Care Home: Kirtling House

What the care home does well An approachable manager who has the support of a national organisation effectively manages the home. The service users said they like living at Kirtling House and they feel safe and comfortable. The service users are encouraged to take part in running their home and to contribute ideas or raise concerns. The service users are encouraged to develop their skills and independence. People can choose how they spend their time but the staff are always seeking ways to motivate and encourage the service users to participate in activities or the local community. The staff are well trained and they know how to support each individual. The recovery (care) plans are person centred; this means they focus on each person`s needs and aspirations and how the staff can support them to achieve their aims. The information in the AQAA shows that the manager is looking at ways they can improve the service for the benefit of the service users. What has improved since the last inspection? This was the first inspection. CARE HOME ADULTS 18-65 Kirtling House 14 Compton Road Winchester SO23 9SL Lead Inspector Kima Sutherland-Dee Unannounced Inspection 30th April 2008 09:20a Kirtling House DS0000071242.V361355.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 Kirtling House DS0000071242.V361355.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. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kirtling House Address 14 Compton Road Winchester SO23 9SL 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) 01962 862580 www.together-uk.org Together Working for Wellbeing Mr Mark Prayag Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0) of places Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies 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: 2. Mental disorder, excluding learning disability or dementia (MD). The maximum number of service users to be accommodated is 8. Date of last inspection New Service. Brief Description of the Service: Kirtling House is a large detached Victorian Home on a residential street, within walking distance of Winchester city centre, public transport is also available locally. The home has been fully refurbished by Knightstone Housing Association who own the property. A national company ‘Together working for wellbeing’ manages the home and provides the staff support. ‘Together working for wellbeing’ also supported most of the service users in their previous home in Winchester and they moved to Kirtling House in November 2007. There are 10 single bedrooms over 3 floors, all have ensuite facilities and some have kitchenettes. A lift provides access to the first floor. Downstairs there are two lounges, a dining room, a kitchen, an office and staff sleep in room. The home is registered to accommodate 8 Service users who have Mental Disorders. The Fees for this service are £844.61 per week. Kirtling House DS0000071242.V361355.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. The inspection included a site visit to the home over a period of four hours and five minutes. During this time we spoke with the manager, 1 member of staff on duty, and five people who live in the home. We also observed the interactions between staff and service users and sampled the assessments, recovery (care) plans, training records, staff files and policies. Other information used to make judgements about the standard of care in the home included their Annual Quality Assurance Assessment (AQAA) completed by the manager. This was received within the timescale requested by the commission. We also received 4 ‘Have Your Say’ surveys completed by the service users. What the service does well: An approachable manager who has the support of a national organisation effectively manages the home. The service users said they like living at Kirtling House and they feel safe and comfortable. The service users are encouraged to take part in running their home and to contribute ideas or raise concerns. The service users are encouraged to develop their skills and independence. People can choose how they spend their time but the staff are always seeking ways to motivate and encourage the service users to participate in activities or the local community. The staff are well trained and they know how to support each individual. The recovery (care) plans are person centred; this means they focus on each person’s needs and aspirations and how the staff can support them to achieve their aims. The information in the AQAA shows that the manager is looking at ways they can improve the service for the benefit of the service users. Kirtling House DS0000071242.V361355.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. Kirtling House DS0000071242.V361355.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 Kirtling House DS0000071242.V361355.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. 1,3,4,5. Every prospective service user has the information they need and the opportunity to get to know the home before they make a decision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA provided by the home said that the manager will liase with Care Managers and family/friends of service user to gauge an accurate impression of the individuals support needs and the homes capacity to meet them. The service users are also given an explanation of the service they provide and the terms and conditions of their tenancy. Prospective Service users are given the opportunity to visit the project and talk with staff and service users on an ongoing basis prior to a trial period. The Project Manager will visit prospective service user in the exisiting home on an ongoing basis to provide information regarding the service. We saw the application forms and the assessments used by the home and these provided detailed information so that the home could be sure they can meet each persons needs. The manager said they still intend to update the information about the home to make it more accessible and ‘user friendly’. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 9 Each service users file had signed copies of their tenecy agreement and their contract with ‘Together working for wellbeing’. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. Quality in this outcome area is good. The service users benefit from being supported to make choices and take risks that increase their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has a Care plan (called ‘recovery plan’). These plans are person centred and clearly demonstrate people’s needs and how these can be met, they also consider peoples religion, diet, and lifestyle choices. Each person also meets with their link worker weekly and monthly to discuss progress and review the plans. The plans also include risk assessments that are aimed at encouraging the service users to develop their skills and independence. Risk assessments were individual and they included the environment, that person’s activity and any issues relating to their behaviour or medical condition. Two of the service Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 11 users said they worked on their plans with their link workers and they knew where they are kept. The plans included each person’s wishes and goals and how they could be supported to achieve them. The service users told us about their participation in the regular meetings and how they are encouraged to make decisions. An example of this is that during the planned move to their new home the service users were supported to draw a plan of how they want their garden to look. The plan is displayed in the dining room and several people told us that they would start this as soon as the weather allowed. The service users explained how they are supported to maintain their home and how they are encouraged to do as much as possible for themselves. They also said that the staff were good at helping them if they were having a ‘bad time or feeling low’. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11.12.13.14.15.16.17 Quality in this outcome area is good. The service users can make real choices about their lives and relationships and they are supported to know their rights and responsibilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person’s recovery plan has detailed information about the support people need to develop their skills. The AQAA says that the staff encourage people to have aspirations and to use different facilities in the community. The service users described their daily routines and they said they always decide how to spend their time. Some people have chosen limited routines and they said they are happy with that, others had been supported to develop foreign language skills or attend other education or leisure activities. The staff continue to ask the service users if they have ideas about activities and the notice board contained these suggestions as well as a leaflet about a muliti cultural show in the local area. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 13 The AQAA states that the staff have developed their skills by working with other agencies to support a service user to understand their relationships. The recovery plan supported this and showed that the staff have given the service users the information and guidance they needed to feel safer and more accepted in the home and in the community. The service users talked about their friendships in the home and the community The AQAA states ‘In Line with Organisational policy we believe that service users should have the same rights and responsibilities as any independent adult living in the community. Staff will confront anyone practising racial, sexual or any form of harassment in an honest and non-punitive manner that allows for learning to take place’. The manager discussed how this had been put into practice with both service users and staff. One recovery plan had a letter to a service user to describe their rights and responsibilities. The plan also had details of how the staff could best support this person and minimise any risks. The service users described how they plan and prepare their meals and have staff support if needed to do this. People prepare their own choice for lunch and then a joint decision is made to plan the super menu. Alternatives are always available and individual needs are met. The AQAA says that after a request from a service user they have BBQ food more often. Most of the service users sit together in the dining room to eat meals but this is flexible according to choice. There is a ROTA so that people share jobs around the home and going to the shops daily for bread. The AQAA states that through appropriate support some service users are now budgeting,cooking and self medicating. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. The service users are supported to maintain their own health and to safely take their medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The recovery plans detail any personal care needs and these mostly involve, verbal prompts and encouragement and the teaching of daily living skills. The staff know the service users well and know how they prefer to be supported. If new staff are working, experienced staff help them and they have relevant information at handover or in the communication book. This book also tells staff about any changes or medical appointments. The AQAA states that the staff support the service users to maintain their physical and emotional wellbeing and they seek consultation with professionals, and encourage the service users to take more responsibility for there own needs. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 15 The plans support this and show that medical appointments are made as appropriate and that the service users do as much as they can for themselves. We saw how medication was stored, administered and recorded and we discussed this process with the manager. This procedure was carried out according to the organisations policies and safe guidelines. Recent changes have been made to make the procedure safer. Each service user signs to say they have had their medication and the staff countersign. The service users are encouraged and supported to take responsibility for administering their own medication. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. The service users are protected from abuse by safe recruitment practices and trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four ‘Have Your Say’ surveys were returned and they all said that people knew how to complain. During the visit the service users said they felt confident to go to either their link worker or the manager if they had any concerns. The complaints procedure has been updated and it is displayed in the hallway. The manager said in the AQAA that they would try to encourage the service users to bring up complaints or informal concerns. The organisation has a clear policy on dealing with complaints and listening to the service users. The staff files show that POVA (Protection of Vulnerable Adults) and CRB (Criminal Records Bureau) checks are always done for new staff. The organisation also has a clear procedure for reporting suspicions of abuse. A new member of staff said they had been told what to do and they were able to describe the correct procedure. Staff are also regularly trained to recognise and respond to allegations of abuse. Service user recovery plans have information about how the staff can support people to prevent self-neglect or self-harm. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 17 Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,30 Quality in this outcome area is good. The service users live in a comfortable well maintained home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service users said they liked their home and felt comfortable. We observed how people moved around their home and used all of the communal rooms and their bedrooms. One survey said that the home was usually clean and fresh the other three said the home was always clean. One of the service users told us that they felt not all of the service users took responsibility for keeping the home clean. However all the other service users said that they did different jobs and the staff helped them if they needed it. One service user offered to show the inspector their room. The room was individual, with personal items and decoration. Each service users can hold their own keys and this matters very much to some of the service users who feel safe and secure. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 19 The manager stated that there is a special cupboard for substances hazardous to health and staff have had training. It was observed that equipment is available in the kitchen and bathroom to prevent the spread of infection. The plans explain how the staff support the service users to keep their rooms and bathrooms to a reasonable standard and free from hazards. The manager said in the AQAA that they hope to make the new home more homely by having more pictures and less formal notices. This is ongoing with involvement from the service users. Kirtling House DS0000071242.V361355.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): 31,32,33,34,35,36 Quality in this outcome area is good. The service users are supported by enough trained and knowledgeable staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of the staff files were seen and they demonstrated the manager used safe recruitment practices. ‘Together working for wellbeing’ provides an ongoing comprehensive training programme, this gives staff an opportunity to develop their knowledge and skills. The manager and the senior support worker also work with staff to assess their competencies. Staff can also access National Vocational Qualifications (N.V.Q) training through the organisation. One staff member has the N.V.Q assessor’s award. The staff files include a record of regular supervision and the staff on duty said they felt well supported by the manager and the other staff. The manager and the staff on duty said that there were enough staff on duty to support the service users. There are two staff sleeping at the home at night and at least two during the day. The manager said that there are staff Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 21 vacancies but permanent staff or regular temporary staff who know the service users are on duty for each shift. The service users commented on how helpful and caring the staff were. They said ‘ the staff are very good, I can always go the manager or my link worker’. And ‘ I like the staff they help me and listen when I need them’. Kirtling House DS0000071242.V361355.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): 37,38,39,41,42 Quality in this outcome area is good. The home is managed effectively and safely, by a manger who is approachable and supportive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is experienced and qualified and the staff and service users said that they were approachable and supportive. The manager has the support of a local care manager and a national organisation. The manager has used the AQAA to identify further improvements that they intend to make for the benefit of the service users and some of these were discussed at the home. Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 23 We observed interaction between the manager and a service user and this demonstrated that the manager knew the person well and communicated appropriately and kindly. The AQAA identified why the service offers value for money and breaks down how the funding from the Primary Care Trust and individual service users is used. Each service user is encouraged to be responsible for their own money. The organisation has policies that are followed to ensure any money held at the home is managed safely. The AQAA states that the service seeks the views of the service users by encouraging people to take part in the running of the home. There are regular meetings and annual questionnaires. The responsible individual visits the home every month and reports are produced after they have spoken to the service users and looked at all aspects of the home. The manager also states that because staff are trained they can encourage the service users to speak out. The organisation has policies relating to health and safety. Files in the home contain certificates and servicing dates for all the equipment and services and these are up to date. This demonstrates that the home is managed safely. The fire records show that tests are carried out and the service users are aware of how to keep safe in the home. Risk assessments have been done that cover all areas of the home. Kirtling House DS0000071242.V361355.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 3 2 X 3 3 4 3 5 3 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 3 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 X X 3 x Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 25 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 Kirtling House DS0000071242.V361355.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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