Care Home: Kestrel House

What the care home does well The staff and management team are working hard to meet the needs of people living in the home, including in conjunction with external mental health professionals. People`s needs are well assessed prior to admission and continue to be reviewed once they move into the home. Good quality care plans, risk assessments and other documentation assist staff in this. People living at the home, when spoken to independently, indicated that they liked living there and that they received a lot of support from staff, that they appreciated. Staff employed at the home are experienced and have a range of skills. The home is well decorated, maintained and provides a comfortable environment for the people that live there. What has improved since the last inspection? At the last key inspection seventeen requirements were made and I was pleased to see that these had all been complied with. The requirements were in the following areas: care plan documentation; meal preferences; personal care; safe administration of medication; details within the complaints procedure; three areas regarding safeguarding adults procedures; seven areas relating to the physical environment of the home; staff recruitment and the registered provider`s monitoring visits to the home. What the care home could do better: At this inspection three requirements are made to further promote the quality of care the home provides. These requirements are in the following areas: safe administration of medication for an identified person; the environment where people are permitted to smoke; staff training; registering the manager with the Commission; two areas relating to quality assurance and identified fire precaution records. Two good practice recommendations are also made at this inspection with regard to safe administration of medication and staff appraisal. The registered provider, the manager and the staff team may wish to refer to the Commission`s Key Lines of Regulatory Assessment (KLORA), to consider how they may further enhance the overall quality of care in the home. CARE HOME ADULTS 18-65 Kestrel House 75 Harold Road Leytonstone London E11 4QX Lead Inspector Peter Illes Unannounced Inspection 19th November 2007 09:45 Kestrel House DS0000007223.V354622.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 Kestrel House DS0000007223.V354622.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. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kestrel House Address 75 Harold Road Leytonstone London E11 4QX 020 8556 4037 0208 558 2761 sean_hush@yahoo.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) Shanti Healthcare Limited Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) place for a service user over the age of 65 can be accommodated. 20th March 2007 Date of last inspection Brief Description of the Service: Kestrel House is a privately operated care home, registered to provide personal care and support to younger adults who have mental health difficulties. The home is a large converted and extended two storey residential property that includes fourteen single bedrooms and one double bedroom, the latter currently being used for single occupancy. Fourteen bedrooms have ensuite toilet facilities. The ground floor comprises: six residents’ bedrooms, additional bath/ shower and toilet facilities, a lounge/ dining room that includes a pool table in its own alcove, kitchen, laundry, entrance hall and staff office. There is a separate bath/ toilet on the landing between the ground and first floor. The first floor comprises: nine bedrooms, kitchenette, an additional lounge that is used as a smoking room and separate bath/ shower/ toilet facilities. The ground and first floors are connected by a passenger lift and two flights of stairs of which one is used solely as a fire exit. The home has a large and attractive rear garden with parking space for one car at the front of the building. The home is situated in a quiet residential street close to local shops and other community facilities; there are also good links to a range of public transport. A stated aim of the home is to provide rehabilitation for people that are able to live in the community and take part in activities according to their needs, abilities, hobbies and interests. The home also states that it aims to offer people a comfortable life and to meet individual, emotional, social, spiritual, cultural and physical needs, while encouraging independence and selfdetermination. At the time of the inspection, the weekly fee was from £500 to £750 per week, depending on the person’s assessed needs. The provider must make information available about the service, including inspection reports, to people living in the home and to other stakeholders. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took approximately seven and one-half hours with the new manager, Mr Shaun Holiday who had been appointed since the last inspection, being present or available throughout. There were fourteen people accommodated at the time and two vacancies. However, the home’s double bedroom is currently used for single occupancy and the manager stated that this meant the home effectively had only one vacancy. One prospective resident was being assessed for this vacancy. One resident was in hospital at the time of this inspection. The inspection activity included: meeting and speaking with the majority of people living in the home, four of them independently. However, several of the people living at the home declined to talk to me independently on this occasion; detailed discussion with the manager; discussion with a number of staff members, two care staff and the cook independently; independent discussion by telephone with a Community Psychiatric Nurse (CPN), based in L.B. of Waltham Forest, who visits the home regularly; independent discussion by telephone with the manager of L.B. of Tower Hamlet’s Community Mental Health Team (CMHT), whose team had placed several of the current people living at the home. Further information was obtained from a tour of the premises and documentation kept at the home. What the service does well: The staff and management team are working hard to meet the needs of people living in the home, including in conjunction with external mental health professionals. People’s needs are well assessed prior to admission and continue to be reviewed once they move into the home. Good quality care plans, risk assessments and other documentation assist staff in this. People living at the home, when spoken to independently, indicated that they liked living there and that they received a lot of support from staff, that they appreciated. Staff employed at the home are experienced and have a range of skills. The home is well decorated, maintained and provides a comfortable environment for the people that live there. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 6 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. Kestrel House DS0000007223.V354622.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 Kestrel House DS0000007223.V354622.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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Current information is available to prospective residents and other stakeholders to assist them to make an informed choice about living in the home. People have their needs properly assessed as part of the home’s admission procedure to allow staff to assist in addressing these. People also have their needs reviewed once they are living at the home to assist staff to be aware of any changes in these needs. EVIDENCE: Since the last inspection the registered manager has left the home and the deputy manager has subsequently been appointed as manager. The new manager had amended the home’s Statement of Purpose and Service User Guide to reflect this change. A system has also been introduced to review this document on an annual basis in the absence of any other changes being made to the service in the meantime. The Statement of Purpose and Service User Guide were seen to contain the information required by the Care Homes Regulations 2001. One new person had been referred to the home since the last inspection and was in the process of being introduced to the home at the time of this inspection. This person’s file was inspected and contained a range of current assessment and other information about the person. This included: a detailed Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 9 application form, a current care planning approach (CPA) assessment, a care plan and risk assessment from where the person is currently living and a spot purchase contract from the referring local authority. The person had already undertaken an introductory visit to the home accompanied by staff from where the person is currently living. The person visited the home on the day of the inspection for a longer day visit where they were remained unaccompanied by external staff while at the home. I briefly spoke to the person although due to a range of circumstances did not have an independent discussion with them. The person presented as being enthusiastic at visiting the home. The manager stated that if these day visits remained successful the person would then have an overnight stay followed by a weekend stay and then be offered a trial stay. There would then be a six-week review and a three-month review before the person was offered a permanent place, in accordance with the home’s admission procedure. The files of three other people, who had lived at the home for a longer period, were also inspected. These included evidence that the home had received assessment information at the time of their admission and that their needs are reassessed at regular intervals to assist the home to meet their changing needs. Evidence was seen on the files inspected that the home prepared its own reports, with the person involved, to inform CPA meetings about the person’s progress at the home and that these CPA meetings took place at least annually. I spoke independently by telephone to a community psychiatric nurse (CPN) from the L.B. of Waltham Forest’s community mental health team (CMHT) who supports a number of the people currently living in the home. She stated that she has visited the home regularly for approximately two years. She went on to say that she felt that in her opinion the staff were doing a good job and that she had not received any complaints or had any concerns about the home since she has been visiting it. I also spoke independently by telephone to a L.B. of Tower Hamlets CMHT manager. He stated that his team had placed a number of the current residents at the home and that he considered the home to be well run and provided an effective service to the people his team have placed over the past fourteen months. He went on to tell me about one person living at the home that has very complex needs and praised the manager and his staff team for the effective joint work they were undertaking with this person. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are consulted when their needs are assessed and these are recorded in their care plans to assist staff in meeting these needs. People are supported to maximise their independence by making as many decisions as possible for themselves. People are also supported and guided in relation to taking appropriate risks in their lives to assist them to safely achieve their aspirations. EVIDENCE: Care plans were inspected for three people that had been living in the home since the last inspection. These were detailed, covered the person’s current needs and gave guidance to staff on how to meet these needs. At the last inspection a requirement was made that the home must ensure that all care plans for people living in the home are kept current with regard to progress in achieving placement goals. This requirement was being complied with. Files inspected showed people’s current needs, goals and progress being made. It Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 11 was noted that one of the three people were currently in hospital although evidence was seen that staff visited regularly and the person also had regular visits to the home during this period. This helped staff to monitor the person’s progress and also kept the person in contact with other residents and staff. The care plans are reviewed every three months or more frequently if the person’s needs change. The care plan reviews were seen to be signed by both the person concerned and the staff involved in the review. People living at the home that were spoken to independently, confirmed that they were involved in the home’s internal reviews and their care planning approach (CPA) meetings. People living in the home are encouraged and supported to make decisions about their day-to-day lives including being involved in any meetings or discussions relating to them. Evidence of this was seen in the record of regular residents’ meetings that are held every two months, review meetings and also from independent discussion with people and individual key workers. People spoken to independently confirmed that they could come and go as they pleased as long as they kept staff informed. I observed staff interacting with residents throughout the inspection in a relaxed, friendly and respectful manner. People spoken to independently also stated that they liked living in the home and indicated in different ways that they appreciated the staff support they received. The manager also stated that people living in the home were invited to give informal feedback as part of the staff selection process, which they appreciated. The home has a written set of house rules for people that include rules regarding alcohol and substance misuse. These are signed for on admission and a copy was seen on those people’s files that were inspected. Staff hold cigarettes for some people that smoke to assist them in controlling the habit, this restriction was seen recorded on one of the care plans inspected. The manager stated that the home was not an appointee for the finances of any of the people living in the home and only looked after personal allowances for them. The personal allowance and records for one person was inspected and seen to be satisfactory. The records included a signed agreement with the person involved. Each file inspected contained both a detailed and up to date general risk assessment and also a nutritional risk assessment. The manager stated that nutritional risk assessments had been introduced at the home to promote healthy eating and to help people become aware of the benefits of this. Both types of risk assessments had been signed by the person it related to and by a relevant staff member. Kestrel House DS0000007223.V354622.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): 12, 13, 14, 15, 16 & 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged and supported to participate in a range of activities including within the wider community. They also enjoy contact with relatives and friends to the extent that they wish. People are supported to enjoy healthy and nutritious meals that they enjoy. EVIDENCE: All of the people living at the home can travel independently. People spoken to confirmed this and that they had freedom passes for public transport to help facilitate independent travel. Two people attend day services outside the home and a third undertakes voluntary work from a local volunteer centre. Other people living in the home are encouraged to have a structured day time programme although the majority of people spoken to stated that they liked their own more informal routines. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 13 The home provides a number of recreational activities both in the home and within the community. People living at the home take it in turns to assist staff with daily shopping trips for food for the main meal of the day, milk and sundry items and newspapers. The home also has its own pool table and facilitates regular activities such as quiz nights, DVD evenings and bingo. Two people are members of a local sports centre, one having been recommended by their GP to attend to assist them with their general health. People also attend other community resources such as the local library and cinema. Trips and walks out to local leisure facilities such as a local lake are more popular in the summer months. People are also supported to travel further a field if they wish. I was informed that six people were accompanied by two staff on a long weekend to Southend earlier in the summer and that trips such as this were popular with some people. One person spoken to independently stated that they enjoyed the trip and had stayed in a really nice hotel. Two people had been supported to undertake trips abroad since the last inspection. One went to Kenya to see their family and another went to Denmark with a relative for a holiday. Specific risk assessments were seen to have been undertaken to support these trips. The manager also stated that a letter was given to one person regarding their medication so they could show that to a relevant medical practioner abroad should they need medical assistance. A number of people living at the home originate from different ethnic communities and needs and preferences, including such areas as food and places of worship were sought from the person and recorded. An example of this was that nutritional risk assessment forms seek information about religious and cultural needs including fasting. Although a number of people have different religions recorded on their files the majority of people did not wish to strictly conform to practices regarding diet or worship that may usually be associated with that religion. Examples of this were seen in files sampled and confirmed by some people spoken to independently. I was informed that currently four people are supported to attend local places of worship. The majority of people living at the home have contact with relatives and friends ranging from weekly to annual contact depending on the wishes of the individuals involved. People living at the home stated that visitors are made welcome. The home has a clear and welcoming policy regarding arrangements for contact between residents and their relatives, friends and representatives that was seen in the home’s statement of purpose. This specifies the home’s commitment to encouraging and maintaining these relationships. The policy also outlines some basic rules the home will operate to ensure that people remain safe and have their wishes adhered to regarding visitors. Daily routines in the home assist to promote people’s independence and people spoken to independently confirmed that they could get up and go to bed when they wished. Staff were seen to interact positively and appropriately with people accommodated throughout the inspection. People are also appropriately encouraged to undertake daily living tasks to assist develop their independence Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 14 skills and this was documented in their files. This includes people being able to cook meals and undertake their laundry with appropriate levels of staff supervision. As stated elsewhere in this report, the home has clear house rules regarding such things as the use of alcohol, smoking and illegal drugs that people living in the home are aware of. The home operates a satisfactory system for dealing with infringements of these rules including issuing formal warning letters that detail the consequence of continued non-compliance with the house rules. The home has a recurring standard menu that was seen and showed a range of healthy and nutritious meals. The main meal of the day is served in the evening with a lighter meal at midday. On the day of the inspection the main meal was sweet and sour chicken with an alternative of Cornish pastie and cherry sponge for desert. Sandwiches were on the menu for lunch although a number of residents requested fried rice that was cooked for them and looked very appetising. The cook and people living at the home confirmed that the menu was regularly reviewed with residents and that alternatives could be requested if someone did not fancy the meals on the menu for a particular meal. The cook also confirmed that she was involved in ordering the food with the manager and that this system worked well. There was a good supply of food in the home that was properly stored. The cook also confirmed that apart from encouraging healthy eating generally and monitoring the diet of people with diabetes, there were no people on special diets. She went on to say that the home could cater for people with specific dietary requirements such as Halal food and had done so in the past. At the last inspection a requirement had been made that the home must ensure that peoples’ meal preferences are offered to them on a regular basis. This was because a resident had told the inspector that undertook that inspection that although the meals were good that they felt that their preferred meal, curry, should feature more regularly. That requirement was being met and one person living at the home also told me that they could negotiate with staff to go out and by a specific take-away meal if they fancied this occasionally. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 15 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs. They also are supported in meeting their physical, mental and emotional healthcare needs. The medication administration procedures within the home have recently been changed to make them more robust to further safeguard people living in the home and this may be further improved by information being more accessible to staff re individual’s medication. EVIDENCE: The manager stated that all of the people living at the home are independent regarding their personal care although some may need varying degrees of verbal prompting on occasion. Peoples’ support needs regarding their personal care were recorded on the files inspected and staff spoken to independently were able to describe how they provided that support in a sensitive way and in keeping with the individual’s preferences. A requirement was made at the last inspection that the home must ensure that people living at the home are proactively encouraged to complete personal care tasks where they have the Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 16 ability to do so. This requirement was being complied with. People living at the home that were spoken to independently were clear that they could and did manage their own personal care without staff assistance. People are supported with a range of physical, mental and emotional health needs and all people are registered with a GP. Satisfactory records of appointments with health care professionals were seen on the files inspected. These records were clear and included both an overview record of the appointments an individual had attended and a separate record of the details of these appointments including any advice or directions for staff as a result of the appointment. The records showed evidence of appointments with GP’s, mental health specialists, general hospital outpatient departments, dentist and optician. A community psychiatric nurse (CPN) who visits and supports a number of people currently living in the home was spoken to independently and she confirmed that staff were proactive in promoting people’s health needs. One person was in hospital at the time of this inspection and records showed that staff kept in touch with the person by visiting them in hospital and by facilitating the person having visits to the home during their hospital stay. The home had a medication policy that was seen to have been updated in October 2007. The home was also in the process of changing its dispensing pharmacist to receive medication from Boots the Chemist in a monitored dosage system (MDS). This is where medication is supplied in individual blister packs for each person for 28 days at a time. Evidence was seen that staff had received training for using this system. At the last inspection a requirement was made that the home must ensure that staff document accurately on medication administration record (MAR) sheets the medication administered. This was because two omissions of staff signatures on identified MAR sheets were noted at that time. Evidence was seen from current MAR charts sampled that there were no omissions and that this requirement was being complied with. Medication and MAR charts were inspected for three people living in the home. These were generally satisfactory although it was noted that one person was on a prescribed medication to be taken three times a day but that the person was now refusing the medication dose that was prescribed to be taken midday. I was told that the home had checked with the person’s GP and verbally told that this was not critical. However, given that the medication was clearly marked to be taken three times a day and that the person had consistently refused the midday dosage for a number of weeks a requirement is made regarding this. The registered person must ensure that the identified prescribed medication for this person, including the frequency it is required to be administered, is formally reviewed by the prescribing GP and a record of this review placed on the person’s file. This requirement is made to evidence that the person’s ongoing health needs are being robustly safeguarded. In view of the changes being made to the home’s medication procedures and as a further safeguard, a good practice recommendation is made that each person that is prescribed medication should have a medication profile attached Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 17 to their MAR sheet that includes the person’s photograph, what individual medication is prescribed, why it is being prescribed and any common side effects or contra-indications that could occur. This recommendation is made to further safeguard people living in the home regarding safe administration of medication. Records of medication being received and disposed of by the home were seen to be satisfactory. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 18 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 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People accommodated are able to express their views and concerns and have these acted on appropriately. The home’s safeguarding adults policy and procedures have been updated to further assist in protecting people from abuse. EVIDENCE: At the last inspection a requirement was made that the home must ensure that the home’s complaints policy includes the correct contact details of the local CSCI office. The requirement also included that home’s Service User Guide must be amended to include these details. This requirement was seen to have been complied with. At this inspection an updated complaints procedure was seen, including in the Service User Guide, and a summary of this was displayed in the entrance to the home with copies of complaints/ suggestions/ comments cards available to all who enter the home. People living at the home indicated that they knew how to raise concerns when they wanted to and that these were listened to and acted upon when raised. The home had received two concerns from people living at the home since the last inspection. Both had been upheld and acted upon in a timely manner. There have been no other complaints made to the home or to the Commission since the last inspection. At the last inspection three requirements had been made regarding the home’s safeguarding adults policies and procedures. These were; that the home must keep on site a copy of the local authority’s safeguarding adults procedure; that Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 19 the home must review its own policies and procedures in accordance with the local authority’s procedures and that staff must receive training in the use of the newly revised procedures. A copy of L.B. of Waltham Forest’s 2007 safeguarding adults’ policy and procedures was seen in the home, Waltham Forest is the local authority that the home is situated in. Evidence was also seen that the home had revised its own procedures in the light of the local authority procedure and that staff had been briefed on the changes. Evidence was also seen of an ongoing training programme for staff in this area. There have been no allegations or disclosures of abuse made to the home or to the Commission since the last inspection. Staff spoken to were able to describe what action needs to be taken should an allegation or disclosure of abuse be made to them. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 & 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is comfortable, well decorated, well maintained and has had significant resources spent on it in the current year. However, further attention is needed to where people are permitted to smoke to further protect everyone in the home and to comply with current legislation. People who live in the home, staff and visitors benefit from the building being kept clean and tidy. EVIDENCE: The home is a large converted and extended two storey residential property that includes fourteen single bedrooms and one double bedroom that is used for single occupancy. Fourteen of the bedrooms have ensuite toilet facilities. The ground floor comprises: six residents’ bedrooms, additional bath/ shower and toilet facilities, a lounge/ dining room that includes a pool table in its own alcove, kitchen, laundry, entrance hall and staff office and accommodation. There is a separate bath/ toilet on the landing between the ground and first Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 21 floor. The first floor comprises: nine bedrooms, kitchenette, additional lounge that is used as a smoking room and separate bath/ shower/ toilet facilities. The ground and first floor are connected by a passenger lift and two flights of stairs of which one is used solely as a fire exit. The home has a large and attractive rear garden with parking space for one car at the front. At the last inspection a number of requirements were made regarding the environment of the home and I was pleased to see that all of these had been complied with. The requirements in this section related to: ensuring extractor fans were fitted in areas that people smoke in, ensuring that all fire doors are kept closed, ensuring that fire drills were carried out at different times of the day, ensuring that tiles were replaced in an identified bathroom ensuring that the refrigerator in the first floor lounge was kept clean and the icebox defrosted, ensuring net curtains were fitted in the windows of communal areas and ensuring that identified carpets in the home’s lounge areas were replaced. During a tour of the building it was noted that all fire doors were closed with the majority of fire doors to the communal areas being fitted with electromagnetic closures linked to the fire alarm, that the identified bathroom tiles had been replaced, that the refrigerator in the first floor lounge had been replaced, was clean and in good working order, that net curtains had been fitted to communal areas and that following consultation with the people living in the home that the carpets in the main communal had been replaced with good quality laminate flooring. It was also noted during the inspection that the home were carrying out regular fire drills at different times of the day including when the night staff were on duty. During the tour of the premises it was noted that an extractor fan had been fitted to the main lounge following the requirement made at the last inspection. However, in July 2007 the Health Act 2006, smoke-free (Premise & Enforcement) Regulation 2006, came into force that places restrictions on where people can smoke, including in residential care homes. The manager stated that from that time people have not been permitted to smoke in the home except in the first floor lounge, which had been designated as a smoking area. This lounge was seen to have a self-closing door and a window but did not have an extractor fan fitted as is required in designated smoking areas by the new legislation. A requirement is made that the registered person must consult with the Environmental Health Officer and ensure that any designated smoking area in the home complies with the Health Act 2006, smoke-free (Premise & Enforcement) Regulation 2006. During the tour of the premises some residents’ bedrooms were seen and it was noted that that these were well decorated, comfortable and had been personalised to the extent that the person wished. The home was generally well decorated and had pleasant atmosphere. The home undertakes routine maintenance checks of the whole building on a monthly basis and satisfactory records of these were seen, the manager stated that anything more serious was dealt with as it occurred. It was also noted that a significant amount of Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 22 money had been spent on the home since the last inspection including on new laundry equipment and a new cooker for the kitchen. The home was clean and tidy during the inspection and the manager stated that people living in the home were encouraged and supported by staff in keeping their rooms clean. The home had newly installed laundry equipment and an infection control policy that was seen and that staff spoken to were aware of. It was noted however that not all staff had undertaken infection control training and a requirement is made regarding this in the Staffing section of this report. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 23 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): 32, 33, 34, 35 & 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A staff team with a range of qualifications and competencies, in sufficient numbers, support people living in the home. The home’s recruitment policy assists in protecting people living in the home. People are supported by staff who have access to a range of appropriate training and formal supervision to assist in further meeting the needs of people living in the home and in their own personal development. However, formal training is needed in relation to infection control to further minimise risk in this area and people living at the home may also benefit further from staff receiving an annual appraisal. EVIDENCE: The home had in post: a manager, one deputy manager, five senior support workers and thirteen support workers. The manager is currently undertaking his registered manager’s award, the deputy manager has achieved the national vocational qualification (NVQ) level 3 in care and the senior support workers have achieved at least NVQ level 3 in care. One senior support worker is a registered nurse although not practicing as a nurse in their current role. Of the thirteen support workers eleven have achieved NVQ level 2 in care and the Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 24 other two are working towards this. In addition to this the home employs two cooks, one works weekdays and one works weekends and one cleaner. Two support staff work the morning shift, two support staff work the afternoon/ evening shift and two waking support staff work at night. The manager’s hours are in addition to this. The manager’s hours are in addition to the rota. The staff rota was seen and the staff on duty reflected those recorded on the rota. At the last inspection a requirement had been made that the home must ensure that all staff personnel files contain full information as outlined in Schedule 2 of the Care Homes Regulations 2001. This was as a result of criminal records bureau (CRB) checks for identified staff having been obtained through another employer. This requirement was checked and had been complied with. Two support staff had been recruited to the home since the last inspection and their staff files were inspected. Both of these files contained: a copy of the staff member’s proof of identity including a recent photograph, two written references including a last employer reference that had been verified, and evidence that the person had an enhanced CRB clearance and protection of vulnerable adults (POVA) check that was applied for by the home and had been received before the person started working at the home. Staff training records are kept and those sampled were satisfactory. The two new staff members had received a satisfactory induction. Evidence seen of other training included: fire safety, safe administration of medication, management of aggression, protection of vulnerable adults, food hygiene and health and safety. Staff spoken to confirmed that they had attended a range of training courses since the last inspection and that they had found the training helpful. However, it was noted that staff training records indicated that staff had not undertaken current infection control training. It was also noted during the inspection that one person living at the home had an occasional problem with incontinence although I was informed that the others did not. A requirement is made that the registered person must ensure that all staff undertake infection control training as part of the core training provided by the home and that staff skills and knowledge are kept up to date in this area. This requirement is made to maximise protection to people living and working in the home. The manager stated that all staff were supervised at least two monthly and both documents sampled and staff spoken to evidenced this. The manager also stated that he has arranged for an external mental health professional, from a community mental health team, to assist him in undertaking supervision for some staff. This is to share the workload and to provide additional expertise to staff through supervision arrangements. Given this, a good practice recommendation is made that each staff member receives an annual appraisal, by that person’s line manager, to review the staff member’s performance and to set agreed objectives for the coming year. This recommendation is made to Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 25 further link and reinforce good staff practice and development to the stated objectives of the home. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home and staff benefit from the home being effectively managed although some further actions are needed by the provider organisation to comply with current legislation, including registering the manager with the Commission and undertaking quality monitoring visits. Despite this people living in the home benefit from differing ways of involving them and other stakeholders in quality assurance monitoring that contributes to identifying how the service can continue to improve. The home has generally effective health and safety procedures in place to protect people living there and others that work or visit the home. However, fire precautions need further work to ensure that this protection is maximised. EVIDENCE: The registered manager of the home had left since the last inspection and the deputy manager had subsequently been promoted to manager. The new manager presented as being knowledgeable about the needs of people with Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 27 mental health difficulties and with the management of a residential care home. He has twelve years experience working with people with mental health difficulties including staff management experience. The manager is currently undertaking his registered managers award and is required to apply to the Commission to become the registered manager of the home. The registered person must ensure that an application for registration is made to the Commission in respect of a suitable manager for the home. This is to comply with legislation and to verify to the Commission that the appointed manager is qualified, competent and experienced to run the home. Services registered with the Commission are now required by legislation to complete an Annual Quality Assurance Assessment (AQAA) and submit a copy of this to the Commission within a prescribed timescale. An AQAA form was sent by e-mail to the previous registered manager but had not been completed and returned to the Commission by the specified date. During a telephone conversation with the current manager, prior to this inspection, he apologised on behalf of the home and stated that he was not aware that the AQAA form had been sent to the previous registered manager. He requested another copy that was duly sent. The manager confirmed at this inspection that he had now received the AQAA form and would return a copy by the due date. The date that a completed copy of the AQAA must now be submitted to the Commission is 11th December 2007 and a requirement is made regarding this. This requirement is made to comply with current legislation and to ensure that the quality of care and support in the home is being formally monitored on an annual basis. The home has a variety of effective mechanisms for monitoring the quality of care and support provided by the home. These include a range of regular questionnaires for stakeholders including people living in the home, visitors, relatives and professionals. The questionnaires were seen to include: an overview of the service from people living in the home, the person’s admission process, daily activities arranged by the home and group outings and holidays arranged by the home. In addition to this the home operates a key worker system, holds regular residents’ meetings and invites people living in the home to give informal feedback as part of the staff selection process. A requirement was made at the last inspection that the home must introduce and implement self-monitoring visits as specified in Regulation 26 of the Care Homes Regulations 2001. Evidence was seen from documentation sampled that this requirement was being complied with although formal written reports of these visits were not available at the home for inspection. A new requirement is made that the registered person must prepare a written report on the conduct of the home following each monthly visit, ensure a copy of the report is provided to the registered manager in a timely manner and that these reports are available at the home for inspection. This requirement is made to evidence that the responsible individual for the registered provider Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 28 organisation monitors and is satisfied with the quality of care and conduct of the home, for which he is responsible for by legislation. During the inspection a number of the home’s key policies and procedures were referred to in order to test the home’s practice against these. It was noted that these were of good quality and had been reviewed by the manager since he had taken up that post. A range of satisfactory health and safety documentation was seen. This included: a gas safety certificate, electrical installation certificate, portable appliance test certificate and evidence that the passenger lift in the home had been serviced. The home’s fire log was inspected and showed that the fire fighting equipment had been serviced, weekly safety checks on fire equipment were being carried and that regular fire drills were being undertaken, including at night time. Updated fire regulations (Regulatory Reform -Fire Safety- Order 2005) came into force from October 2006 and placed increased responsibilities on providers and managers of registered care homes. It was noted that the home was visited on 1st December 2006 and that the fire fighting arrangements were judged to be satisfactory from this visit. However, there was not a current fire plan or fire risk assessment available for inspection at this visit. The manager stated that he had recently undertaken fire training and had identified that this was work that he needed to attend to as a priority. A requirement is made that the registered person must ensure that a written fire plan and fire risk assessment is produced for the home, that these conform to the requirements of the Regulatory Reform -Fire Safety- Order 2005, that the fire precaution arrangements in these documents are made known to both people living at the home and staff and that these documents are kept available for inspection. This requirement is made to maximise protection to all people who live in work in or visit the home. Requirements have been made in this section of the report relating to identified elements in the majority of standard inspected. However, it is my judgement that outcomes for people living in the home relating to the overall conduct and management of the home are currently good. This is because the manager has worked hard to meet all the seventeen requirements made at the last inspection, he presented as being genuinely committed to improving the service further, that feedback from people spoken to including residents, staff and external professionals has been positive about the home and its management and because there are a significant range of positive areas of practice identified in this report. Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 3 X 2 X Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13(2) Requirement The registered person must ensure that the prescribed medication for an identified person, including the frequency it is required to be administered, is formally reviewed by the prescribing GP and a record of this review placed on the person’s file. This requirement is made to evidence that the person’s ongoing health needs are being robustly safeguarded. The registered person must consult with the Environmental Health officer and ensure that any designated smoking area in the home complies with the Health Act 2006, smoke-free (Premise & Enforcement) Regulation 2006. The registered person must ensure that all staff undertake infection control training as part of the core training provided by the home and that staff skills and knowledge are kept up to date in this area. This requirement is made to maximise protection to people DS0000007223.V354622.R01.S.doc Timescale for action 17/12/07 2. YA24 13(4) 17/12/07 3. YA35 18(1) 31/01/08 Kestrel House Version 5.2 Page 31 living and working in the home. 4. YA37 8 The registered person must ensure that an application for registration is made to the Commission in respect of a suitable manager for the home. This is to verify to the Commission that the appointed manager is qualified, competent and experienced to run the home. 31/12/07 5. YA39 24(2) The registered person must 11/12/07 ensure that a copy of an Annual Quality Assurance Assessment (AQAA) is completed for the home and is submitted to the Commission. This requirement is made to comply with new legislation and to ensure that the quality of care and support in the home is being formally monitored on an annual basis. The registered person must 17/12/07 prepare a written report on the conduct of the home following each monthly visit, ensure a copy of the report is provided to the registered manager in a timely manner and that these reports are available at the home for inspection. This requirement is made to evidence that the responsible individual for the registered provider organisation monitors and is satisfied with the quality of care and conduct of the home, for which he is responsible. The registered person must ensure that a written fire plan and fire risk assessment is produced for the home, that these conform to the DS0000007223.V354622.R01.S.doc 6. YA39 26(3) 7. YA42 23(4) 17/12/07 Kestrel House Version 5.2 Page 32 requirements of the Regulatory Reform -Fire Safety- Order 2005, that the fire precaution arrangements in these documents are made known to both people living at the home and staff and that these documents are kept available for inspection. This requirement is made to maximise protection to all people who live in work in or visit the home. 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 YA20 Good Practice Recommendations Each person that is prescribed medication should have a medication profile attached to their MAR sheet, that includes the person’s photograph, what individual medication is prescribed, why it is being prescribed and any common side effects or contra-indications that could occur. This recommendation is made to further safeguard people living in the home regarding safe administration of medication. The home should arrange for an annual appraisal for all staff, by that person’s line manager, to review the staff member’s performance and to set agreed objectives for the coming year. This recommendation is made to further link and reinforce good staff practice and development to the stated management and service delivery objectives of the home. 2. YA36 Kestrel House DS0000007223.V354622.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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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