Inspection on 16/02/09 for Kineton Manor

This is the latest available inspection report for this service, carried out on 16th February 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kineton Manor 18/02/08

Kineton Manor 01/02/07

Kineton Manor 13/03/06

Kineton Manor 09/08/05

Kineton Manor 15/12/04

Kineton Manor 11/05/04

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Bank House

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kineton Manor Manor Lane Kineton Warwickshire CV35 0JT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Deborah Shelton     Date: 1 6 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Kineton Manor Manor Lane Kineton Warwickshire CV35 0JT 01926641739 01926642220 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Ken Inglefield,Mr Edward Graham O`Rourke care home 43 Number of places (if applicable): Under 65 Over 65 43 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 3 1 1 0 2 0 0 8 Kineton Manor is a large converted manor house situated in the village of Kineton and is close to the village amenities. It is set in its own extensive grounds with an outlook onto open fields. The home is surrounded by well kept gardens and a large lawned area. The home is registered to provide personal and nursing care for 43 elderly service users. Ample car parking is available to the rear of the home. The service user accommodation is provided on two floors with 31 single ensuite rooms and 6 ensuite shared rooms. There are two lounges and one dining area. A lift is available to access all floors. The current proprietors Mr Inglefield and Mr ORourke have owned the home since 1988. The scale of fees is not included in the service users guide. Fees are discussed at the point of referral and include hairdressing and chiropody. Care Homes for Older People Page 4 of 36 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. The visit took place on Monday 16 February 2009 between 9.45am and 6.45pm. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Care Homes for Older People Page 5 of 36 Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An Annual Quality Assurance Assessment (AQAA) was completed by the manager and returned to us within the timescale required. This document gives information on how the Home thinks it is preforming, changes made during the last twelve months, how it can improve and statistical information about staffing and residents. During this Key inspection we used a range of methods to gather evidence about how well the service meets the needs of people who use it. Time was spent sitting with residents in the lounge watching to see how residents were cared for and how they spent their day. Discussions were held with residents, staff and visitors to the Home. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Four people living in the home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service, this helps us to see whether the service meets individual needs What the care home does well: What has improved since the last inspection? Care planning systems in place ensure that detailed information obtained about individual care needs are recorded. Care Homes for Older People Page 7 of 36 The number of people living at the Home is in accordance with their conditions of registration. All communal facilities such as the library and hairdressing room are again available for use for their intended purpose by residents. All people living at the Home have a plan of care and risk assessment documentation to meet their identified needs. All people living at the Home have been issued with a contract of residency which sets out terms and conditions of residency, fees and additional expenses. Protection of Vulnerable adult checks are undertaken on all new staff before they work any shifts at the Home. Various areas of the Home have been re-decorated and new carpet laid. The dining room and a number of bedrooms have recently been redecorated and were fresh and clean. New tumble dryers have been purchased and a new fridge for the dedicated storage of medication. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Older People Page 8 of 36 240 7535. Care Homes for Older People Page 9 of 36 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home benefit from having their care needs assessed before admission so that they can be sure the home can meet their needs. Residents and their families are provided with information and visit the service prior to admission to enable them to make an informed choice. Evidence: Three residents were case tracked during this inspection. This involved looking at their care files, talking to them and their family where possible and talking to the staff that care for them. Their living accommodation and the facilities available to them were also looked at. Information available to identify whether appropriate pre-admission processes take place were reviewed. Since the last key inspection an anonymous concern was raised regarding the number of residents accommodated at the Home. A series of random Care Homes for Older People Page 11 of 36 Evidence: inspections were completed to investigate issues raised. During these inspections it was noted that people staying for a short period of respite care did not have care plans or risk assessments in place. Contracts stating Terms and Conditions of admission had not been issued. Letters to the individual and/or their representative informing them that the service would be able to meet their needs, the conditions under which admission would be accepted, the room to be occupied and the fees and other expenses were not available for review. The manager was aware of the previous omissions regarding the respite residents and confirmed that systems are now in place for appropriate pre-admission practices for all potential residents including those staying for a short period of respite care. This was demonstrated in documentation seen, discussions with the manager, three residents and a visitor to the Home. At this inspection pre-admission processes were considered to be acceptable. Sufficient information is obtained about people before the Home confirm in writing that they are able to meet their needs. People who are considering moving in have copies of the Service Users Guide and are told where to get copies of the most recent inspection report. The manager also confirmed that the Service Users Guide is available in large print and could be made available in various languages if needed, although this has not been required to date. The Service Users Guide is being transferred onto compact disk to help those with visual difficulties. A brochure giving other details about the Home is also made available to everyone, and is given out during the pre-admission process. The manager said that all people that live at the Home have been given a contract of residency. The contract was available for the resident most recently admitted. This had been signed and dated and contained all relevant information as required i.e. fees, terms and conditions of residency, extras to be paid for over and above the fees. Relatives and potential residents are encouraged to visit, have a look around and stay for the day before they decide that they would like to move in. This ensures that people have enough information to make an informed choice about whether they would like to live at Kineton Manor or not. One person spoken to during the inspection confirmed I have settled well, I have all of my needs met in a way in which I prefer. A visitor to the Home said I have the Service Users Guide and contract of residency and had all of the information I needed before X moved in. Eight responses were received to our survey. When questioned - Did you receive Care Homes for Older People Page 12 of 36 Evidence: enough information about this home before you moved in so you could decide if it was the right place for you, four people responded that they did not and four responded that they did receive enough information and further commented that they had a brochure or had looked around the Home. Care Homes for Older People Page 13 of 36 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. People living in the home are treated respectfully and are protected from harm by the safe management of medicines. Each person has a plan of care and access to health care services so that their health and personal care needs are met. Evidence: Four care files were reviewed at this inspection. The records of a resident recently deceased and those of three people who live at the Home. Each person had a care plan, daily assessment records and risk assessments. Care plans were based on information secured during the initial care needs assessment and give staff directions about what they need to do to meet the persons needs. The supportive care pathway paperwork is now used to record all care plan information. This documentation has been developed by a multidisciplinary team of professionals in Birmingham for residents with progressive life limiting illness, where the focus of care is on comfort and quality of life. Care Homes for Older People Page 14 of 36 Evidence: Some of the paperwork in care files had not been reviewed on a monthly basis and some not fully completed. For example, one form to be completed within twenty-four hours of admission was not fully completed in any of the files seen, information regarding when to contact relative had not been recorded, details regarding laundry were also not completed. Health and safety risk assessments are undertaken and review information such as history of falling. Information regarding issues that affect risk of falling i.e. medication, blood pressure is recorded. All of the assessments seen had been reviewed on a monthly basis up until the end of December 2008 but only one had also been reviewed in January 2009. All care files contained tissue viability (the risk of developing a pressure area), nutritional, falls, hot water temperature, the risk of injury from the use of bed rails and moving and handling risk assessments and management plans in place. Not all of these had been reviewed on a monthly basis. One pressure area risk assessment had not been reviewed since November 2008 and identified the person as very high risk. Detailed care plans were in place in all four files. These include details of individual needs identified and the action that staff are to take to meet these needs (the support required to provide care and minimise risks). Not all care plans had been reviewed on a monthly basis. Details of the equipment and staff support needed to meet identified needs are recorded. Care plans contain sufficient information to enable staff to meet care needs. Staff spoken to were aware of the needs of the people under their care and the equipment needed to help provide the care. Records show that the people that live at the Home have access to GP, dentist, optician and that specialist equipment is provided. There was no documentary evidence to demonstrate that one resident had been seen by the Chiropodist since 7 Nov 08 or the dentist since October 2007. The manager confirmed that this person had seen these professionals but paperwork had been misplaced. The responses to our satisfaction survey regarding medical support are detailed below:- Do you receive the medical support you need? 2 always 3 usually 2 sometimes 1 never I see the doctor, dentist and optician, I am going to the dentist today, my GP was most helpful as well as my son Care plan summary sheets were completed in all files, these record amongst other things the preferred time for going to bed and getting up and details of any preferences regarding the gender of staff to provide personal care. This document records brief information regarding individual needs, abilities and the type and level of Care Homes for Older People Page 15 of 36 Evidence: assistance required with the number of staff needed to provide the assistance. This can be used as a quick reference guide for staff. Documentary evidence was available to demonstrate that the plan of care had been explained and discussed with the resident and family/carer. This demonstrates that residents have the opportunity to discuss their preferences for the way in which their care is provided. All people have had a mental capacity act assessment, which is used to identify whether or not the person has the mental capacity to make decisions at that time. These were completed and signed by the named nurse. Documentation had been signed regarding individuals wishes regarding resuscitation in case of emergency. These had been completed by family members, staff and GP. One of the documents had been completed by staff as not for Cardio Pulmonary Resuscitation (CPR), however the paperwork regarding this had not been completed by the resident/family. The form in another file states for CPR and yet the do not attempt resuscitation form had been signed by the family member requesting do not attempt resuscitation. The manager must ensure that the wishes of the person and their family are correctly recorded in the care file to ensure that there is no confusion for staff regarding the action they are to take in case of the need for resuscitation. Staff complete daily assessment sheets twice per day morning and night. This standard document requires staff to record whether a care plan need has been A = achieved or V = variance. If V is recorded staff record additional details of the issue i.e. XX needs to wear continence pads as doesnt seem as much control of her bladder as before. XX appetite was poor today. Blood pressure, pulse, urine, weight is recorded on a monthly basis, however information in one file seen had not been updated since December 2008. Key workers complete a monthly report sheet which details information about the persons health and wellbeing during the previous month. The date of the last key worker reports available in files seen was December 2008. Any changes in the health and general wellbeing of residents should be identified and recorded and paperwork should be kept up to date. People spoken to during the inspection confirmed that they receive the care and support that they need I have poison in my leg which was left, only since I have lived here have they started to get to grips with it, I have the care I need in the way that I prefer, I am healthy, I see the GP on his rounds but I am well Care Homes for Older People Page 16 of 36 Evidence: Medication storage, administration and records were reviewed for the three people living at the Home being case tracked. During conversations with the manager it was noted that none of the people at Kineton Manor self administer their medication. However, there is an assessment completed for anyone wishing to administer their medication. A list of staff signatures was available. This is a list of all of the staff who administer medication, their signature is available on Medication Administration Record charts. The list assists with the audit process so that it can easily be identified who has administered medication and completed paperwork. Only registered nurses administer the medication at this Home. Medication records seen were up to date, completed correctly and a code is used to record the reason for any non administration of medication. Controlled medications are stored appropriately in a controlled drugs cabinet, a specific Controlled Drugs book is used to accurately record stock and administration. Controlled drugs were checked and found to be correct. Medication available balanced with records held for the people being case tracked. Records were easy to read and up to date. A new medication fridge has been purchased, this is locked. Appropriate key custody practices are in place. The manager completes a weekly medication audit. The GP completes a GP round every fourteen days and reviews each resident including their medication. The manager confirmed that they try to manage residents conditions without medication as far as possible. Observations during the key inspection visit found that people living in the home looked well cared for and were clean, their hair had been combed and nails were trimmed and clean. They were well presented and wore clothes that were suited to the time of year. Garments were clean and well maintained. Care Homes for Older People Page 17 of 36 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. There are opportunities for some people to maintain their interests to enhance their quality of life. Residents are helped to make choices and have control over their lives. Open visiting arrangements encourage regular contact with relatives and friends. Residents benefit from a varied, tasty and nutritious choice of food. Evidence: A review of daily activities that take place was undertaken. Staff, residents and visitors to the Home were spoken to and records were reviewed to see what recreational activities are on offer on a daily basis. A discussion was also held with the manager regarding the anonymous complaint received in 2008. The complaint raised issues which impact on the social/communal space available for those that live at the Home. These concerns were investigated during random inspection visits and were substantiated. At that time hairdressing equipment was seen in the smaller lounge and we were told that the hairdressing is carried out there. The library was not readily accessible to those who live in the home. The use of the library and the hairdressing room for purposes other than for that which they were intended reduces the amount of communal space available. Observations during this inspection, discussions with the manager and staff show that hairdressing is now being carried out in the hairdressing Care Homes for Older People Page 18 of 36 Evidence: room and the library is again available for use as a library. Throughout the inspection residents were at ease in their surroundings, two communal lounges are available and a conservatory, residents were free to wander into any communal area as they wished. Pictures are on display in hallways to show activities that have taken place. External entertainers provide activities three times per week, pat a dog visits each Monday, Tuesday and Thursday. An external entertainer visits and does exercises to music and arts and crafts, this person also brings his dog into the Home which people confirmed they enjoy. The manager confirmed that the arts and craft activities are very popular. Group activities take place on other days. Records are kept to demonstrate what activities have taken place. A list is kept of the residents who attended the activity. A satisfaction survey regarding activities is undertaken twice a year. Social work or nursing students undertake these surveys on behalf of the Home. The results are recorded in the Homes newsletter which is sent out four times per year. Both positive and negative comments are recorded along with the action taken to address any issues identified. The newsletter, which is given to all residents and relatives, also has pictures of day trips undertaken. We sent out a satisfaction survey before this inspection and eight people responded to the question about activities as below:Are there activities arranged by the Home that you can take part in 5 always 1 usually 1 sometimes 1 dont know People commented, not interested I would like to do personal shopping more often, I enjoy exercise class, I think people enjoy doing the exercises, I would like to paint and draw more often. The chap that does the exercise is very pleasant During the inspection two people commented about activities saying I am quite lazy and a bit shy, I dont really want to do activities, I like to chat to the ladies, I prefer to stay in my room. I would like to do tapestry if they could organise that for me. An activity log is kept in individual care files. The activity log in one file did not have the date that the person joined in activities. Staff have recorded a statement X enjoyed Christmas party with her family and other residents X won a prize in the raffle. Also enjoyed Christmas day, father Christmas visited. The second file seen did not have the date that activities were undertaken. This does not demonstrate that these people have been offered or joined in regular social/recreational activities. In Care Homes for Older People Page 19 of 36 Evidence: another file the activity log for December had been completed to show that the person had joined in activities on 2, 9, 16, 23 and 30 December. Social assessments were in place in each file. This document is used to find out preferences regarding social activities and finds out whether residents like to mix with others or spend time in a quiet environment. Hobbies and interests are recorded as well as preferences regarding reading material i.e. paper or books, music, hobbies and special interests. Not all of the information had been completed on one form. Information regarding the dates of special memories and the type of music they like was also blank. The other two assessments contained detailed information i.e. likes to watch rugby, drink a glass of sherry, listen to classical music. Choice, independence and individual preferences were discussed with the manager, staff and residents. Care plans record detailed information regarding personal care, for example preference regarding bath or shower and level of assistance needed, details of preference of days and times for bath, details of any religious needs regarding bathing. People that live at the Home are asked if they would prefer personal care to be undertaken by a male or female member of staff. Their wishes are recorded in their care file and residents spoken to were aware that they had a choice and were happy about this. People commented that they have a choice about everything I get up and go to bed when I want, I am happy here, I like to get my hair done and wear make up. Spiritual/religious needs are recorded in each care plan. Preferences regarding times for rising and retiring, type of nightwear are also recorded in care files. People are asked if they have any preferences where they wish to eat their meals i.e. bedroom, dining room. These are recorded for breakfast, lunch and dinner. Every morning and afternoon staff ask all residents what they want for their lunch and evening meal. Tick lists are kept which demonstrate what residents have requested. A choice of two meals is available every day, the manager confirmed that if they didnt like either choice they would be able to have an alternative. The dining room was seen, dining tables were nicely laid out with table cloths, serviettes, fresh flowers and salt and pepper. Freshly cut bread and butter was on each table to accompany the main lunchtime meal. Residents are able to have a glass of wine with their meal if they wish The monthly menu was on display in the kitchen, this is reviewed on an annual basis by a dietitian who also undertakes nutrition training with staff. Care Homes for Older People Page 20 of 36 Evidence: Home made cakes had been prepared for afternoon tea. A variety of fresh fruit and vegetables were available in store rooms. There was a list of cold drink preferences and also a list of those residents who have a special diet, likes/dislikes and allergies, those who have a soft diet and food supplements were also recorded. This helps to ensure that catering staff provide meals suited to individual wants and needs. During the inspection people spoke positively about the meals provided and commented I particularly like the cooked breakfast, the food is good The results from our satisfaction survey were mixed, when questioned Do you like the meals at the Home, people responded:- 5 always 3 usually The eat needs cooking sometimes, It is usually very good with a good choice, It is very good, The meat isnt cooked long enough. Needs more variety, I like the soups and the sweets. I do like my vegetables well cooked with salt in the water and they do that Menus seen were varied and nutritious. Care Homes for Older People Page 21 of 36 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place to respond to suspicion or allegations of abuse to make sure people living in the home are protected from harm. Evidence: An anonymous complaint has been received regarding Kineton Manor, which was investigated by us during random inspection visits. The complaint was substantiated. One part of the complaint referred to residents being admitted to the Home in addition to the maximum number of people that the Home is registered to care for. The other part of the complaint related to staff commencing duties before receipt of protection of vulnerable adults checks. The Home accepted that they had admitted three additional people. These people were staying for a respite period. The manager is aware that they must only admit the maximum number of residents as recorded on their certificate of registration. A head count of the people living at the Home on the day of inspection was undertaken. The number of people in the Home on that day was less than the maximum number registered. Residents spoken to were aware of how to make a complaint and confirmed that they would speak to the manager or staff if they had any problems. Residents commented in our satisfaction survey regarding complaints as follows:- Care Homes for Older People Page 22 of 36 Evidence: well you would ask to speak to matron, I would tell the nurse, you have to go to the boss really - there used to be a deputy she was really on the ball, I would talk to her, I miss her a lot. The eight people who replied to our satisfaction survey responded when questioned Do you know who to speak to if you are not happy? 5 always 3 usually Im reluctant to speak to the head because she listens but shes on the payroll, to the nurse, to the manager, one of the heads, the matron, I would speak to my husband The Homes complaint log book was reviewed. Details of the last concern received at the Home in 2007 were recorded and the action taken to address any issues raised. The concern had been investigated and acted upon appropriately. A copy of the complaint procedure is on display. A comments book is available on reception and in the corridor for residents and visits to record any comments they may have. Letters of praise and thanks were kept in this book. The Homes protection of vulnerable adults policy is in the process of being updated. All policies at the Home are being reviewed and updated in line with the blue cross mark of excellence. Warwickshire local authorities multi agency protection of vulnerable adults policy was available in the Home for staff to review as necessary. Staff receive protection of vulnerable adults training. Care Homes for Older People Page 23 of 36 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, 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. 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 living in the home are provided with clean, homely and comfortable surroundings to live in. Recent improvements within the home benefit those who live there. Evidence: A tour of the premises was undertaken, this included looking at all communal areas, laundry, kitchen, bathrooms, the bedrooms of the three people being case tracked plus others. The laundry was clean and hygienic, two new washing machines with sluice facility have been purchased since the last inspection. Both machines were in good working order. Two industrial tumble dryers are available and two domestic type dryers for use on delicate fabrics. There was a clear dirty to clean flow for laundry processes. Red laundry bags are available for use when washing soiled laundry. The use of these laundry bags reduces the number of times that staff have to handle soiled laundry. Disposable towels and liquid soap were available by the wash hand basin and disposable gloves and aprons were available for use by staff undertaking laundry duties. Laundry practices help to reduce the risk of spread of infection in the Home. The dining room was freshly decorated, new carpet has been laid and new dining Care Homes for Older People Page 24 of 36 Evidence: chairs purchased since the last inspection. The dining room was nicely laid out and had a homely and welcoming feel. The large lounge, which was in use on the day of inspection, contained chairs and two seater settees. The television was playing and residents seemed to be comfortable and at ease in their surroundings. The room was clean and bright and furnishings and fittings were in a good state of repair. The small lounge is used for activities, there is no television in this lounge, large windows let in a lot of natural light, the room was clean and hygienic. There is a piano, table and chairs and occasional tables for use by residents. There is a bed in the small lounge propped up against the wall by the door. The manager confirmed that while they are decorating bedrooms (when the Home is full) they give residents the options of sleeping in the small lounge for one night until the paint odour has gone. The manager confirmed that they are using odourless paint. The bed does not give the lounge a homely feel and looks unsightly. The conservatory can be accessed from the small lounge, gardens can be accessed from the conservatory via a ramp. Gardens can also be accessed (via ramp) for nine bedrooms on the ground floor. There are three bathrooms at this Home, two contain assisted baths to aid those with mobility difficulties and one normal bath. There is a hairdressing room in which residents are able to have their hair done by the hairdresser when she visits. The Home has a library containing a large supply of books for residents to read as they wish. The Home have six hoists, five electric and one manual. A sling has been purchased for each resident and six spare slings are available to use when slings are being laundered. These are used to assist those people who have mobility difficulties to transfer from bed to chair etc. The kitchen was reviewed, all equipment was in good working order. The kitchen was organised, records were available to demonstrate that hot food temperatures are monitored and recorded. Currently the Home has six double bedrooms. To maintain the privacy and dignity of those that live in these rooms curtain screening is provided in four and movable screening in two rooms. All bedrooms have en-suite facilities, thirty one of these rooms have shower, toilet and wash hand basin and two en-suite rooms have toilet Care Homes for Older People Page 25 of 36 Evidence: and wash hand basin. Call bells are available in all bedrooms. Bedrooms had been personalised with pictures and personal belongings according to the wishes of the person staying in the room. A commode disinfecting machine is available in the laundry area, however, the manager confirmed that as all rooms have en suite facilities, residents rarely use commodes. All eight people who responded to our satisfaction survey said that the Home is always fresh and clean. People also commented In fact they fuss too much about some things, the floors are swept and vacuumed very often, certainly as far as I can see, always very clean, she comes round and vacuum cleans, its done every day, throughout the rooms are vacuumed and dusted, including bathrooms. Care Homes for Older People Page 26 of 36 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. There are sufficient competent staff on duty to meet the needs of people living in the home. Procedures for employment, induction of new staff and ongoing training ensure that residents are protected and safe. Evidence: The number of staff on duty was discussed with the manager, a copy of the duty rota was also taken for review. The number of staff on duty on the day of inspection was as recorded on the duty rota and this appeared to be sufficient to meet the needs of those that live at the Home. Staffing levels remain the same as at the last inspection and these are:07.30 - 4pm 2 registered nurses and 10 care staff plus 08.00 - 5pm 1 registered nurse (manager) 3.15pm - 9.30pm 1 registered nurse and 6 care staff 9pm - 8am 1 registered nurse and 3 care staff 6am - 7.30am 1 registered nurse and 4 care staff Care Homes for Older People Page 27 of 36 Evidence: Two laundry assistants are also employed and provide laundry cover seven days per week between the hours of 9am - 5pm. Housekeeping staff work five days per week between the hours of 7am - 2pm. Catering staff include a morning cook, evening cook, one kitchen assistant and a hostess who serves meals and sets up the dining room. The Home employ an activity organiser who works the equivalent of 1.5 days per week. Two maintenance people are employed who work one day a week each. They also visit the Home over and above this to complete repairs etc as needed. An accountant, administrator and personal assistant are employed. The personal assistant helps with the organisation of staff training. People spoken to during the inspection responded positively about staff saying staff are full of energy and enthusiasm, staff are very lively, they like to pull you leg, make jokes, they are full of fun, staff are lovely, all friendly and kind, there are male and female staff, I dont mind what happens regarding staff, sometimes I chat to staff at night a lot, management and staff are great. Information recorded on the Homes annual quality assurance assessment records that seven registered nurses are employed as well as nineteen care staff. Fifteen of the care staff have undertaken training and gained a national vocational qualification in care at level two or above. One staff member has been employed since the last inspection visit. The personnel file was reviewed to ensure that robust recruitment procedures are followed. The file seen contained appropriate information, including safety checks and written references before a decision was made to employ. All staff undertake an annual performance appraisal and supervision at least six times per year. Induction records available demonstrate that all staff undertake in house induction training regarding the Homes policies, procedures, systems and practices and care staff undertake the Skills for Care Induction training understanding the principles of Care. Providing ongoing training helps to ensure that staff have the skills and abilities to meet peoples needs. The Home have developed a training matrix which records all training undertaken for the previous year and dates of training planned for 2009. Records show that not all staff undertook mandatory training such as fire safety and moving and handling in 2008, however training is planned for two dates 2009 and the manager confirmed that all staff must attend mandatory training on an annual basis. A variety of training is provided to staff such as privacy and dignity, dementia, nutrition and protection of vulnerable adults. Care Homes for Older People Page 28 of 36 Evidence: The results of our satisfaction survey were mixed, when asked the question - Do the staff listen and act on what you say 6 yes 2 no Further comments were made as follows:mostly, normally they do, they dont take notice of you, my room was moved about without my permission Care Homes for Older People Page 29 of 36 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced and competent person to ensure the service is run in the best interests of people living there. The safety and well being of the residents, visitors and staff are promoted and protected. Evidence: The manager has a PhD in nursing and has been manager at Kineton Manor since November 2003. She has the Registered Managers Award and participates in periodic training to update her knowledge, skills and competence. Management systems in place work efficiently, systems in place regarding supervision and training were good and on going improvements are being made. Quality assurance systems in use were discussed with the manager. Satisfaction surveys are sent out to residents on a regular basis. The results of the surveys are forwarded to social work students. These people collect the results and forward the findings to the Home. Care Homes for Older People Page 30 of 36 Evidence: The manager feels that they have a very good relationship with residents and relatives. A party is held at the Home three times a year. Residents and relatives are invited to feedback any issues to the manager. A discussion is held regarding a hot topic which may be a discussion about a subject of interest such as dementia etc. A quarterly newsletter is sent out to residents and their families. This includes items of interest, details of things going on in the Home and the results of satisfaction surveys. Various audits take place such as a weekly audit of residents bedrooms, checks to ensure bathrooms contain sufficient toiletries and creams and observations to ensure residents are dressed appropriately for the time of year, are well groomed and their appearance is well cared for. Care plan audits take place. A retired nurse helps out with these audits. She reviews all care plans and completes a detailed list of findings. The manager stated that she completes direct observation of staff or works on the floor alongside staff and observes their working practices at this time. Accident audits are undertaken. These record the number of accidents for each resident, the day of the week on which they occur, graphical representation of the place of the fall and a chart records the type of injury sustained. All policies and procedures are in the process of being reviewed currently. Information from audits is analysed and improvements are made where possible. Records were seen to demonstrate that regular staff meetings are held as well as management meetings, meetings of senior care and care staff. The Home do not hold any personal allowance monies on behalf of the people being case tracked. Two other people where chosen at random and their individual spending money records were reviewed. Receipts were available for all expenditure and records held balanced with funds available. Only one member of staff signs records of income/expenditure on some occasions. It is advisable to have a witness to sign records of income and expenditure. The Home has safe storage of all funds. Documentary evidence was available to demonstrate that staff supervision takes place on a regular basis. A different topic is picked and discussed with individuals each month, documentation shows that both the supervisor and supervisee have the opportunity to air their views and discuss issues and training needs etc. Records were reviewed to evidence whether the health and safety of residents and staff is maintained at all times. The five year electrical safety check was last undertaken in 2006 and is therefore not due again until 2011. All records seen regarding water testing, wheelchair servicing, lift and hoist servicing, legionella water Care Homes for Older People Page 31 of 36 Evidence: testing, portable appliance testing, fire services and equipment were up to date and in good order. Fire alarms are tested on a weekly basis and records seen were up to date. Fire extinguishers were last tested by the fire service on 19 April 2008 Fire training is undertaken for all staff. A risk assessment has been undertaken on each resident, each has been given a high/medium/low risk level and the appropriate action for staff to take with each individual in case of fire is recorded. Automatic fire doors are checked on a weekly basis. Residents are protected from risk of harm by appropriate health and safety practices in place. Care Homes for Older People Page 32 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Information regarding the wishes of residents regarding the need to resuscitate must be accurately recorded. This is to ensure that any decisions made by people about the care they receive are taken into consideration. 28/04/2009 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 3 7 7 12 Care plans and risk assessments should be reviewed and updated if necessary on a monthly basis. All documentation in care files should be fully completed. Residents should have access to recreational activities and social stimulation suited to their wants and needs on a regular basis. Documentary evidence should be available to demonstrate this. The bed should be removed from the small lounge as it detracts from the homely feel of the area and looks unsightly. 4 19 Care Homes for Older People Page 34 of 36 5 35 Two staff should sign residents personal allowance records to demonstrate any income or expenditure. Care Homes for Older People Page 35 of 36 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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