Care Home: Kavanagh Place

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What the care home does well Those residents spoken with said that they had been given useful information when they moved in and this had helped them to settle into the home. There are rules and guidelines so that people are aware of their rights while staying in the home. We looked at the assessments carried out prior to and during the admission phase. These were comprehensive and included all aspects of the person`s care including assessment of any risk factors that the person may experience in their daily life. This sort of assessment helps the staff in the home to meet people`s needs. Residents said that they felt relaxed and free to come and go on a daily basis with support from staff. They were also involved with staff in choosing activities they wanted and also meals.Kavanagh PlaceDS0000073274.V377791.R01.S.docVersion 5.3Residents said that they liked the home and that they found staff easy to talk to. One commented that the staff were very good and would `help in any way they can`. Another said: `It`s really good here. The staff get anything for me. They have made sure I get physiotherapy and they help me do some exercises. The talk to me all the time if I need them`. All people spoken with were happy with the food in the home and felt they had a good chioce of daily activity. One person said: `I`ve been here 2 months. It`s alright. There are plenty of people to talk to. I`m going out today with staff. I would give it 10/10. The food is good. Everything is good. My family and friends visit at any time`. This means that people feel supported to live chosen lifestyles. We looked the care records on both units and found plenty of reference to health care needs being met in a consistent manner. It was clear that various health care professionals are involved in the support offered including physiotherapy and other medical input such as the dietician. There is a complaints procedure available for people in the home. This is displayed in the `service user guide`. Those spoken with were very relaxed around staff and said that generally they were listened to so that any concerns could be addressed. We asked staff about their understanding of abuse and how to identify it and how to report any concerns. All staff have undergone training and those spoken with could identify different kinds of abuse and displayed a good understanding of the importance of alerting people in authority. This ensures that people are kept safe. The people spoken with said that the home was very comfortable and spacios. We saw high standards in all areas including exellent disabled facilites so that it is very easy for people with physical disabilty to move around the home and to have their care needs met. This shows that the home are keen to provide for a wide variety of diverse needs. Staff spoken with clearly understood the care needs of the people in the home and could explain their role in providing support. This has ensured a consistent approach. We observed the staff to be warm and supportive in their interactions with the residents and this was confirmed as consistent by speaking to residents.Kavanagh PlaceDS0000073274.V377791.R01.S.docVersion 5.3Page 7We asked about recruitment processes for staff and staff records indicated that staff are recruited appropriately. This ensures that people are protected by the home from staff that may not be suitable. We found that the general management structures in the home supported good monitoring and ongoing development of the care standards so that the home can be run in the best interests of the people who live there. What has improved since the last inspection? This is the services first inspection. What the care home could do better: Key inspection report CARE HOME ADULTS 18-65 Kavanagh Place 1 Rumney Road Kirkdale Liverpool L4 1UB Lead Inspector Mike Perry Key Unannounced Inspection 24th September 2009 09:00 Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 2 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 Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Kavanagh Place Address 1 Rumney Road Kirkdale Liverpool L4 1UB TBC TBC 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) Kavanagh Health Care Ltd Carla Dewick Care Home 40 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (20), Physical disability (20) of places Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home with nursing- Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD Physical disability - Code PD The maximum number of people who can be accommodated is: 40 Date of last inspection New service Brief Description of the Service: Kavagnagh place opened in March 2009 to provide care for people aged 18-65 years of age. There are four ten bedded units. Two of these are for people who have mental health needs and two are for people with physical disability. All bedrooms are en suite. The home is purpose built and provides a high standard of disability aids and adaptations. The home is owned by Kavanagh Health Care Ltd, which is owned by Exemplar Homes Ltd. The Responsible Individual is Kerris Foxall and the Registered Manager is Carla Dewick. The current fees for the service are £1,500 - £2,500 weekly. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection was unannounced and was conducted over a period of one day. All units were visited. All day and recreation areas were seen and some but not all of the residents bedrooms. Care records and other records kept in the home such as health and safety records were also viewed. People who live in the home were spoken to along with members of staff and the Manager. The manager completed an Annual Quality Assurance Assessment [AQAA] prior to the visit, which is a detailed document that gives us a lot of information and updates about the home and assists in focussing the inspection. During the inspection we made observations on the care provided and looked at how staff interact with people and how this may affect their level of well being. The home has been registered for six months and this is the first full inspection. The home is developing and at the time of the inspection had six people living there. What the service does well: Those residents spoken with said that they had been given useful information when they moved in and this had helped them to settle into the home. There are rules and guidelines so that people are aware of their rights while staying in the home. We looked at the assessments carried out prior to and during the admission phase. These were comprehensive and included all aspects of the person’s care including assessment of any risk factors that the person may experience in their daily life. This sort of assessment helps the staff in the home to meet people’s needs. Residents said that they felt relaxed and free to come and go on a daily basis with support from staff. They were also involved with staff in choosing activities they wanted and also meals. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 6 Residents said that they liked the home and that they found staff easy to talk to. One commented that the staff were very good and would ‘help in any way they can’. Another said: ‘It’s really good here. The staff get anything for me. They have made sure I get physiotherapy and they help me do some exercises. The talk to me all the time if I need them’. All people spoken with were happy with the food in the home and felt they had a good chioce of daily activity. One person said: ‘I’ve been here 2 months. It’s alright. There are plenty of people to talk to. I’m going out today with staff. I would give it 10/10. The food is good. Everything is good. My family and friends visit at any time’. This means that people feel supported to live chosen lifestyles. We looked the care records on both units and found plenty of reference to health care needs being met in a consistent manner. It was clear that various health care professionals are involved in the support offered including physiotherapy and other medical input such as the dietician. There is a complaints procedure available for people in the home. This is displayed in the service user guide. Those spoken with were very relaxed around staff and said that generally they were listened to so that any concerns could be addressed. We asked staff about their understanding of abuse and how to identify it and how to report any concerns. All staff have undergone training and those spoken with could identify different kinds of abuse and displayed a good understanding of the importance of alerting people in authority. This ensures that people are kept safe. The people spoken with said that the home was very comfortable and spacios. We saw high standards in all areas including exellent disabled facilites so that it is very easy for people with physical disabilty to move around the home and to have their care needs met. This shows that the home are keen to provide for a wide variety of diverse needs. Staff spoken with clearly understood the care needs of the people in the home and could explain their role in providing support. This has ensured a consistent approach. We observed the staff to be warm and supportive in their interactions with the residents and this was confirmed as consistent by speaking to residents. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 7 We asked about recruitment processes for staff and staff records indicated that staff are recruited appropriately. This ensures that people are protected by the home from staff that may not be suitable. We found that the general management structures in the home supported good monitoring and ongoing development of the care standards so that the home can be run in the best interests of the people who live there. What has improved since the last inspection? What they could do better: We looked at one of the care records on the mental health unit. The care plan written was very generalised and lacked reference to the person’s individuality or the role of the care staff in the care. For example one ‘problem’ was expressed as ‘has depression – organic brain disorder’. The action to support this person’s care need was ‘medication and monitor’. There is a need to place care needs in the context of a more holistic approach including social care. This means describing how disability affects the person concerned as an individual and how the care supports that person to maintain their lifestyle and meet their daily care needs. There was little evidence of initial and ongoing involvement by people in the planning of the care. None of the residents have a copy of the care plan. We discussed ways in which this could be achieved so that people can feel more involved in their care. We looked at how the home supported people who were on medication. None of the present residents are self medicating. The wishes and ability to selfmedicate need to be included on all admission and pre-admission assessments so that any independence can be supported. We saw that some entries on the medication records where handwritten. Some of these were signed by one staff member only. We would strongly recommend that all such entries are checked and signed by two staff as this ensures that the risk of error is reduced. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 8 Some people are on PRN [give when necessary] medication. The MAR chart said to give ‘when required’ but there were no references as to why the medication should be given. We would recommend that all PRN medication is referenced in a care plan so that the reasons are clear and also this can be subject to continued evaluation and review. We did see some laundry that had been placed on the laundry room floor rather than using the laundry baskets provided and this was dicussed with reference to good pracice around infection control. We looked at assessments for a person on the mental health unit who has needs around mobility and uses a wheelchair at times. There was no reference to specific moving and handling assessments and this must be included so that individual tasks such as transferring from bed to chair [for example] are described fully and staff can be clear about how care should be carried out. 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. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are carried out prior to residents being admitted and these are clear so that a completed picture of care needs can be obtained. EVIDENCE: Prior to admission senior staff complete a preadmission assessment by going out and visiting the person. We saw assessments on both mental health and physical disability units. The assessments were consistent in detail and quality and clearly identified care needs. The assessments were backed up by information and assessments from both health and social care professionals who had referred the resident so that a good idea of the care needs were apparent. There where also some risk assessments completed which were appropriate. The assessments completed also showed evidence of the people using the service being involved so that care needs can be personalised and people can feel more involved in the process. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 11 We looked at the information made available to people at the point of admission. The ‘Service User Guide’ is clearly written and gives information about the home such as who is in charge and who to raise any concerns with. This helps people to settle into the home. The people we spoke with said that staff were helpful and assisted them to settle in the home. The home have been careful to recognise the need for developing a range of diverse information for people with disability. For example an audio version of the service user guide for a person who is blind. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): All key standards Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are generally encouraged to be independent and make choices but there needs to be more evidence of their involvement with the care and, on the mental health unit, there needs to be a more individualised approach to care planning so that individual care needs are better described. EVIDENCE: We visited both units and reviewed all residents generally and looked at the care of two people [one from each unit] in more depth. We found the staff knowledgeable and able to talk about the people being cared for and it was clear that they had built up positive relationships. One commented that the staff were very good and would ‘help in any way they can’. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 13 Another said: ‘It’s really good here. The staff get anything for me. They have made sure I get physiotherapy and they help me do some exercises. The talk to me all the time if I need them’. This shows that staff are supportive and involved in the care of people in the home. We discussed this with the manager and there is a realisation that as the home fills up there will be a need to maintain the current good standards and this will present with some challenges in terms of staff input. We looked at care records on both units. These are being developed independently at present. We found the care planning on the physical disability unit to be quite comprehensive and detailed. There was evidence of a more holistic approach to care. For example one care plan discussed the risk of the person becoming depressed and talked about medical input but also included planned interventions around care staff being involved in supporting the person. All of the care needs had been regularly reviewed and we were able to follow the care of the person. We looked at one of the care records on the mental health unit. Again the staff were knowledgeable but the way the care plan was written was very generalised and lacked reference to the persons individuality or the role of the care staff in the care. For example one ‘problem’ was expressed as ‘has depression – organic brain disorder’. The action to support this person’s care need was ‘medication and monitor’. Other care needs were expressed in the same way so that ‘verbal and physical aggression’ was described only in general terms and the care interventions were very non specific and also generalised. We discussed this in some depth. There is a need to place care needs in the context of a more holistic approach including social care. This means describing how disability affects the person concerned as an individual and how the care supports that person to maintain their lifestyle and meet their daily care needs. This removes barriers to disability that medical diagnosis may perpetuate. The use of language [diagnosis] can fail to identify how the disability affects the person’s daily life and therefore make it more difficult to plan specific care interventions. We asked the people we spoke with whether they had a copy of their care plan and whether they had been involved in the drawing up of the care plan. There was little evidence of initial and ongoing involvement. None of the residents have a copy of the care plan. We discussed ways in which this could be achieved so that people can feel more involved in their care. The way that risk is assessed is covered in a multitude of risk assessments. These include things like ‘going out’ as well as more immediate physical risks Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 14 such as pressure sore development. We spoke with people who said that staff support them as much as possible to maintain their lifestyles. For example one person goes out locally with the support of 2 staff. The home is also looking at ensuring a more appropriate wheelchair to support this person’s mobility. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 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): This is what people staying in this care home experience: Key standards People using this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The daily life in the home is supported by good structures so that people are supported to keep active and maintain their lifestyles. EVIDENCE: The pre inspection information [AQAA] supplied by the manager states: ‘We have documented evidence showing visits to local parks, beach resorts, shopping trips, cinema, local lakes, safari park, zoos and meals out. A number of outdoor games have been purchased such as ten pin bowls, snakes and ladders, ludo, dominoes and swing ball which the residents can Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 16 participate. Dietary and feeding needs are catered for with a balanced and varied menu selection. There is access to a kitchenette for drinks and snacks should the residents wish to make their own’. We found from speaking to people in the home that this was generally the case. On the day of the visit two peple were being suported to go out locally shopping. One said, ‘this is a regular occurance’. Another resident told us about regular trips out locally to the pub and this was suported by two staff. The home is at an early stage of development and the manager explained that once the home has more residents there will be a specific role for an activities or ‘life skills co ordinator’ to be employed to ensure that people are continued to be supported socially. All people spoken with were happy with the food in the home and felt they had a good chioce of daily activity. One person said: ‘I’ve been here 2 months. It’s alright. There are plenty of people to talk to. I’m going out today with staff. I would give it 10/10. The food is good. Everything is good. My family and friends visit at any time’. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Key standards People using this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Residents have access to health care and this is supported so that ongoing monitoring and review promote good practice and residents are encouraged to stay healthy. EVIDENCE: We looked the care records on both units and found plenty of reference to health care needs being met in a consistent manner. For example on person reviewed had needs around mobility as well as needing planning for dietary needs and also ongoing reviews of mental health needs. It was clear that various health care professionals are involved in the support offered including physiotherapy and other medical input such as a planned programme from the Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 18 dietician. Those people spoken with said that the staff where quick to refer for medical support if needed. There are a variety of on gong assessments in the care files that ensure health care issues are monitored. These include nutrition and pressure sore risk for example. We looked at similar assessments for a person on the mental health unit who has needs around mobility and uses a wheelchair at times. There was no reference to specific moving and handling assessments however and this must be included so that individual tasks such as transferring from bed to chair [for example] are described fully. [See management section]. The home has an excellent range of aids and adaptations such as specialised beds and mattresses as well as baths and showers developed for people with disability. This ensures that people with a diverse range of physical care needs care can be supported comfortably and both privacy and dignity can be enhanced. Those people seen and spoken with had good standards of personal care and said that staff where patient and supportive at all times. We looked at how the home supported people who where on medication. None of the present residents are self medicating. This was discussed with reference to the home’s policies and procedures and good practice. Currently, there is no assessment tool in use for residents if they were to self-medicate to any degree. This was discussed with reference to an example document. The wishes and ability to self-medicate need to be included on all admission and pre-admission assessments so that any independence can be supported. This is recommended as good practice in promoting independence and autonomy for people. The medication administration records [MAR charts] were seen and these were generally clear and we could see when medication had been given and by whom. Those people spoken with said that staff gave medication on time. All nursing staff have received medication updates and said they felt comfortable with the present system. We saw that some entries on the medication records where handwritten. Some of these were signed by one staff member only. We would strongly recommend that all such entries are checked and signed by two staff as this ensures that the risk of error is reduced. Some people are on PRN [give when necessary] medication. The MAR chart said to give ‘when required’ but there were no references as to why the medication should be given. This is important to ensure that all staff are consistent when they make a decision to administer this medication. We would recommend that all PRN medication is referenced in a care plan so that the reasons are clear and also this can be subject to continued evaluation and review. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 19 Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures and staff are trained so that peoples concerns are listened to and reported and they are protected EVIDENCE: There is a complaints procedure available for people in the home. This is displayed in the service user guide. Those spoken with were very relaxed around staff and said that generally they were listened to so that any concerns could be addressed. We have previously asked the manager to investigate one complaint we received. This was received anonymously and expressed concerns around staff being competent to care for a person who had very high dependency care needs. This was reviewed by the manager who responded appropriately. We asked staff about their understanding of abuse and how to identify it and how to report any concerns. All staff have undergone training and those spoken with could identify different kinds of abuse and displayed a good understanding of the importance of alerting people in authority. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 21 The training ensures that all staff have up to date information regarding current good practice. The manager was knowledgeable and could explain how to contact the local safeguarding team and understood how an investigation would be organized and has experienced this. This helps ensure that residents are kept safe in the service. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Key standards People using the 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 maintained well and provides comfortable accommodation for people with a diverse range of care needs. EVIDENCE: The AQAA states the home is: ‘purpose built modern accomodation decorated and furnished to a very high standard. All bedrooms have en-suite facilities and exceed national minimum standards in size. Consists of 4 ten bedded units, each unit having 3 communal lounges, dining room and sensory bathroom. There is also a Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 23 training room, meeting room, sensory/chill out room and en-suite accomodation is also provided for relatives wishing to stay overnight. The furnishings etc are designed with the younger adult in mind by using experience gained from previous homes. Residents are encouraged to choose and decorate their own room’. We found evidence of all of the above. The people spoken with said that the home was very comfortable and spacios. We saw high standards in all areas including exellent disabled facilites so that it is very easy for people with physical disabilty to move around the home and to have their care needs met. This shows that the home are keen to provide for a wide variety of diverse needs. All areas where clean. We did see some laundry that had been placed on the laundry room floor rather than using the laundry baskets provided and this was dicussed with reference to good pracice around infection control. Staff generally have recieved training however and were aware of good practice. There are regular audut checks of the environmental standards by senior managers and also the maintainance person. This ensures continued monitoring and ensures standards are maintained. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Key standards People using this service experience good quality outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Staff are recruited and trained appropriately so that the care needs of residents can be met. EVIDENCE: There were 6 people supported in the home at the time of the inspection. There were both trained nurses and care staff on each of the units. The manager reported that when the 10 bedded units are full each will have a minimum of 1 nurse and 2 care staff. These are supported by senior management, housekeeping staff and administration and catering staff. Staff spoken with felt that they were supported by the management and that there was enough staff to carry out the care needs of the residents. Staff spoken with clearly understood the care needs of the people in the home and Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 25 could explain their role in providing support. This has ensured a consistent approach. We observed the staff to be warm and supportive in their interactions with the residents and this was confirmed as consistent by speaking to residents. Most staff are involved with some training. The AQAA for the service states: ‘One weeks induction training is given prior to commencing work, this includes all mandatory training ie team building/communication, customer care/core values, employment legislation, fire, first aid, health and safety/COSHH, infection control, safeguarding adults, food hygiene, NAPPI (Non Abusive Physical and Psychological Intervention), moving and handling. This is all done in-house with trainers within the company. The home also is in the process of undertaking NVQ training. We are a City & Guilds approved training centre. Staff meetings are held and minuted’. We saw training records which were up to date. This shows that the staff have the basic skills to care for people in the home. One staff commented: ‘The training is excellent and we are well supported’. We asked about recruitment processes for staff. We saw staff files for three staff and these were comprehensive in that all of the necessary checks required to ensure staff are fit to work with vulnerable adults, such as references and criminal record checks, have been completed. This ensures that people are protected by the home from staff that may not be suitable. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are management structures in place to ensure continued monitoring of standards and improvements in care so that the service is run in the best interests of people living there. EVIDENCE: The manager is Carla Dewick. We spoke at length and she was able to give a clear outline of the current needs of the service in supporting residents with both physical and Mental Health needs. Also how current developments would fit in with best practice. For example she was well aware of current developments such as the Deprivation of Liberty safeguards which have been Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 27 developed to ensure people’s rights are respected. She was able to discuss an example of how the home had referred one person and why this had been appropriate. We asked how the service promotes peoples views and suggestions and was told about how the service canvas opinions of residents through surveys so that people can provide feedback about the service and feel more involved in the running of the home. The manager discussed the various internal audits that are carried out including regular environmental checks and also visits by a service manager who completes a regular inspection and report [Regulation 26 report] which provides further feedback for the manager. We found that the management of health and safety in the home was generally good. The pre inspection information [AQAA] completed states that all safety certificates are up to date and some of these were spot checked on the inspection. This ensures that the environment for people is safe and maintained. The Health and Safety policy is available. Staff receive good training in Health and Safety and this was confirmed by the available training records as well as staff interviews. We looked at assessments for a person on the mental health unit who has needs around mobility and uses a wheelchair at times. There was no reference to specific moving and handling assessments however and this must be included so that individual tasks such as transferring from bed to chair [for example] are described fully and staff can be clear about how care should be carried out. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 4 2 x 3 X 3 X X 2 X Version 5.3 Page 29 Kavanagh Place DS0000073274.V377791.R01.S.doc Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA42 Regulation 13(5) Requirement All people living in the home must have specific moving and handling assessments and this must include individual tasks such as transferring from bed to chair [for example]. This is so staff can be clear about how care should be carried out. Timescale for action 01/11/09 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 YA6 Good Practice Recommendations We would strongly recommend that all people living in the home have a copy of thier care plan. The care plans on the mental health unit need to be developed more holistically and include a more social context as discussed. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 30 There needs to be evidence of ongoing input by people living in the home into the evaluation and reviews of care plans. 2 YA20 Currently, there is no assessment tool in use for residents if they were to self-medicate to any degree. The wishes and ability to self-medicate need to be included on all admission and pre-admission assessments so that any independence can be supported. We would strongly recommend that all handwritten entries on medication records [MAR charts] are checked and signed by two staff as this ensures that the risk of error is reduced. We would recommend that all PRN medication is referenced in a care plan so that the reasons are clear and also this can be subject to continued evaluation and review. 3 YA30 All laundry should be managed using the baskets provided. Kavanagh Place DS0000073274.V377791.R01.S.doc Version 5.3 Page 31 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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