Care Home: Kingston Farmhouse

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What the care home does well What has improved since the last inspection? There were no outstanding requirements from the previous inspection. The home is currently undergoing major refurbishment to improve the bedrooms, kitchen and communal areas of the home, for the benefit of the residents. What the care home could do better: The visit did not identify any regulatory requirements. In discussion with the registered manager, it was recommended that the home`s quality assurance system could be developed to fully demonstrate how the home seeks regular feedback from residents, staff, relatives and others and what action is taken in response to feedback about the service. The manager produces an annual newsletter and the results of the quality assurance surveys could be summarised in the newsletter. CARE HOME ADULTS 18-65 Kingston Farmhouse Beatrice Avenue Whippingham East Cowes Isle Of Wight PO32 6LL Lead Inspector Annie Kentfield Unannounced Inspection 29th November 2007 12:00 Kingston Farmhouse DS0000012503.V350044.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 Kingston Farmhouse DS0000012503.V350044.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. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingston Farmhouse Address Beatrice Avenue Whippingham East Cowes Isle Of Wight PO32 6LL 01983 294145 01983 289667 kingstonoffice@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) Mrs Jennifer Ann Bacon Mrs Trudie Manton Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd March 2007 Brief Description of the Service: Kingston Farmhouse is a registered care home that provides care support and accommodation for up to nine adults of both sexes with learning disabilities. The home is a detached property situated in a semi-rural position in a quiet cul-de-sac on the outskirts of East Cowes. The house itself has some historic interest, having connections with the nearby Osborne House Estate. It sits in its own grounds and offers views of the Medina Valley from some of the rooms and the secluded rear garden. The home is within ¼ mile of a main bus route and is convenient to ferry services to the mainland. Residents lead full and active lives and all are engaged in a variety of educational, social and recreational activities. The manager and staff strive to promote independence amongst the residents and support them in developing a range of social and life skills. All rooms are for single occupancy and have been decorated to residents’ individual tastes. One resident with mobility difficulties is accommodated in a ground floor room that has had major alterations, including the installation of an en-suite bathroom. Communal areas consist of a spacious lounge and separate dining room. Weekly fees are determined by the social services funding arrangements, currently £413.91 for the basic care support package. The manager states that a copy of the home’s service user’s guide, together with the terms and conditions of residency are provided to all prospective residents, or their representatives where applicable. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is a summary of information that we have received, or asked for, since the last inspection in March 2007. The manager sent us their Annual Quality Assurance Assessment (AQAA). This is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We also looked at information that the home have sent us in the form of ‘notifications’ and how they have dealt with things that have happened in the home. We sent survey forms to residents, staff, relatives and health and social care professionals who visit the home and we received feedback from 7 residents, 6 staff and 2 relatives. We made an unannounced visit to the home on 29th November 2007 with one regulation inspection (Annie Kentfield) and met the registered owner and one of the residents and we made an additional pre-arranged visit to the home on 5th December 2007 in order to meet with the registered manager and more of the residents and staff. Comments received about the service were generally positive from residents, staff and relatives about all aspects of living in the home. What the service does well: What has improved since the last inspection? There were no outstanding requirements from the previous inspection. The home is currently undergoing major refurbishment to improve the bedrooms, kitchen and communal areas of the home, for the benefit of the residents. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 6 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. Kingston Farmhouse DS0000012503.V350044.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 Kingston Farmhouse DS0000012503.V350044.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 and 2 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. To ensure residents care and support needs are met, a full assessment is undertaken before they move into the home. Residents are provided with information about the home that is available in accessible formats. EVIDENCE: The home has 8 residents at present and there is one empty bedroom. The manager explained that because of the current refurbishment work, this bedroom would remain empty until the work is completed. We discussed the home’s policy for assessing new residents and it is clear that following a support and care needs assessment of prospective new residents, there is consultation and discussion with existing residents, and staff, before new residents move into the home. Prospective residents are invited to a residents’ meeting and to visit and/or stay for a meal, or a weekend before deciding if they will move into the home. Information about the home is available for new residents and/or their representatives in a written or pictorial format and also includes a copy of the most recent inspection report and the complaints procedure for the home. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 9 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 and 9 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to be as independent as possible and to take sensible risks, which enhance their enjoyment of life. EVIDENCE: Individual care/support plans are detailed and person centred. Each resident has a key worker and support plans are reviewed every 5 weeks with the key worker. Support plans include individual risk assessments and agreed information about how any risks can be minimised or reduced. Residents say they can also speak to the manager or any member of staff at any time if their key worker is not around. One resident is involved with an advocacy group and attends the periodic meetings that are held. The manager explained that there is a strong emphasis on self-advocacy for those with the cognitive ability to do so. For others the home will access the advocacy service when required or if there is a particular issue that a resident needs support with. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 10 We looked at the system in place for managing residents’ finances. Each resident has their own bank account and is given support to be as independent as possible in this respect. The arrangements were fully explored and judged to be appropriate. One resident told us that the residents’ meetings each week usually agree a rota of who does what task in the day-to-day household routines such as laying the table, washing up, assisting with the cooking etc. The meeting recently decided on what the Christmas menu would be and is also an opportunity for residents to discuss outings, holidays and other activities. T Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 11 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, 15, 16 and 17 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to have opportunities to take part in work, leisure or social activities of their choice. EVIDENCE: Some of the residents have additional 1:1 support from staff where this has been identified as appropriate and this time is used in either personal care, agreed therapeutic exercises, activities of choice, or for emotional or behavioural support. A record is kept of this additional support for residents. Residents have an individual weekly programme of planned activities and these can include meaningful activities such as work, going to a number of local day centres, shopping, visiting friends and relatives or going out to social events. Residents like to have a more relaxed weekend and weekend activities are agreed informally. This year all of the residents and some of the staff went on a holiday to Disneyland Paris, flying from Southampton. If a group holiday is Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 12 agreed, this is usually discussed at the weekly residents’ meeting. The home has it’s own transport and a dedicated driver. Transport is usually provided by the home if residents are going to day centre resources or have other appointments, but residents also pay for taxi transport at other times. We received one comment from a relative who was not happy about their relative having to pay for taxi transport and this was discussed with the registered manager. When residents move into the home they are made aware of any additional expenses that may arise, such as transport, holidays etc. The manager also confirmed that residents are receiving appropriate benefits that should cover transport costs. Meals are prepared each day by staff, with assistance from some of the residents. There is a rolling and wide-ranging menu but alternative choices are always available. One resident told us that the food is good and was full of praise for the staff that do the cooking. If residents are at home during the day, a lunchtime snack is available, some of the residents take a packed lunch with them if they are out, and the main meal of the day is in the evening. Residents have a dining room attached to the kitchen and it was evident that the kitchen and dining room provide the ‘hub’ of the home and it is the place where residents and staff have lots of social interaction. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 13 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 and 20 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of the residents are being met by the home. Medicines are safely stored and dispensed. EVIDENCE: Each resident’s support/care plan records in detail their health care needs with information for staff on the support needed to meet those needs. For those residents who are independent in personal care, staff offer support, prompting and guidance. Residents are supported to access health care services including health promotion services such as the well man or well woman clinic. Particular health issues are discussed and reviewed in the care plan reviews and care management reviews to ensure that changing health care needs are re-assessed and needs met. Staff have access to written health care information so that they are fully aware of the individual health care needs of each resident. We received comments from residents and a relative that confirmed care is provided with regard to dignity and privacy. Medicines that are prescribed for the residents are kept in a locked cupboard. The manager explained that there are plans for a new medication storage area Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 14 in the basement and the manager has taken advice on best practice for this. The home also has a copy of the guidance on the safe administration of medicines for care homes and ensures that policy and procedures in the home meet guidelines for good practice and also meet regulatory requirements. The manager would like to develop residents’ opportunity for self-medication, subject to a risk assessment and the provision of a safe lockable place for medicines. This is to be discussed with staff in their next ‘team briefing’. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 15 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 and 23 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has policies and procedures in place to protect residents from the risk of harm or abuse. EVIDENCE: Residents have a number of opportunities to express their views about living in the home; the weekly residents’ meeting or talking to their key worker. The comments that we received from residents indicated that not everyone was sure about the complaints procedure, as such, but residents did say that they would speak to their key worker or the manager if and when they had any concerns about anything. In the Annual Quality Assurance Assessment (AQAA) the manager said that the home could produce a better system for logging complaints or concerns and plans to keep a ‘complaints log’. The manager supports the use of independent advocacy support for the residents and confirmed that there is a local advocacy service that residents can use. In the notifications sent to us about things that have happened in the home, the home have shown that they have managed issues well and are aware of the agreed policies and procedures for reporting any concerns or incidents that may affect the safety or well being of the residents. The training calendar for staff shows that safeguarding and protection are part of the staff training and development programme. Residents are also protected by the home’s staff recruitment procedures. Staff do not start working in the home until there are satisfactory written references and checks in place. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 16 Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 17 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 and 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment. EVIDENCE: The home is currently undergoing major refurbishment. The work plans to refurbish some of the bedrooms and install en-suite facilities, provide new flooring and carpets, and refurbish the kitchen. Residents have a newly decorated and furnished sitting room and each of the residents was invited to produce a picture – these have been framed and hung on the walls of the sitting room. Residents also have a dining room that is adjacent to the kitchen. The environment is homely and comfortable and residents looked very much ‘at home’. We were also told that improvements have been made to the water supply for the home, and to the central heating system. With major building work going on it is difficult to maintain usual standards of housekeeping, however, comments from residents and relatives confirmed that the home is always clean and tidy. The manager explained that they try as Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 18 much as possible to ensure that residents are not inconvenienced whilst the work is in progress. The manager recently attended a training session on infection control at the local hospital. The manager is confident that the infection control policy in the home is sufficient for the needs of the residents and some of the staff have also done infection control training. However, the manager plans to review the policy for the home to ensure that procedures meet the guidelines for safe practice, one of the additions to the policy will be the ordering and supply of masks for staff to use. The home does not have a clinical waste disposal contract and it was recommended that the manager seek specialist advice to ensure that the home is meeting good practice and the relevant regulatory requirements with regard to clinical waste disposal. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 19 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, 34 and 35 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by an effective staff team and protected by the home’s recruitment procedures. EVIDENCE: We looked at the staff rotas, training and supervision records, and recruitment records and received comments and feedback from 6 members of staff. We also received 7 surveys from residents and additional comments that confirmed satisfaction with the staff team in the home. One relative wrote that the home could improve with more trained staff and better communication – “as messages don’t always get passed on”. However, we found evidence of an ongoing commitment to develop staff skills and knowledge through regular access to training, and this was confirmed by the staff comments and training records. Almost half of the staff team have already achieved the National Vocational Qualification (NVQ) in Care level 2, and 2 of the staff are working towards this. The training calendar shows that staff training is regularly updated in the mandatory areas of safe working practice, and in addition, training has been offered in the new Mental Capacity Act, Person Centred Planning, Safeguarding Adults, and Epilepsy Awareness. The training plan Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 20 needs to demonstrate that staff have access to other specialist areas of care training relevant to the needs of the residents, such as autism or learning disability and the manager said that she was looking to develop further areas of training. However, we did note that the manager makes available for staff, written information and guidance on a number of topics relevant to the needs of the residents. We looked at the recruitment records for the most recently employed member of staff and these were satisfactory with evidence of relevant checks and references. This ensures that the welfare and safety of the residents is protected. For new staff, the manager has adapted the nationally agreed ‘core induction standards’ to meet the particular needs of the residents in the home. This ensures that all new staff follow a planned training programme when they start working in the home that includes all necessary safety training and core principles and values of care. The home does not use agency staff and any gaps in the staff rota are filled by the home’s own bank of staff. There are arrangements in place for staff supervision and annual appraisals. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 21 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 and 42 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from an organised and well managed home. The health, safety and welfare of the residents and staff is promoted and protected. EVIDENCE: We looked at what the home have told us in their Annual Quality Assurance Assessment (AQAA), looked at some of the home’s records, and we also received feedback and comments from residents, staff and relatives. We found that the home is well managed and residents have regular opportunities to air their views in the weekly residents meetings, or in private discussion with their key worker, about any issues that arise. The AQAA gave us some information about how the home manages health and safety checks and maintenance although there were some gaps in the information provided. There were also some gaps in the home’s list of Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 22 necessary policies and procedures and the manager will address this. In discussion with the manager, we were able to confirm that relevant health and safety checks are in place and that all staff (except very new staff) has done basic food hygiene training. The home currently has a 4 star food safety/hygiene certificate. As well as the residents’ meetings and care plan reviews, the quality assurance systems for the home include a bi-annual customer satisfaction questionnaire. The quality assurance systems need to be developed and to be a co-ordinated part of the home’s development plan. The manager produces an annual newsletter and this could be used to summarise the action that has been taken in response to feedback and comments about the home. The quality assurance system needs to focus on how well the home is meeting outcomes for the people using the service and make this information available to people who use the service and others who are involved in the service. The AQAA also needs more evidence of what the home does to ensure that equality and diversity issues are promoted and incorporated into what the home does. However, in discussion with the registered manager, it was evident that the approach of the home is based on respecting and meeting the individual needs of the residents. Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 23 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X 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 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Kingston Farmhouse DS0000012503.V350044.R01.S.doc Version 5.2 Page 26 - 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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