Care Home: Esken House

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What the care home does well The service provides a family environment in which the person it supports can live a meaningful life as possible. The home is a safe, pleasant and homely environment in which the person who used this service can enjoy his life with freedom of choice and movement. The person who used this service is supported in a way that meets his needs The health and well being of the person who uses this service is positively promoted. The person that uses this service has an interesting and active social live with lots of opportunities for outings and holidays. What has improved since the last inspection? The home has improved the way it supports a service user with the effects of aging. More input has been sought from health and social care professionals. There has been improvement in the way the home formally monitors quality. What the care home could do better: There was no need for any recommendations or requirements to be placed at this visit. Key inspection report Care homes for adults (18-65 years) Name: Address: Esken House 69 Charlesford Avenue Kingswood Maidstone Kent ME17 3PH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Mills     Date: 2 0 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Esken House 69 Charlesford Avenue Kingswood Maidstone Kent ME17 3PH 01622843786 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Esme Davis care home 2 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 2 The registered person may provide the following category of service only: Care home only(PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Learning disabilty (LD) Date of last inspection Brief description of the care home Esken House is a detached chalet bungalow providing accommodation for up to two service users who have a learning disability. Service user accommodation is on the ground floor. The owner lives on the first floor of the premises. The home is situated in a quiet residential area approximately eight miles from the county town of Maidstone in Kent. The ground floor accommodation includes a bedroom with nurse call facility, bathroom for sole use of the servivce user, lounge, separate dining room, study, music room, guest room, conservatory, kitchen and utility room. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 2 Brief description of the care home The home has its own transport and provides car parking facilities to the front of the property. There is a large garden with swimming pool to the rear of the house. The home is described as a, Home for life, for the person living there. The owner has provided care to the current service user for over twenty years and there are no plans to admit any other people to the home. The weekly fees for this home were given as £600 at the time of this visit. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This visit formed part of the annual regulatory process of the recently formed Care Quality Commission (CQC) under the Care Standards Act. It was unannounced. Evidence gathered during this visit and information we have received prior to the visit, such as the views of supporters and health and social care professionals and notifications required by the Act, will be used to make a judgement about the quality rating for the home. During this visit we spent a lot of time in the company of the person this service supports; we communicated with him in a verbal and non verbal way; and spoke to the people in the home who support him. Important documentation, such as the care plan, staff file and health and safety records, was examined in detail. A tour of the home was made and in depth discussion was held with the registered provider/manager. A member of staff was spoken to in private. Care Homes for Adults (18-65 years) Page 6 of 25 The person who uses this service, the staff member and the registered provider/manager are all thanked for the welcome they gave and for their help throughout this inspection. The quality rating for this home is 2 stars. This means that the person using this service experiences good quality outcomes in all aspects of his care. Care Homes for Adults (18-65 years) Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home gives good information about the service and rights and responsibilities are made clear. Evidence: The home has a comprehensive statement of purpose and service user guide. The person who uses this service has lived at the home for a long time and observation showed that he is very much at home in his environment. There have been no new service users admitted to this home for many years and the registered provider has told us that she has decided not to take offer provision for any more people. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home supports the service user to make informed decisions and take appropriate risks. Evidence: The care plan for the person this home supports was examined. It clearly defines cultural and religious needs, likes and dislikes and preferred activities. Observation showed that the service user is able to choose what he does. During this visit time was spent chatting to the service user and making observations. It was evident that he is able to choose activities. There are a number of indoor activities available, such as puzzles and crafts. Outside there is a large garden with a patio and seating area. The service user indicated that he really loves going out and that his preferred activity is to go out for a pub lunch. Discussion with the manager and a staff member showed that they offer choice appropriately and recognise needs and wants. They use a mixture of verbal and non verbal prompts to determine wishes and, because they have looked after the service Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: user for over twenty years, they are able to understand his expressed wishes easily. Risk assessments are in place for activities that may have associated risks. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service user is offered a range of activities both within the home and in the local community which means he can lead an interesting and meaningful life. Evidence: The service user leads a busy social life. Activities were discussed with the provider, staff member and the service user. The service user was shy and reticent about joining in the chat until outings were mentioned when he began to take much more interest, mentioning names of people he likes to visit. The provider told us that he takes part in all aspects of life in the home and lives very much as a member of the family. He really enjoys going out, especially for pub lunches and to visit family and friends. He also enjoys visits from the providers family. The service user also accompanies the provider and her family on two holidays each year. Another holiday to Spain is planned in the near future. Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: The service user does not have an individual appointee but does have his own bank account and is known by local bank staff. Two signatures are required for monies withdrawn. Receipts and records are kept of money spent and these are regularly audited. Visitors are welcome at all reasonable times and the provider will provide transport from the station for those relatives who need it. Efforts are made to help the service user keep in touch with friends and family but the ageing process has meant that there are now fewer visitors who are able to make the journey. The service user helps to choose the food he wants to eat and accompanies the provider on shopping trips to buy food. There was plenty of fresh fruit in the home on the day of this visit and the provider told us that the service user eats a balanced diet. He indicated that he enjoys his food and appeared very well nourished and in good general health at the time of this visit. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home promotes the health and well-being of the service user so he can enjoy as healthy a life as possible. Evidence: The health section of the service users care plan was examined in detail. Care plans are important documents because they are one of the means by which the service user and his supporters can know that identified needs are being met and care is being given in the way they would wish. In addition they one of the main sources of information for staff who must ensure care and support is given in a consistent way. There was good written evidence that the health needs of the service user are well met. There is regular input from a number of health care professionals such as the General Practitioner (GP) and chiropodist. Specialist health care is accessed as needed. There was good evidence to show that the registered provider has been proactive is seeking health care advice on behalf of the service user. The registered provider/manager is a registered nurse who has maintained her continuing professional development. She and the staff member on duty showed a Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: very good awareness of the needs of the service user. Observation showed that they are sensitive to his needs and that care is given in a consistent and supportive manner. There are clear policies to protect privacy and dignity. Discussion with the provider and staff member showed that they have a good understanding of how this should be put into practice and observation showed that the service user was afforded respect and privacy at all times throughout this visit. There are sound policies and procedures in place for the management and administration of medicines. The provider works closely with the local GP to ensure that only medication levels are correct and at the lowest level possible to maintain good health. The Medicines Administration Record (MAR) was examined and found to be up-to-date and in good order. There have been no medication errors since the last inspection. Storage of medicines is safe and secure and there is a sound system for the receipt and disposal of medicines. Only those trained in the administration of medicines are permitted to give them. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home understands the concerns of the service user and works to reassure him. Evidence: The home has a sound complaints procedure. A copy of this is contained in the Statement of Purpose and the Service User Guide. The provider understands the service users likes and dislikes and can tell if he is unhappy. Both the provider and staff member said that they always know if the service users is unhappy about something and that they then find ways of dealing with his concerns. Observation showed that there is good understanding and interaction between the provider, staff member and the service user. There have been never been any formal complaints from relatives or care managers about the care of the service user in in the home. Conversation with the provider and staff member showed that they have a good understanding of safeguarding procedures and have accessed training in this important area of care. Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained, clean and safe and provides a homely and pleasant place for the service user to live. Evidence: The home originally provided services for up to five people. Now there is only one service user. He has his own room, separate lounge and dining room. Although his bathroom is not en suite, he has sole use of a ground floor bathroom that has the necessary aids to meet his needs. The home is run as a family style domestic premises. All areas are well decorated and comfortably furnished. The service user was happy to show us his room. He indicated that it is decorated in his favourite colour and that there are matching covers and curtains. He has lots of his favourite things on display and he was pleased to show off his new slippers that also match his room. There are sound infection control measures in place, with safe arrangement for the handling of laundry. There are hand washing facilities and disposable gloves available in the bathroom. All areas of the home were very clean and clutter free on the day of Care Homes for Adults (18-65 years) Page 18 of 25 Evidence: this visit. Outside there is a large, safe and enclosed garden with a patio and seating area. We were told that the service user likes to spend time sitting in the garden when the weather is fine. To the front of the home there is a large sweep round drive and plenty of parking space. The homes Annual Quality Assurance Assessment told us that all necessary maintenance and safety certificates are current and that there are no health and safety requirements. No health and safety hazards were identified during this visit. Care Homes for Adults (18-65 years) Page 19 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service user is well supported by experienced staff who understand his needs and treat him with kindness and respect. Evidence: The care needs of the service user are met by the registered provider and one part time support worker. The service user is seen as very much part of the family and family members also provide care and support from time to time. All those who input into the care of the service user have Criminal Records Bureau (CRB) checks and received appropriate training. The staff file was examined. There is good written evidence that all necessary preemployment checks have been carried out, including CRB checks, written references and previous employment history. A staff member was spoken to during the course of this visit. She said that she has worked at the home for over seven years and loves the work. She told us that both she and the registered provider have attended training courses to make sure they are up to date in care practice. They have also received individual updates from epilepsy and continence nurses who visit and give advice. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the person who uses this service. Evidence: The registered provider/manager is well qualified and experienced in the field of learning disabilities. She trained as a registered general nurse and also as a registered nurse for mental health. She has maintained her continuing professional development and her registration as an RNMH. She has run the home successfully for over twenty years and now only provides the service for one person. The home is run as a family. Most of the care is given by the registered provider/manager with the assistance of family members and one part time member of staff. There are few formal meetings and most debate and discussion about the running of the home are held over the meal table. The person who uses this service is present during these discussions and can make his needs and wishes known. There are only rudimentary formal quality assurance procedures but these meet the Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: needs of the service and the service user. The home takes into account the known wishes of the service user and his supporters when decisions are made about the running of the home. The financial affairs of the service usr are properly managed. He is involved as much as possible, visiting the bank and meeting the cashiers. there is also input from family members and the care manager when necessary. The homes Annual Quality Assurance Assessment (AQAA) confirmed that all required health and safety measures are in place, including fire safety, electrical appliance checks and general maintenance. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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