Care Home: Kilburn Gardens, 53

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What the care home does well The needs and wishes of each person have been assessed. This means that staff know how to provide the care and support they need. The staff monitor their health and wellbeing closely and obtain professional healthcare as and when necessary. Each person is treated as an individual and is able to pursue a lifestyle of their choosing. including a wide range of social activities. They get out and about in the community regularly. The manager and staff know about the importance of protecting the people they care for from harm and have been trained to do this. The staff team make sure that the home is clean, warm and pleasantly furnished so the people who live at the home have a comfortable place to live. The staff are supervised and trained so they know how to provide the people who live at the home with good care. What has improved since the last inspection? The dining and kitchen areas have been refurbished, which has improved the appearance of these rooms. Records are kept of the food served, which helps to show whether people are getting a healthy, varied diet. The manager receives reports of visits by senior managers, which helps them know how well the home is meeting the needs of the people who live here. What the care home could do better: Some staff need to remember to close the bathroom door when they are supporting service users with their personal care, so their privacy and dignity is respected at all times. Any creams used to treat medical conditions, should be labelled with the name of the person being treated. This is to ensure that the cream is not used for anyone else, which helps to protect against cross infection. The temperature of the place where medications are stored should be checked daily. This makes sure that medication is stored at the right temperature so it does not deteriorate. The staff have a menu plan, but do not always follow it. This means that sometimes, service users are not always eating a well-balanced, varied diet. The records of food provided should be reviewed to ensure that service users are offered a varied, healthy range of choices. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Kilburn Gardens, 53 53 Kilburn Gardens Collingwood Park, Station Road North Shields Tyne & Wear NE29 6HD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janine Smith     Date: 1 6 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Kilburn Gardens, 53 53 Kilburn Gardens Collingwood Park, Station Road North Shields Tyne & Wear NE29 6HD 01912728714 F/P01912728714 Noemail Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : New Prospects Association Limited care home 3 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 3 Service users are also categorised as having physical disabilities. Date of last inspection Brief description of the care home 53 Kilburn Gardens provides residential care for three adults with a learning disability. Nursing care is not provided. The home is a bungalow on a housing estate in an outlying area of North Shields. The design of the house is in keeping with the other houses on the estate. Public transport is available a short distance away. The nearest local amenities are in North Shields. The home has a variety of aids and adaptations to assist people with physical disabilities. All of the bedrooms are single. There is a large bathroom, which has an assisted bath, a shower and toilet. There is also a separate toilet. The house has a reasonably sized garden at the rear and a small garden to the front. There is a ramp providing wheelchair access to the front door. The home charges from £1524.16 to £2,159.03 per week. Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Before this visit we looked at information we have received since the last visit on 14th June 2007; how the service dealt with any complaints and concerns since the last visit; any changes to how the home is run; the providers view of how well they care for people; the views of people who use the service and the staff. We sent out a range of surveys to the home but at the time of writing this report, no responses had been received. An unannounced visit was made on 16th June 2009. During the visit we talked with people who use the service, staff and the manager; looked at information about the people who use the service and how well their needs are met; looked at other records which must be kept; checked that the staff had the knowledge, skills and training to Care Homes for Adults (18-65 years) Page 5 of 26 meet the needs of the people they care for; looked around parts of the building to make sure it was clean, safe and comfortable; checked what improvements had been made since the last visit. Since the last inspection, there has been a change of manager. The new manager intends to apply for registration with the Commission shortly. We told the manager what we found during the inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at signficant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 7 of 26 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service, have the information they need to help them decide if it will meet their needs. Evidence: The people who live at the home have their own individual files called all about me. The records showed that people, who are interested in moving into the home, have their needs assessed before a place is offered. They are also offered opportunities to look around the home to make sure it will meet their needs. The home have a guide for service users, which is in a format which is easy to understand. Care Homes for Adults (18-65 years) Page 10 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living here are involved in making decisions about their lives and play an active role in planning the care and support they receive. Evidence: Two care records were looked at, which showed that each persons needs had been assessed. Both service users had been involved in discussions with staff about how they would like to be cared for and the help they would need to achieve individual goals. The care plans were reviewed monthly with their key worker and pictures were used to help service users understand them. Risk assessments are carried out and recorded in the care records. This is done to ensure that service users are protected from harm as far as possible in their day to day lives. Service users are encouraged to participate in running of the home as far as possible. One participates in interview panels to select new staff when vacancies arise and has also had training in carrying out quality checks and assists in audits of the home. Care Homes for Adults (18-65 years) Page 11 of 26 Care Homes for Adults (18-65 years) Page 12 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living here are supported to make choices about their lifestyle. They are able to enjoy good social lives, but would benefit from more support in choosing healthier meals. Evidence: The records showed that service users pursue a variety of social interests, such as bowling, swimming, going to the pictures, meals out, pub quizzes, shopping trips and the staff spoken to confirmed this. They each have their own transport and the staffing rota is planned around their needs. A service user said they were happy living here and liked the staff and the food. He described the social activities he enjoys doing and said he sees his family regularly. Care plans were seen showing that service users are helped to keep in touch with their family or other important people in their lives and staff spoken to confirmed this. There is a menu plan but staff said this was used as a Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: general guide and in practice staff prepared what the service users asked for. Advice had been sought from dieticians when necessary. There was fresh fruit and vegetables in the home, which staff said they prepared for residents, although they were not recording this very well in the record of food provided. The record of food provided showed that residents were sometimes eating less healthy, high fat foods, such as burgers and sausages, quite frequently. Care Homes for Adults (18-65 years) Page 14 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs and wishes, but care can be improved by ensuring that their privacy and dignity is respected at all times. Evidence: The health and personal care needs of the people living here are written in detail so the staff have accurate information and know how to care for them. Their health and wellbeing is monitored closely and the records showed that they have routine health checks as well as seeing other healthcare professionals when necessary. Residents can choose the gender of carers providing their personal care and the manager has taken this into account when recruiting new staff. On two occasions during the inspection, support staff did not close the bathroom door when assisting a service user with their personal care, which compromised their dignity. The manager was able to show how staff were trained to deal with medication, though actual training certificates were not seen due to a misunderstanding about where they were being kept. Advice was given about how the service should evidence the training of staff to administer specific medication by specialised procedure. The medications are carefully stored, but no Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: checks are being carried out to make sure that they are stored at the correct temperature. A sample of records and medications were checked. There was some duplication of records, but the manager is planning to introduce a new medication system shortly, which will improve the record keeping. Medications were fully labelled apart from one cream, which did not show who it was provided for. Care Homes for Adults (18-65 years) Page 16 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access ato a robust, effective complaints procedure. They are protected from abuse. Evidence: There is a complaints procedure in place. Some of the people living here do not communicate with spoken words but there was evidence to show that the care staff observe for signs that they may be unhappy and explore this further, with other professional help if necessary. The manager knows what action to take should any concerns about possible abuse be brought to her attention. She is also intending to update her training in this area. A recently employed support worker confirmed they had been guidance and training about adult protection and could describe what the whistle blowing procedure was about. Care records showed that risk assessments are carried out if any service user presented challenging behaviour and a staff record showed training had been given about challenging behaviour. Records were kept of the fees paid by service users and amounts paid by local authorities. Service users are given support by staff to manage their finances. Appropriate records and audit procedures were in place for this. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout enables the residents to live in a safe, well maintained and comfortable environment. Evidence: The bedrooms looked comfortable and the people who live at the home had personalised them. There are enough bathrooms and showers. The home has specialist equipment, but there is not a lot of storage space. The kitchen and dining areas have been refurbished and the home was clean and well maintained. Radiators are safeguarded for the protection of service users. The laundry facilities were in working order and the manager confirmed that protective clothing is readily available for the staff to use. There is a pleasant outdoor area. The manager has plans to improve the garden in the near future. Care Homes for Adults (18-65 years) Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people living in the home. Evidence: The manager and staff said that the staffing is planned around the needs and wishes of the people who live here. Their wishes are also taken into account concerning the gender of the staff who help them with personal care. There are usually three or four staff from 8 am to 4 pm, three from 4 pm to 10 pm and two through the night, one of whom remains awake. The manager said they have a team of bank staff, who help to cover any unexpected absences. Due to a misunderstanding, training certificates were not seen during this inspection. But from talking to the manager, staff and regional management, it was evident that staff receive induction and ongoing training to give them the knowledge and skills to do their job. This includes, for example, mandatory training, such as moving and handling skills and first aid, as well as vocational qualifications and specific training about other aspects, such as autism, epilepsy, pressure area care. A support worker confirmed that they receive individual supervision and support to help them do their job. The record of someone recently recruited showed that vetting checks were carried out before they were employed, which the person confirmed. Care Homes for Adults (18-65 years) Page 19 of 26 Care Homes for Adults (18-65 years) Page 20 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being managed appropriately and has effective quality assurance systems, which help safeguard the people who live here. Evidence: The manager, Gillian Dodds, had recently begun working at the home but has previous experience of managing a care home for people with learning difficulties. She said she has enrolled for management training, including the National Vocational Qualification at Level 4. She also said she has recently had training in equality and diversity, as well as providing care for people at the end of their life. A quality assurance system is in place, which includes audits as well as seeking the views of service users about their experience at the home through surveys. Due to the absence of a manager for some time, there have not been as many meetings with staff or residents, but this will be addressed. Although certificates of staff training could not been seen, discussions with the manager, staff and senior management, provided evidence that staff receive training in essential areas of health and safety, such as fire safety, moving and handling skills, food hygiene, etc. The fire log book also showed that there are regular Care Homes for Adults (18-65 years) Page 21 of 26 Evidence: fire drills and training, as well as checks on the fire safety systems in the home. A sample of maintenance and servicing documentation was seen for the fire alarm, emergency lights, hoist and malibu bath, and gas system. Care Homes for Adults (18-65 years) Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 18 12 Support staff must provide 30/08/2009 personal and intimate care in private, by making sure that doors are not left open. If doors are left open when personal care is being provided, this means other people can see what is happening and it compromises the privacy and dignity of the service user concerned. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 17 The food records and menu plan should be reviewed, to ensure that service users can be offered healthy options at all mealtimes. This helps ensure that service users have the opportunity to choose a well balanced diet. The temperature of the place where medications are kept should be checked daily. This helps ensure that medications are stored at the right temperature so that they do not deteriorate in quality. Creams provided to treat medical conditions, should be Page 24 of 26 2 20 3 20 Care Homes for Adults (18-65 years) labelled with the name of the service user. This helps ensure that the cream is only used for that person and so avoiding cross infection. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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