Care Home: Kynaston Care(80)

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What the care home does well We were pleased that the new manager has worked well with the staff and people in the home to meet all of the requirements made at the previous inspection. Individuals are able to have a say in how the home is run. Needs are identified and plans involve the person in their care. People are able to make a choice about how they spend their day. What has improved since the last inspection? All the requirements that we made at the last inspection have been addressed. These related to care planning, staff training and recruitment. Checks on health and safety at the home have been completed, so we can be sure the environment is safe. What the care home could do better: No requirements have been made. We have recommended that a full employment history is obtained on any new staff members. Key inspection report Care homes for adults (18-65 years) Name: Address: Kynaston Care(80) 80 Kynaston Avenue Thornton Heath Croydon Surrey CR7 7BW two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janet Pitt Date: 2 0 0 4 2 0 1 0 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983   Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: Kynaston Care(80) 80 Kynaston Avenue Thornton Heath Croydon Surrey CR7 7BW 02086654798 02086654798 farisean@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Efilidah Tambudzayi Smith Name of registered manager (if applicable) Mrs Victoria Omonigho Ojemen Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Learning Disability Code LD, maximum number of places: 4 Date of last inspection A bit about the care home 80 Kynaston Avenue is registered to provide support to three young adults with learning disabilities with a variation granted to allow one person over the age of 65years to live there. The home is owned and managed by Mr and Mrs Smith and is run as a small family type service. Located in a quiet residential area in Thornton Heath, there are accessible transport links within easy reach, including buses and trains. There is a ground floor bedroom and two bedrooms on the first floor with a staff sleep in room situated in a loft extension. Communal areas include a lounge, kitchen dining area, bathroom toilet and a good size garden available to the service users. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is two star. This means that people experience good quality outcomes. One inspector undertook this inspection. An unannounced site visit was made that lasted three hours. During the site visit we looked at peoples care plans and were able to speak to some individuals that lived in the home. Staff and people that live in the home completed surveys that we sent them about the home. We have used information from these in this report. We were able to look around the home and speak to staff members. The home sent us their Annual Quality Assurance Assessment which tells us about what they can do for people and how they hope to improve. What the care home does well We were pleased that the new manager has worked well with the staff and people in the home to meet all of the requirements made at the previous inspection. Individuals are able to have a say in how the home is run. Needs are identified and plans involve the person in their care. People are able to make a choice about how they spend their day. What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Janet Pitt National Correspondence (London) Gitygate Gallowgate Newcastle upon Tyne NE1 4WH Tel: 03000 61 61 61 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website http:/www.cqc.org.uk/. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make an informed choice about whether they want to live at Kynaston. Assessments are carried out to make sure an individuals needs can be met. People are involved in this process. Evidence: Information from the AQAA told us: We give prospective service users and their families a chance to Test Drive the home and a chance to come and meet the staff and the other services users. We carry out a thorough needs Assessment before admitting or taking on someone into our service. Should a service user want to move on to another placement we support them with their choice. When we visited the home were looked at individuals care plans. We found that people had been able to visit the home before moving in and had been able to stay for a night. The people that live at Kynaston have been there for many years. No one new has moved in for a while. Individuals that replied to our surveys said that they were able to make a choice about where they lived. They thought that they had been given enough information to help them decide it they wanted to live at Kynaston. At our previous inspection we said that the Statement of Purpose needed to be updated. We found that this had been done and we happy with the new document. Care plans we looked at showed assessments of peoples needs. We saw that there was information form the placing authority and health professionals who knew the individuals, such as the Joint Learning Disability Team. People are involved in their assessments. Evidence: Each person that lives in the home is given a contract that tells them what they can expect from the service. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make choices about their care. They are involved in deciding what will help them maintain skills. Individuals are able to take risks and are supported by staff. Evidence: The AQAA told us: We have Service user plans and care plans which we review six monthly and we also have on external review annually. This involves all the members of the multi disciplinary team, next of kin and service user. and we do risk assessments and encourage and support our service users to undertake those identified risks safely not to avoid it totally.Encourage our service users to take risks that are beneficial to them When we were at the home we looked at care plans. We saw that they were well organised and it was easy to find information. The plans had details of peoples religion, medical history and people who are involved in their care, such as doctors and social workers. Peoples plans are in the process of being reviewed, so that they are written from the persons viewpoint. We noted that there was some good detail on how individuals communicate: [The person finds it] difficult to engage in face to face or one to one conversations [They]speak English, can read and write. [They are] also capable of making choices.and I choose what I want to eat by pointing. Evidence: Some people are able to communicate by using Makaton signs. Staff are given guidance how to support individuals: Allow to open [their] mail and share with [staff] the contents of the letters should [they] wish to. Some people are unable to read or write, so the home have recorded audio versions of their care plans and risk assessments. Staff At Kynaston undertake regular reviews of peoples care plans. They also ask placing authorities to do reviews, at least once a year. Individual are able to make choices and risk assessments are carried out. Risk assessments covered areas, such as medication, health and safety, food cooking/preparation. Personal care skills and domestic tasks, travelling and finance. Examples of information included: No sense of hot/cold dependent for all personal needs.and not able to do any domestic tasks but enjoys participating in passing things to staff. The plan then told staff how to support an individual. Some people have seizures, but do not know why. We saw that these assessments described what would happen and how staff should make sure that risk is minimised. Other evidence of choice that we found was: Bath in the bathroom.and sit at the table nearest to the door leading to the garden. People who answered our surveys said that they were able to make choices about how they spend their day. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that they can make real choices about how they want to live. Staff support individuals to make and maintain relationships. Interests and hobbies are encouraged and independent living skills promoted. Evidence: Individuals that live in the home are able to decide how they want to spend their time. They are able to continue with interests and hobbies and develop new ones, if they chose. Staff aim to support people to maximise their independent living skills. During our visit we saw that holidays were being planned. One person wanted to go abroad and staff had helped them apply for a passport. Others have decided to go to centre parcs and the manager told us that they were getting information to plan the break. People are supported to manage their money if they want to and are able to. For example one plan said: [They] spends [their] money wisely, but needs support to buy [their] clothes. Peoples cultural and faith needs are addressed, one person has chosen not to [practice their religion and this is respected. Some people go to day centres or educational classes of their choice. Other interests that people were able to do included walking, shopping, visiting places eg pubs. One person liked to have a pint of Guinness and we saw that they had one on the day of the site visit Evidence: with their evening meal Information from the care plans told us that individuals are able to keep contact with their families and friends. One person wishes to have a friend of the opposite sex.The manager said that staff are supporting them in finding such a friend. People are encouraged to assist with meal preparation and menu planning. We found examples of this in their care plans: Make tea, coffee or sandwich with support and prompting.and likes setting the table for dinner, doing the dishwasher. Go shopping with RM- he likes shopping. I am unable to cook on my own without support. I can chop fruit and vegetables and can set the tables. Staff need to continue to help me make choices and record what I have eaten. evidenced in records. there is a weekly menu planned by myself and my housemates. People are able to chose whether they go shopping for food with staff, as follows:Goes shopping on Wednesdays for personal toiletries. Doesnt like food shopping so doesnt do it. Each person is supported with household tasks and has responsibility for keeping their room clean and tidy. We saw that the weekly menu had been planned by people that live in the home. The manager reported that alternatives were available if asked for. The home told us in their AQAA that: We encourage and support our service users to form and maintain relationships within the community and their families. Service users are encouraged and supported in their daily activities. [We plan] to continue to encourage and involve our service users in the menu planning and their daily routines. To continue to encourage our service users to eat healthily. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people that live in Kynaston can be confident that their health and personal care needs will be met. Medications are adminstered and handled well. Evidence: In the AQQA we were told: Our Support Plans identify what sort of support is needed with regards to personal hygiene for each individual service user. Only staff with medication handling training administers service users medication. We maximise service users privacy, dignity and independence when giving personal care. We were able to confirm that this happened when we were on our site visit. The care plans we looked at covered areas such as eating and drinking, mobility and sleeping. There was good information on how to handle individuals behaviour to minimise risk. For example: [The person is]autistic and has a History of obsessive behaviour and depression. Depression has been exacerbated [due to]change in routine. Staff to support with all [their] health appointments.and make sure change is kept to a minimum. People we met on the day of the site visit were clean, tidy and smartly dressed. Peoples care plans on personal hygiene indicated how staff supported individuals to maintain their personal appearance. For example: smart at all times Totally dependent on carers to shower and shave. Carers to prompt to change [their] clothes daily and to assist [them] to choose clothes that go with the weather. We found evidence of other health professionals being involved in peoples care. There were records of appointments with opticians, dentists and general practitioners. Individuals wishes ion death and dying had been sensitively recorded: wishes [their relative] to be there when [they] die[s] and also said [they] wants to be at [their Evidence: relatives]funeral. Now wants to be buried. Would like [staff] and a [named service user]to be present. We looked at how medication is handled and administered in the home. Medication records had been completed accurately and staff had been assessed as competence to administer them. We saw that information on different medication was kept with the persons medication record. This means that staff are able to find out what the drug is for and any side effects. The pharmacist from Croydon Primary Care Trust has recently visited. Their report did not raised any areas of concern. Each person had a monthly report done by there keyworker. This covered areas such as health appointments attended, activities and personal goals. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are protected from harm by the safeguarding policies and procedures. Individuals are able to talk about any concerns they may have and can be confident that staff will listened and act on what they say. Evidence: The home considers that; We have a clear and effective complaints and compliments policy and procedure, service users and their families and staff are all aware of this and have copies of our policy. Where concerns have been raised we have immediately acted upon them to address them. We immediately set about getting help on board to remedy any reoccurring concerns and complaints through additional training and making necessary changes to operating procedures. When we visited Kynaston the manager told us that they have not received any complaints or concerns. CQC have not received any concerns. We saw in the minutes of Residents Meetings, that are held regularly, that people are asked if they have any concerns. Each person has an incident log, where any accidents or incidents are recorded. We noted that there were actions in place if needed to prevent recurrence. We looked at the homes Safeguarding Vulnerable Adults policy. the policy has been updated as required at the previous inspection. The policy linked with the local authoritys guidance and gave clear instructions on what staff must do if they suspected any form of abuse. Staff who replied to our surveys stated that they had attended training in Safeguarding. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is comfortable and domestic in style. They can be confident that the house will be kept clean and tidy. Evidence: The AQAA tells us: We keep and maintain the homely feeling all around the home. Individual service user rooms are personalised to their taste and style. The home is airy, cheerful and free from inoffensive odours. The home is accessible by public transport and local amenities. Our laundry facilities are well away from where food is stored and prepared. We were able to look around the premises during our visit. We saw that people could use a large kitchen/dining area. There was space for staff to support individuals in meal and drink preparation. The house was clean and tidy. There were no inoffensive odours. People are able to access a small garden where they can sit in the fresh air. Washing was on the line and the home had a relaxed, comfortable atmosphere. People who responded to our surveys said that the home was clean and tidy and they were able to bring in their own personal possessions. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that there is safe recruitment in place. Appropriate checks are carried out prior to a person starting employment. Staff are given the training they need to support individuals. Care is needed by the management to make sure that training is put into practice. Evidence: We examined staff files and found that there is a good, safe recruitment process in place. Files had an application form, details of a persons employment history and two references. All required checks, such as , criminal records, had been carried out.There were copies of job descriptions in the persons file. it is recommended for the future that an individuals full employment history is obtained. At the previous inspection there was a requirement relating to training. Staff files evidenced that training is provided by external providers and e-learning. Staff received induction training when they started work and had a training plan. the AQAA told us: We get our staff to receive all the mandatory training and the right qualifications inline with their job descriptions. Each member of staff have an annual Development Plan for staff developments. All our members of staff are having their supervision regularly as required. We were able to evidence this when we looked at the staff files. Training given included infection control, 1st aid, medication handling and safeguarding. Some staff survey respondents felt that they could be given more opportunities to put training into action. This was particularly relevant to Person Centred Planning. it is recommended that this is discussed with staff at their regular meetings. We observed that there were adequate numbers of staff on duty to support the people Evidence: that live in the home. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a proactive manager who makes sure they are included in the running of the home. Quality Assurance systems make sure that peoples views are heard and acted upon. The environment is safe and well maintained. Evidence: The AQAA stated: The home is run and managed by a competent and qualified registered person and an Acting Manager. All our policies and procedures have been updated. We spoke with the acting manager, they said that they has been interviewed by CQC to be registered with us and is currently awaiting a new certificate to confirm that they are registered. We were able to look at the services annual Quality Assurance programme. The programme runs form January to December. Feedback received from relatives or representatives did not raise any concerns. As previously stated regular meetings are held with people. Topics talked about include concerns, menus and holidays. We saw that all Kynastons policies and procedures had been reviewed and up dated as required at the previous inspection. References to professional organisations and guidance had been included in the policies. We noted that there is now an emergency plan in place. This gives staff instructions on what to do if people have to be evacuated to live somewhere else. This could be due to fire or flooding. Evidence: We did not identify any health or safety issues during our site visit. The homes business plans shows how the service wants to continue to improve and how the service hopes to achieve this. Information from surveys and meetings is included in the plan. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 34 35 It is recommended that a full employment history is obtained for new people applying to work in the home. It is recommended that staff are supported to put all of their training into practice. Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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