Care Home: Kenneth House

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What the care home does well What has improved since the last inspection? The manager wrote in the AQAA that in the last 12 months, "Residents feel they are more involved in decision making; key worker packs are more informative; areas of the environment have been decorated." The service has a comprehensive quality assurance system in place, enabling people living in the home, and their supporters to underpin the development of the home. The shower room is being refurbished, making it a more pleasant room for people who use it. Some rooms have been redecorated, making it more homely. What the care home could do better: Two requirements have been made as a result from this inspection. The food people are offered and provided must be recorded to ensure that anyone who inspects the home can determine whether the diet is satisfactory in relation to people`s specific dietary needs. The fire risk assessment needs to be updated to ensure that all people living in the home are safeguarded. Key worker reports need to be completed in a more meaningful way, reflecting people`s goals and activities, so that people`s needs can be met effectively. General record keeping is good, but more attention to health appointments needs to be improved. The AQAA told us what the service could de better and how they are going to do this. This included key worker packs becoming more detailed with guidance through team meetings and supervisions, and encourage independence for service users by assessing risks and finding new ways of completing tasks. CARE HOME ADULTS 18-65 Kenneth House 487 Gloucester Road Horfield Bristol BS7 8UA Lead Inspector Nicky Grayburn Unannounced Inspection 27th August 2008 09:30 Kenneth House DS0000026587.V367918.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 Kenneth House DS0000026587.V367918.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. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kenneth House Address 487 Gloucester Road Horfield Bristol BS7 8UA 0117 9511082 01275 372151 Kennethhouse@freewaystrust.co.uk 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) Freeways Trust Ltd Mrs Deborah Anne Carpenter Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (9), Mental disorder, excluding of places learning disability or dementia (2) Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can accommodate 2 named persons of service user category `Mental Disorder` (MD) will revert to LD when persons leave. 23rd November 2006 Date of last inspection Brief Description of the Service: Kenneth House is registered with the Commission for Social Care Inspection to provide accommodation and personal care for up to nine people who have a learning difficulty. Accommodation is provided over three floors and the home does not have a lift. The house itself is situated on a busy main road and blends in well with the local surroundings. It is close to a busy shopping area, with good amenities and public transport routes. The home has a mini bus for residents use. The home is operated as part of Freeways Trust Ltd, which is a registered charity. Part of the ethos of the home is “To encourage service users to reach their full potential…to enable service users to develop valued social roles in their wider community.” Kenneth’s Statement of Purpose The cost of placement is between £554.09 - £1,290.77, the price dependent upon assessed need. There are no additional charges made. Prospective residents can be provided with information about the home and this will detail the services and facilities available at the home. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was Kenneth House’s key inspection. It was unannounced and was carried out over one day. Prior to the inspection, we looked at information held in our office. The manager had completed the Annual Quality Assurance Assessment (AQAA) within the given timescales. The AQAA is a self-assessment document, which focuses on how well outcomes are being met for people who use the service. It also gives us some numerical information about the service. We carried out an Annual Service Review on 8th April 2008. We sent out and received surveys back from people who use the service; health professionals; staff and relatives. As a result of this, we decided not to change our inspection plan and to carry out this key inspection as planned. However, some people wanted to speak with an inspector, so we visited the home on 17th April, and met with those who wanted to meet us. Some of the information we gathered from this review is included in this report. We sent out 10 surveys for staff to complete for this inspection. We received four back. We received one survey from an external health professional. We did not send out surveys for people living in the home, as these were completed in April. Freeways regularly send us monthly reports carried out by members of the senior management. These update us with what is going on in the home. During this visit we met with five people living in the home; the assistant manager, and three members of staff; looked at key records held in the home, and undertook a tour of the property. What the service does well: The manager summarised what the service does well in the AQAA. This included “enable service user to have input in the décor of the home…include service users in selection and recruitment of the new staff…provide a homely environment for service users…staff work as a team.” Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 6 A member staff added a comment on their survey when asked what the service does well: “encourages and supports individuals to live in a safe and relaxed environment and make as many of their own choices about their lifestyle as possible.” What has improved since the last inspection? What they could do better: 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. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 7 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 Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from having information about the home prior to deciding to move in. People can visit the home to make sure it is the right place for them. People’s needs are met. EVIDENCE: Nine people live together at Kenneth House, of which three are female and six are male. The age range is currently from 38 years old to 74 years old. The majority of people primarily have a learning disability. One person has been diagnosed with dementia. The Statement of Purpose is available in the hallway of the home, which was reviewed in March 08. A large pictorial book about the home is also there for people living in the home. The newest person to move into Kenneth House was in April. We were told about this move, and relevant assessments were carried out beforehand to ensure that Kenneth could meet their needs. The monthly report from April also told us that visits and overnight stays took place. We spoke to the person who told us that they were happy living at Kenneth and wanted to stay. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 9 Someone wrote on their survey from April “I came to stay here for a couple of weeks, then decided to stay.” Freeways have a detailed policy about moving to a new home, written with people living in homes operated by Freeways. Some people living in the home are thinking about moving to supported living. They told us about their preferences and what they would like. One person told us how they have started visiting supported living arrangements to see what is available. As detailed within this report, people’s needs are being met. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s changing needs are reflected in their plans of care. People can make decisions about their lives and are involved in the running of the home. Risk assessments are in place to enable people to take risks as part of their daily life. EVIDENCE: People living in the home have plans of care in place, which are reviewed and updated at different intervals depending on the document. People have ‘care plans’ which are reviewed annually. The person’s social worker, family or advocates, and their key worker could be involved in this review. Two care plans were read and had been carried out recently. Key workers write monthly reports with the person. This report covers leisure, hobbies, holidays, day services/college activity, major events, health issues, Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 11 each with goals and actions to be taken. The monthly reports by the area manager tell us that these are up-to-date. We read some reports for two people, spot checked others, and discussed them with the assistant manager. Some were better than others. We found that there was some repetition; health appointments were not being recorded, and some major events not being recorded. Examples were given to the assistant manager and she was going to address these in supervisions. People living in the home also have ‘Listen to Me’ books which give information to support staff such as ‘Who is part of my life’; ‘great things about you’; ‘your list of favourite things’; ‘what can we do to successfully support you?’, and ‘other things we need to know and do’. These were well completed giving a person centred approach to the person. A member of staff added that they think the service does well in “promoting independence and listening to individuals and respecting them as individuals.” Another member of staff added that despite waiting for social worker involvement to update assessments, “in-house reviews are held regularly and care plans are reviewed as part of the monthly key worker packs.” One person has just achieved one of their life long ambitions, with the support from the staff team. A risk assessment was done. The nature of the achievement shows that the home’s equalities policy is functional and staff support individuals fully. There are regular house meetings to discuss any issues and up-and-coming events. The minutes from these are available on the notice board and the last two meeting’s minutes were read. It is clear that people are involved in the running of their home: doing household tasks; deciding on the décor of the lounge; where they want to go on holiday; choosing what goes on the menu, and participating in quality assurance questionnaires and the inspection process. The AQAA told us that one area that the service can do better in is to let people know that they can make suggestions for the home, and there is a small book but it is not currently used widely. Risk assessments were read for the two people case tracked, and others were spot-checked. These are in place to enable people to live as independently and safely as possibly. These are reviewed regularly. New assessments are also done as and when necessary. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s lifestyles meet their individual needs and preferences. Daily routines are respected. Staff support people to maintain their relationships, and are respectful of these. People benefit from being part of the community and engage in leisure activitities. Meal times are enjoyable and flexible. EVIDENCE: There is a range of diverse lifestyles within Kenneth House. People told us in April, and during this inspection that they can choose what they do and when. Some people go to Freeways day centre at Leigh Court, and/or other local day centres. Some people have part time jobs within the community, and some people told us what kind of activities they do such as going to the library, Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 13 going to the pub, going to the cinema, shopping, play in a band, do jigsaws, and go to parties. One staff member commented in the survey how the rota is flexible and extra staffs are rostered on for specific occasions and trips to meet the individual needs of the people living at Kenneth. There is one volunteer who visits the home once a week which people look forward to. They are not counted as part of the duty staff. People who want to go on holiday do. Some people are going to Greece, and some are going to Weymouth. People are getting excited and plans are up and away for this. Staff support people with independent living skills. People have life skills days when they do things like their laundry, shopping, and clean their rooms. People told us about how staff have helped with taking a local bus confidently. One person did this for the first time during the inspection and was extremely pleased and proud of themselves. This has helped them with their independent skills. Some people have relationships with their family, and have friends outside of the home. These are maintained and supported by staff. Personal relationships are also respected. People told us, and we saw that some people have keys for their bedrooms and the front door. Some people choose not to lock their doors. People’s daily routines are respected and people can get up and go to bed when they wish. For example, daily entries show when people choose to have a lie in. It was observed how people could eat breakfast and lunch when it suits them. People also come and go from the house when they want, with or without support. There is weekly menu on display in the kitchen, which showed that a range of foods is planned for the week. Minutes of the menu planning meeting were read and records what individuals have suggested. People told us what they have if they don’t like the planned meal. There is no record of what people actually eat, which needs to be in place to ensure that any person inspecting the record of food can determine whether the diet is satisfactory in relation to nutrition and any special diets. A requirement has been made regarding this. Two people have special dietary requirements, which staff told us about. However, we couldn’t ascertain whether this is being followed. One person living in the home is responsible for checking on the milk and bread supplies, and there are plans for people to start going to the local grocers to buy the fruit and vegetables. This encourages independent skills and involvement with the running of the home. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health needs are met, in a way they prefer and require. Medication procedures safeguard people. People are generally safeguarded by the medication procedures. EVIDENCE: The responses from health professionals were positive and confirmed that individual’s health needs are ‘always’ met; people’s privacy and dignity is ‘usually’ respected, and the service ‘usually’ supports individuals to live the life they choose. They added “the staff are always friendly and helpful and always respond appropriately to the people that live there…[the person] has never said a bad word about the staff or [their] care.” A survey from a General Practitioner told us that their patient visits the surgery with support from a member of staff “who is well informed”. They stated that they are satisfied with the overall care of the home. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 15 External professionals advice and support is sought when necessary. The assistant manager told us that she was going to refer one person to a speech and language therapist to ensure that they are supporting them in the best way. A psychologist has recently been involved with one person’s behaviour and has introduced monitoring charts to help them and the staff team understand certain behaviours so that they can be supported effectively. A physiotherapist is working with one person, and guiding the staff team to make sure they also know how to help the person with their exercises. It was difficult to ascertain whether some people had seen external professionals recently as some appointments were not recorded according to the home’s procedures. However, from looking at past records, we found that people do see their opticians; dentist; chiropodist, and doctor when necessary. Some people were in need of their annual check-ups, and some people need a follow up appointment to ensure that their health is monitored. The medication system was inspected with a member of staff on duty. They explained the training process to us. Staff have a days training at Freeways’ head office with a test at the end, then they are observed up to 16 times by an experienced member of staff. There are no controlled drugs held in the home. The medication administration records were fully signed and the medications corresponded to the plans of care. Everyone has a medication profile for quick information about their medication. The member of staff knew what to do in case an error was found or made. The manager notifies us when there have been errors with anybody’s medication, and the correct procedure is followed to ensure that people are safeguarded against errors. One person’s medication to be taken ‘as and when necessary’ (PRN) was found to be out-of-date by two years. The assistant manager was informed and it was going to be taken back to the pharmacy that day, when the new prescription was being picked up. Therefore, an immediate requirement was not issued. A phone call to the manager was made two days later and she confirmed that it was no longer in the cupboard. Homely remedies are available and separate records are kept. Spot checks of the stock were carried out and were found to be all correct. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home feel that they listened to and their views are acted upon. People are safeguarded from abuse. EVIDENCE: Freeways have a comprehensive complaints policy in place. This can be found in the home’s Statement of Purpose; the service user guide, and it is on display on the notice board in the hallway. A requirement had been made to make sure the pictorial complaints procedure was updated to include timescales. This has been done, but the timescales are in text rather than in keeping with the pictorial format. A pictorial format should be done to ensure that all people know when they should expect their response. Two people told us that they would talk to the manager or their key worker straight away if they had any concerns. All 4 staff surveys confirmed that they knew what to do if someone had a concern about the home. One person added “Freeways has a clear complaints policy. There is also an accessible version of this on the resident’s notice board.” Some staff explained the procedure on their survey. The AQAA told us that there has been one complaint in the past 12 months, which was upheld and resolved within 28 days. The manager wrote that staff could encourage people to feel more comfortable about speaking up for themselves. The complaints book could not be found on the day of inspection, Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 17 therefore was not read. The nature of complaints and concerns was discussed with the assistant manager. Issues are raised in house meetings (as seen in the minutes), in key worker monthly reviews, and in staff meetings. Incidents and accidents are recorded, and a selection was read. Appropriate action is taken to ensure that people are safe and incidents are prevented from happening again. A recent incident involving two residents, which could have been potentially abusive, was dealt with immediately and advice was sought from the local safeguarding team. No further incidents have taken place. We were also informed at the time. Staffs receive regular training in the protection of vulnerable adults. A monthly report stated that this was last done in February 2008. Staff training records showed that some people did ‘Understanding Abuse’ in July 08. Staffs new to care also cover this subject in their Learning Disability Assessment Framework within their first six months of employment. The AQAA also told us that there are risk assessments in place for those people whom self-harm. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a homely, comfortable, clean and safe environment. Bedrooms are personalised and suit individual needs. Shared spaces complement the number of the people living in the home and there are plans for improvements. EVIDENCE: Kenneth House is a large end of terrace house situated on a main road near the centre of Bristol. It is close to local amenities, which are used by people who live at Kenneth. There are bedrooms on all three floors. There is no lift. There is a lounge, dining room and kitchen on the ground floor. The AQAA and monthly reports told us that the dining room, kitchen and ground floor toilet Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 19 have been re-decorated in the past 12 months. This was confirmed during the visit. One person told us that they still need to finish off the dining room by putting pictures back up and curtains. The kitchen is now more accessible for people as the layout has changed. One cupboard door was missing and some were a bit loose. These need to secure in case they fall off when someone is using it. The AQAA also told us that there is a plan to “make the lounge look more up to date and informal”. There are two displays in the house showing the initial stages of the ideas, which had also been discussed in house meetings. Some people find the house to be a bit noisy sometimes, and there is a plan for the area under the stairs to be made into a quiet area. This will benefit those people when it is done. The last report highlighted that the hallway stairs needs cleaning or replacing. It is looking old and is worn in places. Since the inspection, the manager has informed us that it was replaced, and will be cleaned once the current maintenance work has been completed. There is a garden at the rear of the property and some people who live there are keen gardeners who showed us what they have been planting this year. One person also did some weeding at the front of the house during the visit. The monthly report from June told us that there is a team day planned to paint a mural in the garden. Two people living at the home told us about this and the ideas they had for it. The ideas from people living in the home are also on display in the hallway. However, due to the weather, it hasn’t yet been done. There was a requirement made at the last inspection for the shower base tray seal to remain clean and fresh looking. One person wrote on their survey in April that “the shower isn’t very good.” The shower room is being completely refurbished and is currently not in use. There is one bathroom on the top floor, and three additional toilets in the house. One person has a shower cubicle in their room, which they have allowed one person to use, as a bath is too difficult to use. We saw some people’s bedrooms during the visit in April, and saw four this time. All were very personalised and nicely decorated. The newest person to move in told us and showed us their chosen the colours for their room. People have always been proud to show us their rooms. A requirement had been made in 2006 to ensure that the rust was cleaned or the bed replaced in the identified bedroom. It was repeated in the inspection in 2007. The person who lives in the bedroom now, showed us their room and the room now has carpet. Therefore the requirement has been met. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 20 People living in the home have individual household tasks, for example, empting the dishwasher; polishing; vacuuming. People told us about them and how they keep their home clean. These tasks are also discussed in the house meetings to make sure that everyone is still in agreement with them. The member of staff who works at night also cleans the home, and someone who lives in another Freeways home comes twice a week to clean. The AQAA told us that the home has a policy for preventing infection and managing infection control, and 12 staffs are trained. The laundry room floor is impermeable and laundry is washed at appropriate temperatures. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are trained to support people effectively. People living in the home are safeguarded by robust recruitment practices. People benefit from having a supervised staff team. EVIDENCE: In one person’s quality assurance questionnaire, they added, “Kenneth is a wonderful place and everyone gets on well with staff.” The AQAA told us that there are 12 permanent staff members, of which eight are part time and four are full time. We met with three support staffs and spoke with two. The assistant manager was available throughout the inspection and even though she has only been working at Kenneth for a few months, she was well aware of people’s individual needs and her role in the home. One member of staff was very aware of their role in supporting people with their independent living skills rather than doing everything for them. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 22 We received four surveys back from staff. These were all positive. All four members of staff confirmed that Freeways carried out the appropriate recruitment checks prior to them starting; receive training which is relevant to their role; and they are given up-to-date information about the individuals living in the home. The only less-than-positive response was in answer to if they think information is passed on well about people who use the service. All four staffs ticked ‘usually’ rather than ‘always’. A member of staff added on their survey that they had a “very good induction which then continued into training and development to carry out role.” The Learning Disabilities Assessment Framework is completed within six months of someone starting in care work. One staff told us about this, as well as the AQAA. The visit to Freeways’ head office, the training summary in the quality assurance folder, and staffs’ comments evidenced that training is taken seriously and there is a rolling programme to ensure that staff are competent in their role. Certificates on file showed us that people are generally up-todate with their mandatory training. We visited Freeways head office in May 2008 where they keep all the personnel records on staff. These were found to be in good order and are kept securely. We read the newest member of staff’s recruitment file during this inspection. It contained a completed application form; two satisfactory references; confirmation that the person is fit to work, and confirmation of a satisfactory Enhanced Criminal Records Bureau check. All 4 surveys from staff confirmed that their manager regularly meets with staff to support and discuss how they are working. One person added, “supervision is organised for 6 weekly intervals. She [the manager] is also available by phone if specific issues arise in between these.” Three people’s supervision notes were read. There is a proforma for the supervisor to use, which covers ‘how are you?’; workload; key responsibilities; administration; policies and procedures; terms and conditions, and feedback. The notes were good and meetings were regular. The manager and assistant share this role of supervising staffs. The AQAA told us that in the past 12 months there has been a very successful team-building day. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a well run home. People living in the home are involved in the development of the home. The record keeping for the home is up-to-date and documents are kept safe. The health and safety practices safeguard people from potential risks. EVIDENCE: Ms Debbie Carpenter is the Registered Manager for Kenneth House, and has been since April 2003. She spent some time managing another home within Freeways but has returned to Kenneth. Ms Carpenter is a LDAF Assessor and carries out training for support staff in dementia, and loss and bereavement. Ms Carpenter holds Stage one in Further Adult Education Teacher’s Certificate. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 24 Monthly reports told us that the requirements from the previous inspection had been completed, which was confirmed during the visit. An outstanding requirement from 2005 was to make sure that a quality assurance system was in place for residents to underpin the development of the home. Kenneth House now has a specific folder containing records evidencing how the home is developing. ‘Service User Inclusion and Satisfaction’ questionnaires had been completed by seven people living in the home in April 2008. These results had been collated and show that people are generally happy living in their home. Questionnaires had also been sent to family members in October 2007. From these, action points had been written and a letter was sent back to families informing them of the results. General feedback was that services provided are person centred and they are happy with the care management. We receive regular monthly reports written by members of the senior management team, under Regulation 26. These continue to be of a high standard and tell us lots of information about the home and people living there. A member of staff wrote on their survey, “Freeways appears very committed to ensure that staff are kept aware and equipped to deal with changes in policy, procedure and practice.” There is a specific group of people living within Freeways’ homes who work with staff to write policies. These have been shared with local placing authorities and are praised by external professionals. The AQAA gave us dates of when the home’s policies were last reviewed. The AQAA gave us the dates when equipment and maintenance checks have been done within the home, for example the electrical installation check; the gas check and the portable appliance checks. The certificates held in the home confirmed these. Fire drills are carried out regularly, and people’s names and times taken to evacuate are recorded. We asked three people living in the home what they would do if they heard the fire alarm, and they told us what they would do and where the meeting point was. However, one person was unsure what to do if the fire was on the stairwell. The two fire risk assessments were read and one was last reviewed in May 2006. There was no information about people who use a wheelchair or those with hearing and visual impairments. Since the inspection, the manager has informed us that there are separate assessments for specific people in case of an emergency. The generic assessment needs to be updated, and signed by the author. Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 25 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 3 4 3 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 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 3 3 2 X Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 26 NO 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 YA17 Regulation Schedule 4 (13) 23(4ciii) Requirement A record of food provided for people living in the home must be kept. The fire risk assessment must be updated to ensure adequate arrangements are made for all persons in the care home in the event of an evacuation. Timescale for action 31/10/08 2. YA42 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kenneth House DS0000026587.V367918.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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