care plan had been created to meet identified needs. This person and their funding authority met with the Manager and staff at the home to review the placement and to make sure the person was happy at the home. The Manager said the contracts with funding authorities for the people living at the home were not clear and needed to be updated and reviewed. She has started to do this. This is important because it is not clear who pays for different services and equipment for each person. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are not clearly recorded within care plans and guidelines on how to support people are not always clear. There is not enough information on people’s likes, dislikes, wishes and interests. People are starting to participate more in all aspects of life in the home but need more support to continue to do this. People are not always supported to take risks and risks that people do take have not always been assessed. Information about people is not stored confidentially. EVIDENCE: Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 11 Each person has a care plan. Information in these is not always clear and the plans are quite disorganised. For example, important information is hidden behind other things in plastic pockets, there are no sections in personal files and all information just mixed up together and guidelines from different people and different dates put in one file but not summarised into a single care plan. Care plans record personal care and health needs and there is very limited information on likes, dislikes, hobbies, interests and social needs. Some information had been updated or changed by hand making it difficult to see what the up to date plan is. Some old information conflicted with newer information. Some personal files contained reports, guidelines or information from other professionals, yet the care plans had not been updated with this. For example one file included a change in someone’s dietary needs and another included instructions from a dentist. Both pieces of information were written on loose sheets of paper and not included within the care plan. There was no photograph of residents in their care plans. Some of the terminology used by staff is very technical could be simplified to make things clearer. For example people’s eating and drinking is referred to as ‘oral intake’ and ‘feeding regimes’. The staff have all had training in person centred care planning and one member of staff has started work with a resident to create a more meaningful plan for them. They showed us this. The plan included information on likes and dislikes, pictures and photographs. The staff member had worked hard to create something that was useful, attractive and based around the resident’s wishes rather than just care practices. The staff need to help other people create plans which are meaningful to them. Some of the things people told us about care planning were: ‘We are looking forward to the introduction of PCP strategy.’ ‘Some people have high complex needs and it is sometime difficult to balance health and social needs. The manager is trying to encourage PCP to achieve a better balance.’ Residents who completed surveys said that they were supported to make some choices but not always. The staff have worked with other professionals to support some people to communicate their needs. We saw one person’s keyworker meeting with Speech and Language Therapists to discuss the best way to support this person. They had created a communication board and they were discussing new equipment which would enhance this person’s life and give them opportunities to make decisions and tell others what they are thinking and Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 12 feeling. Work to support people to communicate and to make choices must continue and the staff should be committed to empowering residents. There are no risk assessments for individual residents. People should be supported to make informed choices where they can and to take risks. For example one person can move around the home independently. However, there should be written evidence to show how hazards have been identified and action taken to minimise any risks. There should also be written evidence of the assessments around any restrictions on people. Risk assessments should include the views of the person themselves and any other relevant party. Risk assessments must be kept under regular review. Records about residents, including care plans, guidelines and medical information are stored in the main lounge. Some of these are kept on the desktop which is accessible to everyone. Others are stored in unlocked cupboards. There are notices to staff, minutes of meetings, a complaints book and other records also stored in the lounge. The staff telephone is located in the lounge and confidential telephone conversations are discussed in communal areas. There is no meeting room for staff to have handovers or meetings in private. We saw a member of staff meeting with other professionals and discussing one resident in the presence of other staff and residents because there was no where else for them to go. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who live at the home are starting to have more opportunities for personal development and to meet their leisure needs. However this is an area where the staff need to give more support. People live in a relaxed and friendly environment. Visitors are made to feel welcome and people living at the home are supported to stay in touch with them. People are usually respected by staff, but sometimes people are not treated with respect or dignity. People have a healthy diet but are not always given a full range, able to make choices or are involved in the preparation of their meals. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 14 EVIDENCE: People take part in a variety of different activities and have tried some new activities in recent months. Some people do activities on their own or in small groups, but many things are organised for everyone to share. Activities include swimming and music therapy. Everyone recently enjoyed a ST Patrick’s night party at the home. People who want to are supported to attend local places of worship. However, people need to be able to do a wider variety of things which they chose and which reflect their interests. The Manager and staff have started to explore things people might be interested in, such as Yoga and music sessions. She has made links with local activity groups. She has also enquired about college courses which people could enrol on. It is important that these plans and enquiries are now put into action and that varied and meaningful opportunities are created for each individual. On the day we visited there was a planned group music therapy session in the afternoon but no planned activities in the morning. People seemed relaxed but were mostly left without doing anything and without any direct staff support. Each person is assigned a keyworker to give them special support to meet their needs. The keyworkers should be able to help people to achieve their individual wishes and needs and to plan for what they want to do in the future. This way of work is new to the home. The Manager has asked the staff to involve people in more activities which effect their everyday lives, such as shopping for food, household belongings and personal items and helping to keep the house and garden tidy. People have started to do this and we saw photographs of one person on a shopping trip and another person sweeping the leaves from the patio. The Manager said that she wants to make a notice board of information for residents about community and planned events. She said that she is looking at purchasing new sensory equipment and accessible computer equipment. Some of the things which people told us were: ‘I think that attempts are being made to have better links with the local community, in particular the local college and attending church services’ ‘Proper training is being given to staff to enable them to properly assist people. More opportunities are being given to go out and more choices being offered.’ Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 15 ‘I observed clients day care programme needed to be expanded. The manager is making links with the community, local organisations and college.’ ‘There are usually staff available to support my relative to attend mass on Sundays.’ Residents who completed surveys said that they sometimes did activities that they wanted to do but not always. Some of the people who contacted us said that they felt activities and opportunities for people needed to be improved. There is a warm and family style atmosphere at the home and staff show that they care about residents. They are friendly and chatty when spending time with residents and people felt relaxed. Residents and staff shared jokes and the staff offered people opportunities to sit outside, listen to music and spend time in the rooms. There was a welcome home poster displayed for one person who had recently been in hospital and the staff were planning a birthday party for another person. Relatives told us that they were made welcome at the home and the staff supported their relative to stay in touch. They said that they usually felt informed and consulted. One relative told us, ‘The staff do not always top up the mobile credit on my daughters phone’. The relatives have set up their own support group which meets regularly to discuss common issues. The Manager has given information and brought special guests to these meetings. Although staff were friendly and chatty with residents most of the time, we saw some practices which were not acceptable and showed a lack of respect for residents. In particular we saw that people were not supported appropriately at mealtimes. We saw a member of staff moving one person’s wheelchair around while they were seated in this and eating their lunch. We saw another member of staff standing over someone while helping them with their meal. We saw a person who had gone to sleep being woken up to have their lunch. The staff supporting people at mealtimes did not chat with them or talk about the meal. The spoonfuls people offered were often large and looked daunting. One member of staff sat next to a resident they were supporting but their chair was much higher than the residents. We saw a staff member used a paper towel to wipe someone’s face. One member of staff referred to a resident as a ‘good girl’, this is not appropriate. Someone was cleaning and dusting around the area that a resident was having their lunch in. Some of the people use Percutaneous Endoscopic Gastrostomy (PEG) feeds. Meals are prepared for the other people in the kitchen area. But there is no cooker or hob top, so many meals are prepared frozen dishes. A dietician has Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 16 had input into the menu, but residents are not involved in choosing meals or preparing their own food. We saw some people’s meals being prepared. The staff blended ingredients together. The different parts of the meal (such as vegetables, carbohydrates and protein) should be blended and kept separate on the plate and not mixed together. Roy Kinnear House DS0000038036.V363696.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People receive the personal care they need. People are usually supported to stay healthy but sometimes the staff do not follow safe procedures and guidelines and people’s health is put at risk. People do not always receive the medication they need. EVIDENCE: People told us that the residents’ personal care needs were met. One person said, ‘The staff provide very good personal care’. Another person told us, ‘the care staff are very good at looking after people’. People told us that they felt the staff worked hard to keep residents healthy. The local community team said that the staff worked closely with them. Some of the comments people said were: ‘There is a real team effort to support our relative with health needs.’ Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 18 ‘Health care needs are met to a high standard.’ ‘Health needs are complex. The home ensures my relative is in good health and respond quickly to symptoms.’ However, there was some evidence that health care needs are not always met. For example one person recently became ill and had to go to hospital because the staff did not respond appropriately when this person’s health changed. Since then new guidelines have been introduced to make sure staff know what to do and when to ask for medical help. Visiting professionals, relatives and the Manager all commented that they had witnessed people being moved in a dangerous or undignified way. Some people told us that the staff did not always follow guidelines on using lifting equipment and sometimes there were not enough staff to support people to move safely. One person told us, ‘Guidelines for transferring and hoist care are not always followed. Sometimes two staff are not available’. The Manager has set up regular meetings with the local community team to discuss the health of the residents and how their needs can be met by the staff and other professionals. Both the Manager and representative from the community team said that these meetings were going well and were really useful. There are plans to involve other professionals in the care of some residents. There are problems with medication stock control. For example some medication has excess stock while other medication has run out without new supplies being delivered. On one occasion a resident went without their medication for 5 days. One person is assigned to be in charge of medication ordering and stock control. The Manager said that the information about this and the procedures they followed were unclear and others did not know how to do this if they needed to. The way in which medication is stored is confusing and staff were not able to clarify which medication was in use at that time. There is no work surface near the medication cabinet for staff to use when administering medicines. Records of medication held were not clear. One member of staff who was checking medication told another person that they could not read the label clearly because they had forgotten their glasses. We have asked our Pharmacist Inspector to visit the house and conduct a thorough check of medication procedures, practices, storage, records and training. They will write a separate report for the home, making requirements where things need to be improved. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People know how to make a complaint. People are not always kept safe and protected by staff practices. EVIDENCE: People told us that they knew what to do if they were unhappy about something or wanted to make a complaint. The way in which residents’ finances are stored and recorded has improved to help prevent mismanagement or theft. However, the Manager said that only one person has their own bank account. She said that she is supporting people to open their own bank accounts. While we were at the house a person who was not known to the staff arrived and told the staff that they were due to work at the home another day and they had come to see where the house was before they started work there. A senior member of staff did not ask for any identification or clarify when the person was due to work there or in what role. They then proceeded to show them around the house, including residents’ bedrooms, office paperwork and medication. They showed them in rooms where residents were resting. They then left the person alone in a corridor expecting them to show themselves out of the house. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a well maintained, clean and attractive environment however there is not enough space for everyone to live and work effectively and comfortably. EVIDENCE: The house is a detached building set back from the road with a small number of parking spaces. There is a large attractive garden. The home and garden are decorated nicely and the building feels light and airy. There are nice personal touches and sensory ornaments, mirrors and lighting. Bedrooms are highly personalised and attractive. There are a few areas of wear and tear that need attending to. Some paintwork and skirting boards are marked and damaged. The flooring on the ground floor needs to be replaced as it is damaged in different areas. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 21 Last year the environment was changed to create 3 new bedrooms. The home’s separate kitchen, staff office and laundry rooms were removed. A kitchen area and the staff office were relocated to the lounge. This has made this area smaller and more cluttered. There are no proper cooking facilities, no hob top or oven. All food is prepared in a microwave. The fridges and freezers take up what used to be floor space in the lounge. The kitchen area including worktops and sink take up space in the lounge. The staff office, including cupboards, records, work desks and chairs are all within the lounge. There is no separate area for storing records confidentially or meeting in private. Records and notices for staff were displayed in the lounge. Care plans and confidential information was not held securely. Many of the residents use wheelchairs and other large equipment. The space in the lounge is not sufficient for people to use this comfortably. We visited on a warm day and some people were using the garden, however the lounge still felt crowded and staff were looking at records, supporting people with lunch and meeting other professionals all in the same area. There is building designed to be a sensory room in the garden. This was not available for use as one person’s belongings were being stored in one part and a table and chairs were stored in another part. A risk assessment has indicated that it is unsafe to use the hoist in the sensory room therefore making this room inaccessible for some people. There is not enough communal space available for people to live comfortably and safely. The fire risk assessment has identified that the washing machine and tumble dryer create a hazard in a fire escape route. There is limited room for storage of belongings, records and equipment and the result is that things are stored inappropriately in bathrooms, corridors, communal areas and outside. Food was stored in the same drawers as some records. The office chairs in the lounge are old, worn and look unattractive. The wooden pathway in the garden gets slippery when wet and is a hazard. Some of the things people said were, ‘the building needs to be extended as it is a cramped house’ and ‘there needs to be proper cooking facilities’. When we visited the home was clean throughout and a domestic is employed to keep the home clean each day. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People are not always protected by a well trained staff team. Some of the staff cannot communicate well or understand English and this puts residents at risk. There is good information sharing through formal group meetings but staff do not always receive individual supervision and support. EVIDENCE: Over the past few months a number of staff have left the home and this has left the home short staffed at times. However, the Manager has recently recruited some new staff and more staff interviews were planned shortly after the inspection. Two new members of staff were at the home when we visited. They were shadowing staff as part of their induction. One new member of staff said that they felt welcomed at the home and felt that they were having a good induction. There is a nurse on duty at all times. The Manager said that sometimes there is confusion over which member of staff should do which duty on a day to day Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 23 basis. The structure of the staff team is not clear and the staff do not have a good understanding of who they report to and who is responsible for different tasks. The Manager is introducing a shift plan to help staff have a clearer idea about their responsibilities each day. The staff have recently attended training in person centred planning and food and drink. The Manager said that fire safety training was planned for the near future. The staff training records need to be updated so that all training is clearly recorded and dates for refresher training are clear. A medical professional who works on the Board of Trustees visits the home and offers the nursing staff clinical supervision. She has also started giving the staff tutorials about clinical practices and accountability. The Manager said that it would be useful if this person could visit the home more often to give support to nurses and other staff to help them understand the changes that are taking place and the reasons for this. The Manager said that the staff recruitment files were incomplete and needed updating and auditing and that she is doing this. She said that thorough checks were made on all new staff but some information needed to be obtained for exisiting staff. Staff recruitment includes a formal interview with the Manager and other senior staff at the home. Some of the things people said about the staff were: ‘Generally communication about events or changes is poor and definitely needs improvement. I have concerns about the reduction in staffing levels with one 1 nurse on duty’ ‘Sometimes I have concerns about the staffing levels in relation to following guidelines around hoisting and transfers.’ ‘Language difficulties still are sometimes problem. I am never sure if the staff understand what is being explained to them.’ ‘We need to continue to improve communication between staff and parents and management.’ ‘The staff carry out care well but English is a problem. There is a lack of understanding about food and preferences. Communication can be frustrating and confusing. People who have poor English skills are not always good at accompanying people to medical appointments.’ ‘We have identified the need for further staff training in Person centred care, manual handling and intensive interaction.’ Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 24 One member of staff completed a survey meant for residents by mistake. The survey included questions about moving to the home, activities, food and the support they received from staff to make choices. The staff member who had completed this form had not realised that this form was intended for residents even though the questions made this clear. The questions were also accompanied by pictures and symbols to make it easier for residents to understand. We are concerned that this staff member has such poor communication skills they were unable to identify which survey they were meant to complete. This indicates that they would not be able to understand written instruction or guidance about the care of residents. Lots of the people who contacted us told us that they were worried about communication. People felt that some of the staff did not have good written or verbal English language skills. Relatives and visitors told us that messages were not always understood or passed on correctly. One person said that some staff did not understand what medical professionals were saying about residents. Some staff cannot understand the care plans and guidelines about residents or policies and procedures and this means that people are not protected or safe. The Manager said that one member of staff was not able to tell her what they would do in an emergency, they did not know the number for emergency services and did not know the home’s address. The Manager said that another member of staff did not know what their own job description said. A recent fire risk assessment identified that staff lacked awareness of fire safety issues. During our visit we asked some staff questions. Some of the time it seemed that the staff had not understood the question. The staff told us that they were generally happy at the home but some people said that they did not have support or regular supervision from their Manager. They said that they did a range of training but wanted to do NVQs and were not given the opportunity to do these. They felt that they were short staffed and that sometimes changes were not communicated to them clearly. The Manager told us that the staff did not always communicate well with her. She gave examples of incidents which staff had not told her about, some of these effected residents’ health. The Manager has started to give some staff supervision but this has not been regular and some staff have not had any individual supervision meetings. This is partly due to the amount of work the Manager has been doing at improving the service and partly due to shortages in a senior staff team. However, individual supervision meetings are essential and the Manager must make sure regular planned meetings take place. Monthly team meetings and nurses meetings have recently started. We saw minutes of these and saw that people were given clear information and opportunities to contribute. The Manager should make sure all staff who could Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 25 not attend meetings sign the minutes to show that they have read and understood them. Roy Kinnear House DS0000038036.V363696.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There have been improvements to the management of the home and the running of the organisation and changes to improve the running of the home have started to take place. Records do not always reflect the practice and procedures of the home and need to be improved. There have been improvements to health and safety but there are still serious hazards which put people at risk and these must be addressed. EVIDENCE: Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 27 The Manager started working at the home in November 2007. She has not yet submitted an application to be registered with the CSCI and must do so. The Chief Executive also needs to make an application to be registered as the Responsible Individual. A new part time senior manager has been employed to give the Manager supervision and to carry out monthly quality inspections. The Manager said that he is very supportive and has started to build up a good relationship with residents and staff. He makes recommendations for change and improvements in his monthly quality inspections and the Manager reports to the Board of Trustees about the progress in meeting these and the home’s achievements. When the Manager came to post there was a lot of outstanding issues and problems. The Manager has started to address some of these but making the changes needed is taking time and she has had to prioritise. The staff lacked clear direction and were not used to giving people support through a person centred approach or keyworking. Records, the environment, communication and training need to be improved. Work has started in these areas. The staff team need to work with the Manager to improve the service and the support given to the residents. The Manager needs to make sure she communicates changes effectively through team meetings and supervision. One person told us, ‘now the new manager is in place issues such as more appropriate outings, better training and person centred care are being introduced which is great.’ Some of the policies and procedures at the home have not been reviewed for several years. Some information needs updating. The Manager needs to make sure procedures are reflected in current practice and that all staff have read and understood these. Many of the records at the home are unclear and badly organised. The Manager has started work to improve these, however further work is needed to make sure information is clear and accessible. The electrical appliances in the home have all been tested recently. The Manager has introduced a series of regular checks on health and safety and these are recorded. A fire risk assessment of the home has identified a high (22) number of hazards and risks, which must be addressed to make sure people living at the home are safe. These include, one person’s wheelchair is too large to fit through the fire escape, electrical wiring in some areas is unsafe, the fire procedure is not clear, not practiced or taught, no fire awareness training for Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 28 staff, unsafe storage of combustible materials, blocked fire exits, areas of the building without proper fire protection, bedroom doors propped open and insufficient evacuation plans and equipment for some residents. The assessment shows that residents are not safe or protected in event of a fire and all areas identified must be addressed within the time scales set by the fire officer. The Manager said that work to make the house safer had begun. Regular checks on fire safety equipment have recently started and are recorded. Risk assessments for the service on the building and equipment were due for review and updates. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 2 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 3 3 X 2 2 X Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5 Requirement Timescale for action The Manager must make sure 30/11/08 the contracts for each person accurately reflect the terms and conditions of residency, what services and facilities are provided and who is responsible for providing these. The Manager must make sure 30/06/08 care plans are accurate, clear, up to date, well organised and include all guidelines and information from other professionals about individual needs. The Manager must make sure 31/07/08 that a person-centred approach is implemented at the service, and that this is used to enhance the care planning and record-keeping. Previous 31/01/08 requirement 2. YA6 12 15 3. YA6 12 15 Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 31 4. YA9 13 The Manager must make sure 31/07/08 risks residents face and all restrictions are fully assessed and that written assessments are kept under review. The Manager must make sure 30/05/08 records with information about residents are stored securely and confidentially. The organisation must make 30/05/08 sure staff do not hold confidential meetings about residents in communal areas. The Manager must make sure 31/07/08 each resident participates in a range of leisure, educational and therapeutic opportunities which meet their needs and interests and that they have full and varied lives. The Manager must make sure 15/05/08 the staff treat residents with respect and dignity when supporting them. The Manager must make sure 31/05/08 people are given choices about the food they eat and that they are given opportunities to participate in meal preparation. Meals must be presented in an attractive and appetising way. 5. YA10 12 6. YA10 12 7. YA14 16 8. YA16 12 9. YA17 12 16 10. YA19 13 The Manager must make sure 15/05/08 staff follow guidelines and seek appropriate medical help to DS0000038036.V363696.R01.S.doc Version 5.2 Page 32 Roy Kinnear House keep people healthy. 11. YA19 13 18 The Manager must make sure 15/05/08 staff are appropriately trained and follow guidelines when moving and lifting people. The staff must make sure people are moved safely and respecting their dignity. The Manager must make sure 15/05/08 residents are always offered their medication and that the home has sufficient stock of all medicines. The Manager must make sure 15/05/08 staff do not show strangers around the house. All visitors should be asked for identification. Visitors should be seen to the door when they leave. The organisation must review 31/07/08 the current arrangements for food preparation and staff office work to make sure residents have enough communal space, that privacy is respected and different methods of prepared food are available. The review should be recorded and the organisation should record the actions they plan to take to solve the problems presented by the current arrangements. The pathway in the must be made safe. garden 31/05/08 12. YA20 13 13. YA23 13 14. YA28 23 15. YA24 13 Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 33 16. YA35 18 The Manager must make sure 30/06/08 there is an up to date record of all staff training. The Manager must make sure 31/08/08 that all staff have up-to-date training in food safety, health and safety, infection control, fire safety and moving and handling. Nurses must be kept up-to-date with more specialised training to ensure the residents are receiving relevant and safe care practices. Previous 28/02/08 requirement 17. YA35 18 18. YA36 18 The Manager must make sure 31/05/08 all staff have regular planned formal supervision. The Manager must make sure 31/05/08 all the staff have the verbal and written English skills to meet residents’ needs, keep them safe and to understand and follow procedures and guidelines. The Manager must make sure 31/07/08 staff recruitment records evidence thorough checks on their suitability. The Manager must submit an 31/05/08 application to be registered with the CSCI. Previous 31/10/07 requirement 19. YA32 19 20. YA34 19 21 YA37 9 Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 34 22. YA37 7 The Trustees must ensure that 31/05/08 an application for a Responsible Person is submitted to the CSCI. Previous 31/10/07 requirement 23. YA41 17 The Manager must make sure 31/08/08 records are accurate, up to date and appropriately maintained. The organisation must relocate 30/06/08 the washing machine and tumble dryer so that all fire escape routes are clear. The organisation must make 31/08/08 sure all actions identified in the fire risk assessment are completed within agreed timescales. 24. YA42 13 25. YA42 13 24 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 YA15 Good Practice Recommendations The staff should make sure they support people to have sufficient credit on their mobile phones. The Manager should consider providing specialist training for staff on how to support someone at mealtimes. DS0000038036.V363696.R01.S.doc Version 5.2 Page 35 2. YA16 Roy Kinnear House 3. 4. YA28 YA24 The organisation should consider installing a hob and oven. The organisation should make sure there is sufficient storage space. The organisation should consider re-situating the nurse station to ensure confidentiality. 5. YA24 6. YA42 The Manager should make sure service risk assessments are reviewed. Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Roy Kinnear House DS0000038036.V363696.R01.S.doc Version 5.2 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. 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