Care Home: Kingston Residential Care Home

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What the care home does well The home has ample communal space and ambulatory people are able to use all areas freely. Staff were observed treating people with dignity and care and taking time to communicate with people in a manner they preferred. The deputy manager has produced a very simple guide for staff detailing why medication is given for individuals to assist their understanding of service users needs. A document has also been produced for staff to record significant changes in behaviour or choices if a service user is unable to communicate. Any changes can then be reviewed over a day or so to determine possible causes of distress. What has improved since the last inspection? Three of the four requirements made have been met and the fourth is currently being reviewed. The registration certificate has been amended and is on display. Staff training is ongoing and has improved with the introduction of courses that meet specific and changing needs of the people living there. The service users kitchen has had the heating regulated by opening a window in the room. The medication administration files all now have pictures and the service users contract has been partially met with further information to be added regarding services provided. What the care home could do better: There are some areas in need of repair and redecoration. Plans have been submitted to the head office of the company with a view to dividing the home into two smaller units. If this occurs much of the repair and redecoration would be included in the changes. Repair must be undertaken despite future plans. A corridor wall has a hole in it behind a door; the centre strip of carpet in the lounge is very worn. There is a broken radiator cover in the lounge. The serving hatch in the kitchen is broken and has been boarded up. Some waste bins around the home including the kitchen, did not have lids. Several of the people in the home use wheelchairs but the home only has a saloon car. It would benefit people if a larger and wheelchair friendly vehicle were available. Wheelchair users cannot access all areas of the garden. There are four staff on at the weekend and no chef or domestic help. This means staff have cooking and cleaning to undertake that encroaches into their care and support duties. A recommendation is made for the home to consider reviewing the rota to allow full staff hours to be used for support work. CARE HOME ADULTS 18-65 Kingston Residential Care Home 27-31 Westbrook Road Margate Kent CT9 5AU Lead Inspector Wendy Gabriel Key Unannounced Inspection 29th May 2008 09:30 Kingston Residential Care Home DS0000023485.V363698.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 Residential Care Home DS0000023485.V363698.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 Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingston Residential Care Home Address 27-31 Westbrook Road Margate Kent CT9 5AU 01843 292412 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) kingston.house@craegmoor.co.uk Craegmore.co.uk Parkcare Homes Ltd Mrs Joanne Jeavons Care Home 17 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disabilities (LD) Physical Disabilities (PD) The maximum number of service users to be accommodated is 17 (seventeen) 1st June 2007 2. Date of last inspection Brief Description of the Service: Kingston provides residential accommodation and care for adults with differing degrees of learning disability. The service users may have an additional physical disability. The Home, owned by a large Company, is a Victorian terraced property on three floors. All bedrooms are single occupancy. The home is situated in a residential area of the seaside town of Margate and is within walking distance of all local amenities, including the seafront and local shops. There is on road parking to the front of the property. The Home provides 24-hour staff cover, including staff on wake-duty at night. The fee levels are set according to the needs of the individual and dependent on the staffing hours required to provide this support. Fees are in the range of £799.71 to £1,443.31 per week. Please contact the provider for up to date information. Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We used the following to inform the outcomes of this report. An accompanied tour of most of the premises was undertaken, some records and documents were viewed and observations were made of interaction between staff and people living in the home. Information from the previous report together with information the service notified us of and compliance with the Requirements made from the previous inspection. An annual quality assurance assessment (AQAA) had not been requested at this time. A brief telephone conversation was held with the area manager during the inspection, who gave up to date information regarding different issues affecting the service. The deputy manager, three support workers, team leader, chef, maintenance man, and a domestic were on duty. A second domestic worker came on duty later that morning. There was also a support worker who worked solely on a one to one basis for one person who lives at the home. There are currently 12 people living in the home. Most service users have limited communication therefore no discussions took place with the people who live in the home however, staff introduced service users to the Inspector. A police investigation is underway and the registered providers are employing the appropriate policies and procedures. What the service does well: The home has ample communal space and ambulatory people are able to use all areas freely. Staff were observed treating people with dignity and care and taking time to communicate with people in a manner they preferred. The deputy manager has produced a very simple guide for staff detailing why medication is given for individuals to assist their understanding of service users needs. A document has also been produced for staff to record significant changes in behaviour or choices if a service user is unable to communicate. Any changes can then be reviewed over a day or so to determine possible causes of distress. Kingston Residential Care Home DS0000023485.V363698.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. Kingston Residential Care Home DS0000023485.V363698.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 Residential Care Home DS0000023485.V363698.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Pre admission assessments meet the needs of the prospective service users. EVIDENCE: The deputy manager was in charge at the time of the inspection and discussed with clarity the routine for a new admission. Following a referral, the home manager will visit a prospective service user, and visits by the family/advocate and the prospective service user to the home will be undertaken. The deputy manager said that they had recently had a new service user admitted. Because of pre-assessment findings for the individual, the home has recruited a member of staff to undertake one to one specifically in accordance with assessed needs. The family was also closely involved and did some decorating and brought in the possessions of the service user. The care plan and daily record of this service user were viewed and this confirmed the verbal evidence. A requirement from the last inspection to include details of what services are provided in the service user contract has partially been met. Some details Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 9 have been written and need to be added to the contract. The deputy manager said she would organise this. Kingston Residential Care Home DS0000023485.V363698.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans are reviewed and contain assessed needs. Service users are enabled where possible, to make decisions about their daily lives supporting independence and appropriate care. EVIDENCE: Care plans are detailed and are regularly reviewed. Key workers have meetings and then individually will inform the service users about contents of the plans when required and where possible. Three care plans were looked at and these included risk assessments and details about personal care, finances, clear details about medication, service users guide and complaints procedure that is in a simple picture format. There was evidence of regular reviews. There was good evidence of the use of health care professionals and of health care appointments. Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 11 The deputy manager has devised a very clear recording chart as an aid for staff to determine the possible causes of any service users distress or unusual actions. This is good, proactive practice. There was evidence that advice of health care professionals and the local learning disability team is regularly sought. Kingston Residential Care Home DS0000023485.V363698.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Choices are encouraged. Leisure activities take place in and out of the home but equality for some wheelchair users is not supported. Appropriate friendships with friends and family are respected. Meals are healthy and varied. EVIDENCE: Staff support outings and activities and service users have the opportunity for choice. During the inspection, different staff approached the deputy manager for money for them to support individual service users to go shopping in the town. The home has a saloon car but as there are several people in wheelchairs this is not useful for taking those service users out. This does not support equality Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 13 for those service users whose outings are therefore limited because they require the use of wheelchairs. A company audit has recently been undertaken for service users finances. Service users money is held in individual wallets and all records and the money is held in the safe in a secure environment. A sample checked corresponded with records kept. During the inspection several phone calls were received from families making general enquires. The deputy manager spoke to the callers and there was a friendly, unhurried and informative conversation held each time. The broken serving hatch in the kitchen has been boarded up and has a broken frame. This looks unsightly. An open top bin is being used in the kitchen. The dishwasher is very small for a home of this size and appears to be just for washing glasses due to the insert to hold the items to be washed. It is the providers’ responsibility to maintain hygiene and infection control within the home and therefore these issues should be addressed. The kitchen was otherwise tidy and well organised. The chef clearly records meals taken and fridge and freezer temperatures. Some of the staff including the deputy manager were completing a course on ‘healthy eating’. This includes understanding nutrition. Meals are varied and alternate meals were seen being provided at lunchtime. There is no domestic cleaner or chef on duty at the weekends. The four support staff on duty have to undertake cooking and cleaning as well as care and support work. A recommendation is made that the staff rota be reviewed which would enable this extra work by the support workers at the weekends to minimise detriment to the residents. The home has pictures on the walls that the service users have done and that had previously been displayed in the local library. The home has a pet cat (who is identified among the staff photos on display in the hallway) a rabbit and guinea pig and there is a fish tank. The living room is large and goes into two separate areas. There is also a small, disused room that the deputy manager wants to change to a sensory area. The garden is completely concreted over and looks uninviting despite staff efforts to brighten the area by painting it. The deputy manager said that a step down area is to be raised to make it all one level and be safer for wheelchair users who can access the area via a ramp from the lounge. This layout currently limits their access and enjoyment of the garden. She added that she and the staff have plans to make this area more interesting for service users to look out on and to use. Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 14 Kingston Residential Care Home DS0000023485.V363698.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The medication administration system is robust and service users are protected by medication policies and procedures. Personal support and emotional needs are identified and met. EVIDENCE: The home has a dedicated medication administration room. This is clean, well organised and secure and there are hand-washing facilities. There are appropriate policies in place and only trained staff may administer medication. Records identify healthcare appointments made and staff carry a document to record advice given during appointments. The deputy manager has usefully recorded why service users have their individual medication. Temperatures of the fridge and the storage are maintained. Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 16 Emotional needs are recorded, and in one instance a support worker is employed to work solely with a service user on a one to one basis to meet identified needs. Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Policies and procedures can protect the service users from abuse, neglect and self-harm. EVIDENCE: The home has a simple complaints procedure and all service users have a copy in picture format in their care plans. Because communication is limited with some people, the service has key workers whose role is to inform and promote the choices of individuals if they cannot do so for themselves. The deputy manager said that some families work closely with the home to support service users. There is a whistle blowing procedure for staff. Staff undertake a PoVA (Protection of Vulnerable Adults) course and NVQ and induction training underpins their understanding of adult protection. A police investigation is underway and the home and the owning company are employing suitable adult protection procedures with regard to the matter. The deputy manager is aware of adult protection policy and procedures. Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users benefit from a large and clean home although some areas need upgrading and repair. EVIDENCE: The kitchen serving hatch is boarded up and the frame very worn; a circular window on a landing has a cracked frame, a strip of carpet in the lounge is very worn and could cause tripping, there is a hole in the wall behind a door in the corridor outside of bedroom 3, a radiator cover in the lounge is substantially broken. The deputy manager stated that she has arranged for a replacement cover for the radiator. The area manager stated that plans for altering the layout of the home into two units have been forwarded to the owning company for approval and should they be accepted the redecoration and refurbishment would be Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 19 undertaken as part of the changes. Whilst a decision is being made by the company the issues identified pose a health and safety risk to the residents and staff. Repair and replacement must be undertaken in the meantime. Service users bedrooms are individual and comfortable. Keys to bedrooms are available if the service users have been assessed as able to use them appropriately. Bathrooms are bright and clean and a new toilet has been put in since the last inspection. The laundry was well organised but the floor is a possible source of cross infection as it is worn behind the machines and does not cover the whole laundry area. The deputy manager said that they had considered different ways of achieving this. A requirement is made for the floor to be made hygienic and for there to be a written assessment of the area. Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff recruitment practice and policies protect service users. Staff undertake appropriate training and are qualified to work in the home. EVIDENCE: Staff on duty at this time included the deputy manager, team leader and three support workers. A support worker whose role was solely to provide one to one support for one service user was also working in the home. The chef, domestic and maintenance man were also on duty. There are two wake staff on duty at night. The home was currently recruiting a new senior member of staff. Recruitment is robust and the company supports the procedure with interviewing, obtaining documents including references and CRB (criminal records bureau) checks and after employment, with an induction process. All but four of the staff has their national vocational qualification (NVQ) and five staff has NVQ3. The deputy manager has NVQ4. Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 21 Since the last inspection where a requirement was made for staff to be appropriately trained to support the changing needs especially sensory loss, the home has provided further training. These include, autism, epilepsy behaviour management and Maketon. The deputy manager was planning to speak to a care manager and the learning disability team about further information for specific training regarding a service users’ sensory loss. Two staff files were viewed and these contained suitable information and were in good order. Observations made during the day indicated that service users were comfortable with the staff and although communication for some people was limited, staff took the time to reassure and guide them. Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users are protected by the homes policies and procedures and welltrained staff promotes their wellbeing and safety. EVIDENCE: The deputy manager was in charge of the home at the time of the inspection and showed a very good awareness of the ethos of the home and of maintaining the well being of the service users. Management support has been given to the deputy manager through the company organisation. Service users were observed to be comfortable and relaxed with the staff during the inspection. The home currently has service users who have a wide range of needs and Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 23 the company is being pro-active in its planning for the future of the home of dividing the home into two units to offer choices that meet different needs. Although the home undertakes basic redecoration and staff keep the home as clean and tidy as they can, there is room for improvement by replacement and repair. It is the providers’ responsibility to manage infection control and health and safety within the service. The company undertakes regular audits and these include, among others, health and safety, clinical governance, fire reports, and quality improvement plan. The insurance and registration documents were seen to be in order and in date. Finances are reviewed and have recently undergone a thorough audit. Staff are trained in core skills and the support of health care professionals is used to protect the health and welbeing of the service users. Life skills are developed and routines are dictated by the assessed needs and wishes of the service users. Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 24 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 X 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 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 X 36 X 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 2 13 3 14 2 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 2 X Kingston Residential Care Home DS0000023485.V363698.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 13 (3) Requirement The laundry & linen room must be made fit for purpose. Timescale for action 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA42 YA33 Good Practice Recommendations Repairs to the home as identified in the summary are to be undertaken. The rota is to be reviewed to provide support to weekend staff in cooking and cleaning duties. 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