Care Home: Kairos Community Trust

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What the care home does well The residents that we spoke to were very positive about the service and the support they receive at 59, Bethwin Road. Comments from residents included: "My attitude to recovery has changed since I have been here, it involves more than just putting down the drink and drugs." "It`s a very good programme, I am leaving next week and I feel much more confident about succeeding". "I like it here we get good support and it`s professionally run". Effective care plans and risk assessments are drawn up with residents. They are supported and encouraged to take responsibility and make decisions about their lives while at the home. There is support for residents to access training and educational opportunities. Residents are free to maintain their lives outside of the programme and are supported to establish effective links with the community into which they will be moving when they leave the home. Where appropriate residents are encouraged to maintain and develop relationships with family and friends. There is significant emphasis on rights and responsibilities throughout the programme. The health and emotional needs of residents are well met and the service`s medication policies and procedures protect residents. They are also protected by the service`s complaints and adult protection policies and procedures. Staff working at the home are well qualified and experienced to be able to effectively meet the needs of residents and given opportunities to undertake training. The home is well run and managed by the Manager who is experienced and qualified. What has improved since the last inspection? Specifically the following improvements have been achieved since the last inspection: A record of meals that are prepared is now maintained that should with a little more detail help to ensure that the menu is sufficiently varied and balanced for residents. A record of the induction programme undertaken by new staff and trainees is now being maintained. All staff do now receive supervision as required within the home on a regular basis. The Deputy Manager and the Housekeeper told us that they ensure that residents are provided with some instruction and training around basic food hygiene prior to being allowed to work in the kitchen. There is now more consistency in gaining and drawing up needs assessment information carried out by the local authority prior to a service user being admitted to the service. What the care home could do better: CARE HOME ADULTS 18-65 Kairos Community Trust 59, Bethwin Road London SE5 0XT Lead Inspector David Halliwell Unannounced Inspection 23 September 2008 09:30 rd Kairos Community Trust DS0000007078.V372586.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 Kairos Community Trust DS0000007078.V372586.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. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kairos Community Trust Address 59, Bethwin Road London SE5 0XT 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) 0207 701 8130 0207 701 8130 kairosbethwin@talk21.com Kairos Community Trust Mr Lee Pierce Slater Care Home 16 Category(ies) of Past or present alcohol dependence (16) registration, with number of places Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2007 Brief Description of the Service: The Kairos Community Trust rehabilitation centre sited at 59 Bethwin Road provides a therapeutic programme for individuals with support needs related to alcohol/drug dependency that have completed a detoxification programme. The programme is of 12 weeks duration after which service users move on to alternative accommodation. Service users commit to the programme by signing a contract, which includes regular attendance at counselling and daily attendance at group meetings at which personal weekly objectives are agreed. The service is based in a detached house over three floors and is located close to community facilities. The home has a stair-lift, which is not currently needed for present service users, but which is maintained should the need arise. The service is accessible via public transport. A number of bus routes run within walking distance of the home with underground and train stations sited slightly further away. Accommodation at the home consists of seven double and two single bedrooms. There are a number of communal areas on the ground and second floors and a patio to the rear of the building. Toilet/bathrooms are located on each floor. The home operates the Minnesota method of treatment based on the twelve steps of alcoholics/narcotics anonymous. A care plan is devised between service users and staff by the end of their second week at the service and is subsequently reviewed half way through what is a three-month programme. Links are maintained with service users when they leave the service and they are able, if appropriate, to move on to supported housing, which is run by Kairos Community Trust. The contract, which all service users must agree to upon admission, makes it explicit that the use of alcohol or mood altering drugs is not tolerated. The staff team consists of a Team Manager, four full time staff, one part time staff member and a staff member who works on a sessional basis. There is also one volunteer who lives in. A cook is employed to cook regular main meals but service users participate in this and a range of household activities. The service makes information available to potential service users by sending them an information booklet, through emails and answering telephone enquiries. A copy of the most recent inspection report is kept on display in the foyer of the home making it accessible to all current and prospective service users who where possible are always required to visit the service for an assessment prior to admission. Weekly fees charged are £430.00. Additional charges are made for those service users who attend the service on a DRR Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 5 (Drug Rehabilitation Recommendation) as part of a condition of a probation order, which may involve compulsory testing at £7.00 per test. This information was given to CSCI in September 2008. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The stars quality rating for this service is good. This means that people who use these services experience good quality outcomes. They said that they like to be called residents. A completed AQAA was received prior to the inspection. No enforcement activity has occurred since the last inspection. This was an unannounced inspection visit for the Kairos Community Trust’s service at 59, Bethwin Road and was carried out over 1 day. The Inspection covered all the key standards in the National Minimum Standards for Younger Adults. The inspection involved a tour of the home, a review of all the homes records and formal interviews with 3 staff, the Manager and the Housekeeper. 5 residents were spoken with formally and more informal interviews were conducted with 2 other residents as a part of the tour of the home. 4 staff and 4 residents’ files were inspected as was the policies and procedures manual for the home. 5 new requirements have been made as a result of this inspection and 9 new recommendations have also been made. Feedback on the requirement and recommendations was given verbally to the Manager and the Deputy Manager at the end of the inspection visit. The residents and staff were very helpful and they are to be thanked for their assistance over the course of this inspection visit. The agencies Registration Certificate with the Commission for Social Care Inspection was seen displayed appropriately in the main hall. There have not been any changes in the ownership or management of 59, Bethwin Road, SE5 OXT since the last inspection. What the service does well: The residents that we spoke to were very positive about the service and the support they receive at 59, Bethwin Road. Comments from residents included: “My attitude to recovery has changed since I have been here, it involves more than just putting down the drink and drugs.” “It’s a very good programme, I am leaving next week and I feel much more confident about succeeding”. “I like it here we get good support and it’s professionally run”. Effective care plans and risk assessments are drawn up with residents. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 7 They are supported and encouraged to take responsibility and make decisions about their lives while at the home. There is support for residents to access training and educational opportunities. Residents are free to maintain their lives outside of the programme and are supported to establish effective links with the community into which they will be moving when they leave the home. Where appropriate residents are encouraged to maintain and develop relationships with family and friends. There is significant emphasis on rights and responsibilities throughout the programme. The health and emotional needs of residents are well met and the service’s medication policies and procedures protect residents. They are also protected by the service’s complaints and adult protection policies and procedures. Staff working at the home are well qualified and experienced to be able to effectively meet the needs of residents and given opportunities to undertake training. The home is well run and managed by the Manager who is experienced and qualified. What has improved since the last inspection? Specifically the following improvements have been achieved since the last inspection: A record of meals that are prepared is now maintained that should with a little more detail help to ensure that the menu is sufficiently varied and balanced for residents. A record of the induction programme undertaken by new staff and trainees is now being maintained. All staff do now receive supervision as required within the home on a regular basis. The Deputy Manager and the Housekeeper told us that they ensure that residents are provided with some instruction and training around basic food hygiene prior to being allowed to work in the kitchen. There is now more consistency in gaining and drawing up needs assessment information carried out by the local authority prior to a service user being admitted to the service. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 8 What they could do better: Specifically the following improvements need to be achieved: 1. The Manager should ensure that a more detailed food record is maintained and monitored so that it is a useful tool in helping to ensure that the residents maintain an appropriate diet that is healthy and nutritious. 2. The Manager must ensure that current practices to do with the “despatching” of medications to residents cease and that residents are asked to go to the medical room daily to collect their medications in person. Also that the MAR sheet records be signed off at the time of collection by the resident. Policies and procedures will also need to be amended. Staff should all attend training on the safe handling of medicines. 3. The Manager should draw up a “complaints record book” so that any complaints made can be stored all in one place. 4. Staff should be enrolled for the next protection / safeguarding of vulnerable adults training course with L. B. Southwark this year. It is thought as good practice that all staff should undertake POVA refresher training at least once every 2 - 3 years on an authorised training course preferably offered by L.B.Southwark. 5. An annual redecoration and refurbishment plan should be drawn up by the Manager so that the highest priority areas of need can be met in a timely manner. Residents told us that they would like the bedding to be renewed more regularly. On the top floor the boxing around the sink area in one of the bedrooms needs to be renewed. Also on the top floor in one of the bathrooms the floor covering needs to be sealed where it meets with the bath. 6. The kitchen area needs a “deep clean” with particular attention paid to the “hidden” areas behind cabinets and kitchen equipment. The Manager may need to consider professional cleaning on a monthly basis if the required standards are to be met. 7. The Manager should ensure that staff receive training to do with infection control. This is important so that staff know the required standards and what measures and controls need to be in place to achieve the standards. 8. All staff files should be reviewed and action taken to ensure that they are in good file order and containing the necessary information as described in Standard 34 including employment contracts for all the staff team. Criminal Record Bureau (CRB) checks must be renewed every 3 years and be appropriate to the Kairos Community Trust. 9. Training certificates should be gained for all staff training undertaken and held on file. This is valuable for the staff member in that it provides documentary evidence of the training input they have received and helps to document their CVs. 10. A staff training matrix should be developed as a management tool that identifies future staff training needs and that logs training already undertaken by staff. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 9 11. Notes of management supervision meetings need to be more detailed, recording all the areas of discussion together with agreed actions and timescales for actions agreed. Copies of these notes should be held on staffing files and copies be given to staff for their information. 12. The feedback information that is gained via a number of different sources needs to be analysed by the management team. This is so that the items of individual feedback can be assessed in order to identify any patterns or trends that may help the service to build on and improve their services. It would be useful if this information were included in the business and annual development plan for the home. 13. Electrical installation systems – A check for this is needed usually a 5 year certificate is provided. 14. Hot water temperatures are not being checked adequately. It is required that all hot water outlets are checked regularly and records kept of each check to ensure that hot water temperatures come within the acceptable range. 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. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 & 5 were inspected at this inspection. People using this service experience good quality outcomes in this area. Prospective service users may be assured that their needs will be assessed and that they will also have an individual written contract. EVIDENCE: Standard 2 - Four residents’ files were examined and there was written evidence on each of the four files of detailed needs assessment information being provided by the referring authorities about the prospective resident. The service also carries out its own detailed assessment with residents prior to their admission and this was also evidenced on the four files inspected. The needs assessments referred to above demonstrates that the needs of residents are being thoroughly assessed by staff both in the referring agencies and at Kairos. Standard 5 - All residents’ files that were inspected included a written statement of terms and conditions that had been signed by the residents. The document included information about the fees charged, the room provided and arrangements for reviewing needs and progress and updating care plans. The Manager told us that new residents are also given an information pack relating to Kairos at 59, Bethwin Road that includes a wide range of other information Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 12 regarding the service and that this is issued to all residents on admission. Residents spoken to by us at this inspection confirmed this. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 13 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): Standards 6, 7 & 9 were inspected. People using this service experience good quality outcomes in this area. All service users had a care plan in place that comprehensively addresses their needs and is reviewed. Service users are supported and encouraged to take responsibility and make decisions about their lives whilst at the home. Service users are supported to take responsible risks as part of an independent lifestyle. EVIDENCE: Standard 6 - As already indicated, 4 residents’ files were inspected. Evidence was seen on these files that residents have a care plan that is drawn up with them and this is done as soon as possible after their admission. Each care plan seen had been signed and dated by the resident. The care plans seen were detailed and comprehensive. They identified short and long terms goals and specified the aims/goals of the resident in relation to their rehabilitation and also the support and responsibilities of the staff in respect to addressing personal and social support and any health care needs. It was evident from the care plans and from speaking with them that residents were involved in the drawing up of their care plans. The Deputy Manager told us that reviews are Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 14 held after 6 weeks and that this is carried out with the allocated counsellor and social worker in order to look at the resident’s progress and to identify the continued support that is required and also move on options. There was evidence of reviews having been arranged and completed within the resident’s files. At the last inspection it was reported that there were other mechanisms in place for the monitoring of resident’s individual progress towards achieving goals identified in their care plans, such as a weekly objectives group and one to one counselling sessions and evidence of these was seen at this inspection in residents’ files. This all means that residents know their assessed and changing needs and personal goals are reflected in their care plans. Standard 7 - The programme offered by Kairos promotes that residents take responsibility for themselves and their behaviour. As a result they are supported to make their own decisions and choices. In discussion with 5 residents at this inspection they confirmed this with us. One resident said, “We learn to make decisions in a better way than we did before, it’s all part of this programme”. Another resident said, “We are learning to make the right decisions and staff here help us with that”. Daily records seen by us at this inspection on the four resident’s care files inspected also show how they are supported in making decisions and choices. It is compulsory as part of the programme that residents have to attend at least two A.A meetings (Alcoholics Anonymous), N.A (Narcotics Anonymous) or (C.A) Cocaine Anonymous depending on their previous use of substances. These meetings are based on the principles of peer support and residents can also access a sponsor who continues to provide them with independent support and guidance throughout their recovery. Also, in respect to finances all residents manage their own money. This all means that residents make decisions about their lives with assistance as needed. Standard 9 - There was evidence in all four of the residents files looked at, that risk assessments had been completed with them. These risk assessments identified risks in respect to medication and there was also a more general risk assessment to do with aggressive and self -harming behaviours that may pose a risk to the individual residents’ recovery. The Deputy Manager told us that the aim of the risk assessment process is to support residents to take responsible risks and provide information on which they can base decisions. This means that residents are supported to take risks as a part of developing an independent lifestyle. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 15 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): Standards 12,13,15,16 &17 were inspected. People using this service experience good quality outcomes in this area. The service supports service users to look at opportunities for training and education. Service users are also supported to be part of the local community. Where appropriate service users are supported to maintain and develop personal and family relationships. The programme offered by the service is aimed at promoting the rights and responsibilities of service users. Service users are offered a healthy, nutritious diet based around their choices. They all take part in preparing these meals for the group and a record of meals prepared is now being maintained although this still needs some development. EVIDENCE: Standard 12 - Towards the end of the programme residents are supported to look at ways they can structure their time after they leave and access Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 16 educational or training opportunities. The service has links with a community based education organisation “Next Steps” who come every ten weeks to give residents a presentation on how they can become involved in a six week course that is held at Brixton College and supports individuals with developing their knowledge and skills in Information Technology (IT), Maths and English. Another local organisation, St Giles Trust provides residents with information on ways they can access opportunities in voluntary work. Information about local activities was seen on the notice boards within the home and staff who were interviewed by us said how they do support residents to take as much of an active role in the community as they can. Over the course of this inspection residents were seen to be supported and enabled to take part in appropriate activities. They seemed able to express their wishes and were listened to and responded to with active and appropriate support. Residents are able to take part in age , peer and culturally appropriate activities. Standard 13 - As mentioned already there is an emphasis within the programme provided by Kairos on individual responsibility. Consequently, apart from on the first day of admission and for those residents coming to the service straight from prison the first week of their stay where they are not allowed to leave the premises unaccompanied, there are no restrictions on their movements. Residents are allowed to leave the project freely within the boundaries of having to attend the group programme and individual sessions. Curfew times must also be adhered to. This allows residents to spend time away from the service and to make use of the local facilities such as the shops, a local gym and library and as mentioned to attend A.A or other similar meetings locally. Those residents we spoke to confirmed that they are able to participate in the community. One resident said, “The freedom we have at times outside of the programme allows us to get out into the community and be part of what’s going on.” Another said, “Being able to do things outside of the project helps me in my recovery”. Staff that we spoke to told us that where it is appropriate they encourage residents to engage with the local community. This means that where it is possible, residents do get involved in community activities and events. Standard 15 - Where appropriate residents are supported by staff to maintain and develop relationships with family and friends and where residents have children support is given to ensure regular contact with them is maintained. The Manager told us that one way of encouraging residents to meet people and to develop a support network is through attending meetings such as Alcoholics Anonymous (A.A). However, as part of the programme and residents’ Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 17 rehabilitation they will be encouraged to end unhealthy relationships in which using substances may have been a major part of the relationship and the other person is still using as this could prove detrimental to their recovery. Also, intimate relationships between residents on the programme are strictly not permitted; this is to keep residents focused on the programme. They are informed of this prior to admission and it is also specified as part of their statement of terms and conditions that they sign. Standard 16 – The Deputy Manager explained to us that although there are restrictions in place that residents are expected to adhere to, for example as mentioned there is a curfew in place, it was clearly evident from speaking to residents and through general observation of how the programme is run that the daily routines of the house and house rules generally do promote independence, individual choice and freedom of movement, for example residents are given a key to the house and as stated previously apart from an initial brief period on admission they are allowed to leave the premises as they wish within the boundaries of the programme. Generally staff make themselves accessible so that residents are able to spend time with them. One resident told us, “Yes the staff here respect our rights” and another resident who was present at the time agreed with this. Standard 17 – The Deputy Manager explained to us that a cook is employed to provide the main mid-day meals but a rota is devised that involves 2 residents every evening in preparing and cooking these meals through the course of the week and this includes shopping for the produce needed. We were told that residents are able to state their preferences when the menus are planned and there are discussions about this at the resident’s community meetings, which are held regularly. Minutes seen of these meetings support this. In addition to main meals a range of snacks and drinks are available to residents at all times. At the last inspection it was required that residents be given instruction and / or training around basic food hygiene before being allowed to work in the kitchen. The Deputy Manager told us that the Caretaker does now provide this input to residents at the time of admission to the home and this was confirmed by the Caretaker and by residents in interview. Therefore the previous requirement has now been met. Food menus shown to us indicate that menus are reasonably well balanced, nutritional and cater for the varying cultural and dietary needs of the residents. No complaints about the meals arose during the inspection in fact both those residents interviewed said that they like the food provided at Kairos. At the last inspection a requirement was made so that a record of meals prepared be drawn up and maintained so as to assist in ensuring that a varied and well balanced diet is provided to residents. The Manager showed us a food Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 18 record that is now being kept that logs the meals provided on a daily basis e.g. spaghetti bolognaise or fish and chips. However the detail is insufficient to meet the purpose of the log and it is therefore recommended that the Manager ensures that a more detailed record is kept so that it is useful to help ensure that the residents do maintain an appropriate diet that is healthy and nutritious. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20 were inspected. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users receive support in the way they prefer and require. Service users’ healthcare needs are met by linking into community service such as GPs and clinics. The service’s medication policies and procedures to protect service users in the despatching of medications will need to be amended and appropriate training provided. EVIDENCE: Standard 18 – The Deputy Manager told us that all residents are allocated a counsellor who works with them throughout their stay at Kairos and this is to provide appropriate support; as well as to ensure that the residents care plan objectives are being met as effectively as is possible. A member of staff also told us this in interview and described how they provide this personal support saying, “ I like to engage as soon as possible with residents after their Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 20 admission to help them feel secure and settled and to help work out with them their care plan objectives”. 7 residents that we also spoke to told us that staff are supportive and one said, “staff attitudes are good and I feel supported by them”. Another resident said, “We get the support we need to meet our goals and on the whole it’s pretty good”. Care plans seen by us on the four resident’s files inspected also outline the personal support plans of these residents. This all means that residents do receive personal support in the way they prefer and require. Standard 19 - There was evidence seen by us in the residents’ care plans that individual physical and health care needs are addressed. The Deputy Manager told us that a local G.P is allocated to work with the residents at Kairos so as to ensure that any health care needs that arise are addressed. It is said that residents may also use a local dental service if they wish and can access chiropody if needed from another local voluntary agency, St Giles. The Deputy Manager told us that the local chemist comes into the home on a regular basis to check that the home’s medication system policies and procedures are working properly. He reported that these were satisfactory. This chemist also provides the medical supplies for the home. Evidence was also seen on resident’s files of contacts and appointments that had been made with health care professionals and this means that resident’s physical and health needs are being met. Standard 20 - The Deputy Manager told us that the service has a policy whereby it takes responsibility for holding service users’ medication but does not administer it. It was said that on a daily basis staff ‘despatch’ medication to residents for them to self-administer. It was reported that medication is supplied in dossette boxes by the chemist and then each resident’s daily dose is placed by the Deputy Manager or the Housekeeper into a medicine bottle that is then put beside resident’s beds for each resident to self administer. This means that there is a potential risk that residents may not take their medications at the prescribed times and it is possible that medication left on a bedside table may go missing. This was discussed in great detail with the Manager and the Deputy Manager and a requirement is made to amend this practice given the inherent risks. It was agreed by the Manager therefore that current practice would cease immediately and that residents would be asked to go to the medical room daily to collect their medications in person. The MAR sheet records would be signed off also at the time of collection by the resident. Relevant policies and procedures will need to be revised in the light of these changes. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 21 All residents have a self -administration medication risk assessment carried out with them on admission. Evidence of this was seen on residents’ personal files. Photographs of the residents were attached to the MAR sheets, which helps to ensure that staff “despatch” medications to the right resident. We did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate. The Deputy Manager said that currently only he and the housekeeper “despatch” medication to the residents. Both these staff members have received regular training to do with the safe handling of medicines and evidence of this was seen with training certificates that show this training was received in July 2007. However with a change in practice to do with medication if other staff are to do the “despatching” they also will require the training. This would be seen as good practice so that staff may remain appropriately skilled and resident’s needs continue to be met safely. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 were inspected. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self-harm. EVIDENCE: Standard 22 – the 7 residents, who spoke to us, all individually confirmed that they feel their views are listened to and acted upon. All but one resident said that if they had a complaint they know the procedure to be followed and would do so if they needed to. They all said that they have had no complaints to make about the services they receive at Kairos. The one resident who was unaware of the process was supported by another resident and told by him about the process. Staff interviewed confirmed with us that the residents were aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The homes’ complaints policy was inspected and seen to meet the standards required of it. A copy of it is included in the information pack that is given to each resident upon their admission. We asked the Manager to see the home’s complaints record. We were told that no formal complaints had been made since the last inspection however a “complaints record book” has not been set up and it is recommended that this be done now. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 23 Standard 23 - The home has an adult protection policy that links directly into the L.B.Southwark’s adult protection policy. The Manager informed us that although all staff have undergone appropriate POVA training in previous years they have not had recent training experience. Inspection of the training information held in the staff files inspected made it clear that only 1 member of the 4 staff whose files were inspected had received this training in the last 3 years. We were told that 1 other member of staff is booked onto a training course in October 2008. It is therefore recommended that staff are enrolled for the next protection of vulnerable adults training course with L. B. Southwark over this year. It is thought as good practice that all staff should undertake POVA refresher training at least once every 2 - 3 years on an authorised training course preferably offered by L.B.Southwark. 2 members of staff interviewed confirmed that they know what to do if an allegation of abuse is made and they showed awareness of the procedures to be followed. This means that these staff are aware of what abuse is and the safeguards in place for the protection of the residents should they need them. We saw the allegation of abuse record; no allegations had been made since the last inspection. The Manager confirmed this. The policies and procedures manual for the home includes a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process and evidence of this was seen on file, staff are asked to sign to say that they have read and understood the policies and procedures for the home. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 & 30 were inspected. People using this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents at 59, Bethwin Road are able to live in a homely, comfortable and safe environment. The home is also clean and hygienic but needs an overhaul of the decorations and also some replacement of existing furnishings. EVIDENCE: Standard 24 - The service is based in a large detached house (probably a previous vicarage) over three floors and is located close to community facilities. At the time of this inspection the entire exterior of the house was being redecorated. The home has a stair-lift, which is not currently needed for residents but which is maintained should the need arise. Accommodation at the home consists of seven double and two single bedrooms. There are a number of communal areas on the ground and second floors and a patio to the rear of the building. Toilet/bathrooms are located on each floor. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 25 A full tour of the premises was undertaken together with the Deputy Manager and although the home is homely and is suited to its purpose some of the rooms still require re–decoration. Renewals are required of furniture and furnishings particularly bedding such as duvets and pillows. Some carpets were also noted to be frayed and worn in some parts of the house and were not fitted properly posing a health and safety risk. Some work has been done to refurbish some of the rooms but it is recommended that an annual redecoration and refurbishment plan is drawn up with a priority rating given so that the highest priority areas of need can be met first. Residents told us that they would like the bedding to be renewed more regularly. On the top floor the boxing around the sink area in one of the bedrooms needs to be renewed. Also on the top floor in one of the bathrooms the floor covering needs to be sealed where it meets the bath. The kitchen area needs a “deep clean” with particular attention paid to the “hidden” areas behind cabinets and kitchen equipment. It was noted that a brand new oven was due to be connected at the time of the inspection. The Deputy Manager explained that residents are responsible for cleaning in the house; however the Manager may need to consider professional cleaning on a monthly basis if the required standards are to be met and maintained. Standard 30 –The home has an infection control procedure. However a review of the staffing files and other training information indicated that staff have not received training to do with infection control in the last 3 years and it is recommended that they do so. This is important so that staff know the required standards and what measures and controls need to be in place to achieve the standards. As has already been stated, at the time of this inspection the home was seen to be clean and tidy, hygienic and free from offensive odours. Systems are in place to ensure that the spread of infection is controlled and minimised. Laundry facilities are sited so that soiled articles are not being carried through the kitchen and hand washing facilities are appropriately provided to ensure staff can use them where appropriate. This helps to ensure the protection of the residents’ health and to ensure that the home is clean and hygienic. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 & 36 were inspected. People using this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from the clarity of staffing roles and responsibilities. They may be assured that they are supported by a competent, appropriately trained, qualified and supervised group of staff. The homes recruitment policy and procedures helps protect the residents but some practices need improvement. EVIDENCE: Standard 32 – The Manager told us that all the staff at Kairos are counsellors and they also have substantial experience and are qualified to work in the field of substance misuse either holding or are working towards a counselling qualification and specialist qualifications in addictions. Certificated evidence of these qualifications was seen for 3 of the 4 staff files inspected with the fourth member being a trainee counsellor who is presently working at the service as part of their studies to gain a Diploma in Counselling. All were found to contain the required documents including CRB checks (see also under Standard 34) and two references. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 27 The Manager informed us that as a part of the induction process all staff are issued with job descriptions and are asked to read and discuss the homes policies and procedures. The Manager said that no new staff have been recruited since the last inspection in January 2007 and the induction procedure has not therefore been used. The Manager said that there is a training programme for staff provided both in house by staff and also external agency training. This covers all the essential training required by the staff to do their jobs well and efficiently. The provision of funding for training is also said to be good and the Manager told us that if a training need is identified then a training course can usually be provided. Residents interviewed said that staff are approachable and we saw staff taking time to deal with resident’s questions sensitively and appropriately. This all means that residents are being supported by a competent and appropriately qualified staff group. Standard 34 - There is in place an appropriate recruitment policy. 4 staff files were inspected. Generally the files were in reasonable order however some of the information required under the Standard 34 was not in evidence. A requirement is made that all staff files be reviewed and action taken to ensure that they are in good file order and containing the necessary information as described in Standard 34. Criminal Record Bureau (CRB) checks must be renewed every 3 years and be appropriate to the Kairos Community Trust. Only in 2 of the 4 files inspected had a CRB been carried out in the last 3 years. Staff interviewed did confirm that they do have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home; however a copy should be available for reference on their staff files. Standard 35 - The Manager informed us that a structured induction programme is offered to new staff. However the Manager said that there have not been any new staff recruited since the last inspection and so it has not been used this year. The Manager said that the Agency does provide a good comprehensive training programme for staff that includes all the necessary areas of training to support staff in carrying out their roles effectively and efficiently. However while staff are counsellors and have substantial experience and are qualified to work in the field of substance misuse either holding or are working towards a counselling qualification and also a specialist qualification in addictions some of the more basic areas of training needs have not been adequately met. Basic training for all staff should include the following areas: Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 28 • • • • • • Fire safety First Aid Food Hygene Health and Safety The safe handling of medications Safeguarding vulnerable adults (POVA) It is recommended that staff receive this training and that it is refreshed on a regular basis. Training certificates should be available and it is recommended that certificates are gained for all staff training and held on file. This is valuable for the staff member in that it provides documentary evidence of the training input they have received and helps to document their CVs. It was agreed that a new staff training matrix would be helpful as a management tool that identifies future staff training needs and that logs training already undertaken by staff. This is a useful tool in that it will easily inform the Manager what training the staff team have received and where the gaps in training exist. This is a recommendation. Standard 36 - Overall staffs’ needs in relation to supervision are very well met. We were told by the Manager and the Deputy Manager that all staff receive regular clinical supervision provided by an external supervisor as well as having internal clinical supervision received fortnightly from the Deputy Manager to look at work being carried out with residents by counsellors. The Deputy Manager has a professional qualification in clinical supervision. The Manager carries out performance related and management supervision with staff every 6 – 8 weeks. 2 members of staff interviewed confirmed this and told us that they find this “very supportive, it meets my needs”. However notes of these supervision meetings need to be more detailed, recording all the areas of discussion together with agreed actions and timescales for actions agreed. Copies of these notes should be held on staffing files and copies be give to staff for their information. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 & 42 were inspected. People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well run home. They may be confident that their rights and best interests are safeguarded by the home’s record keeping policies and procedures. EVIDENCE: Standard 37 - The present Registered Manager has been in post since June 2005. Prior to taking up the post as manager he was working as Deputy Manager and has approximately seven years experience working in the addictions field, is a qualified counsellor and has undertaken a course in supervision. The Manager also holds the Registered Manager’s Award (RMA)/ NVQ Level 4 in management. It was evident to us at this inspection that the Manager is competent and has the necessary qualifications to ensure the home is well run and this was Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 30 reflected in the feedback received from both staff and residents that we spoke to over the inspection period. This all means that residents do benefit from a well run home. Standard 39 – During this inspection we asked the Manager about the quality assurance process being used within the home and how this had been progressed over the year since the last inspection. This is important at it helps to assure residents and their representatives that their views underpin all service improvements and developments made by the home. The Manager explained that satisfaction questionnaires are always given out to each resident in the last week (usually the 11th week) of their stay. A blank copy of the questionnaire was shown to us. The Manager also explained that the daily morning meetings provide a forum for the residents to voice their feedback about any aspect of the services provided for at Kairos. In addition to this the 6 week reviews of care plans where often the referring agencies attend provides an additional source of feedback with regards to these services. It is recommended that this information be analysed by the management team so that the individual feedback can be assessed in order to identify any patterns or trends that may help the service to build on and improve their services. It would be useful if this information were included in the business and annual development plan for the home. Standard 42 – We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. Up to date certificates were seen for: Boiler & Gas – 22.8.08 Fire alarms – 4.7.08 Emergency lights – 26.2.08 Fire extinguishers – March 08 Electrical installation systems – A check for this is needed usually a 5 year certificate is provided. Portable electric appliances – 26.2.08 Water legionella tests – 25.5.08 The LFEPA last visited on 11.8.08 with no requirements or recommendations being made. All food was seen to be stored appropriately and properly labelled with dates of opening and expiry. Records were seen that confirmed regular tests had been carried out for the: Fire alarm - weekly Fire extinguishers - weekly Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 31 Emergency lighting – 6 monthly Fridge and freezer temperatures records were checked and records indicate that they came within the acceptable ranges. Accident records were checked – none were recorded since the last inspection, the Manager confirmed this was the case. The Incident records were also checked and all had been dealt with according to procedures. Hot water temperatures are not being checked adequately. It is required that all hot water outlets are checked regularly and records kept of each check to ensure that hot water temperatures come within the acceptable range. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. The Manager showed us a recently completed risk assessment for the building and another for the risk of fire. These are welcomed as it should assist in the prevention of accidents, raise awareness of the fire risks and what to do if a fire should arise and will inform the maintenance programme for the building. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 32 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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 33 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 YA23 Regulation 13 Timescale for action Staff should be enrolled for the 01/01/09 next protection / safeguarding of vulnerable adults training course with L. B. Southwark this year. 01/11/08 All staff files should be reviewed to ensure that they are in good file order and containing the necessary information as described in Standard 34 including: employment contracts, Criminal Record Bureau (CRB) checks must be renewed every 3 years appropriate to the Kairos Community Trust. The kitchen area needs a “deep 01/12/08 clean” with particular attention paid to the “hidden” areas behind cabinets and kitchen equipment. All hot water outlets must be 02/10/08 checked regularly and records kept of each check to ensure that hot water temperatures come within the acceptable range. The Manager must ensure that 02/10/08 current practices to do with the “despatching” of medications to residents cease and that DS0000007078.V372586.R01.S.doc Version 5.2 Page 34 Requirement 2. YA34 19 3. YA24 23(2)(b) &(d) 4. YA34 19 5. YA20 13 Kairos Community Trust residents are asked to go to the medical room daily to collect their medications in person. Also that the MAR sheet records be signed off at the time of collection by the resident. Policies and procedures will also need to be amended to reflect these changes and appropriate training provided. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations The Manager should ensure that a more detailed food record is maintained and monitored so that it is a useful tool in helping to ensure that the residents maintain an appropriate diet that is healthy and nutritious The Manager should draw up a “complaints record book” so that any complaints made can be stored all in one place. An annual redecoration and refurbishment plan should be drawn up by the Manager so that the highest priority areas of need can be met in a timely manner. Residents told us that they would like the bedding to be renewed more regularly. The Manager should ensure that staff receive training to do with infection control. This is important so that staff know the required standards and what measures and controls need to be in place to achieve the standards. Training certificates should be gained for all staff training undertaken and held on file. This is valuable for the staff member in that it provides documentary evidence of the training input they have received and helps to document their CVs. A staff training matrix should be developed as a management tool that identifies future staff training needs and that logs training already undertaken by staff. Notes of management supervision meetings need to be more detailed, recording all the areas of discussion together with agreed actions and timescales for actions DS0000007078.V372586.R01.S.doc Version 5.2 Page 35 2. 3. YA22 YA24 4. YA30 5. YA35 6. 7. YA35 YA36 Kairos Community Trust 8. YA39 9. YA42 agreed. Copies of these notes should be held on staffing files and copies be given to staff for their information. The feedback information that is gained via a number of different sources needs to be analysed by the management team. This is so that the items of individual feedback can be assessed in order to identify any patterns or trends that may help the service to build on and improve their services. It would be useful if this information were included in the business and annual development plan for the home. Electrical installation systems – A check for this is needed usually a 5 year certificate is provided. Kairos Community Trust DS0000007078.V372586.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup DA14 5RH 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. 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