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Inspection on 16/01/09 for Kingland House

Also see our care home review for Kingland House for more information

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

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

It is clear from the comments we received from individuals who live in the home and others that there is a good degree of satisfaction with the quality of care received. The arrangements for providing activities are especially noted with a wide range of stimulating and fun activities taking place not just with groups but also importantly with individuals. Individuals spoke highly of the staff and the commitment they show to the care they provide. "Everybody is so helpful and friendly" "I`m very pleased being here" "whole place is good" "didn`t expect to be as good as this" (from individuals who live in the home.) "The support of the manager and staff has been outstanding. Its wonderful to find somewhere where they truly care" "I always find the staff to be kind, caring and professional" "the carers are extremely conscientious, kind and attentive we have the highest opinion of them" (from relatives)The environment of the home is of a high standard reflecting the updating and refurbishment that has taken place over the past two years. The identifying and provision of care is clearly set out in the home`s care plans and provide a sound basis for providing quality care to meet the needs of individuals who live in the home. The shortfall reflected in this report and resulting requirement do not in the inspectors view indicate that care is not being provided to a good and satisfactory standard which accounts for the quality rating that has been given.

What has improved since the last inspection?

We looked at the requirements that were made at the last inspection and noted that they have addressed and met. This has resulted in improved care planning and assessment of needs particularly the use of outside professionals where this is identified by the home`s own assessment. This has led to improved practice in making sure identified care needs and risks to health are being met.

What the care home could do better:

This inspection identified a number of areas, which must be addressed, to build on the improving practice and care provision that has already taken place since the appointment of a new manager. The identifying of risks to health is an area the home has addressed however it was noted that this needs to be consolidated further to make sure risks to health are not identified but clear specific instructions are given to staff and that recording of action and changes are indeed recorded regularly. The administering of medication must be recorded more robustly where there are variable doses to fully protect the welfare of individuals and there is a clear audit trial of medication that has been given. This also applies where changes are made namely that these changes are not only recorded but staff members evidence the change of dose or medication so that there is accountability and again a audit trial available if so needed. Whilst it is acknowledged that there is generally a good level of training provided to staff and it is noted the training provided outside of what is seen as "mandatory" i.e. Dementia, End of Life Care staff must undertake this mandatory training. This will ensure all staff has the required level of knowledge and skills to fulfil the needs of their post. As noted in the report an Immediate Requirement was made regarding all staff undertaking fire drills and practice. Evidence has been requested of staff having undertaken these drills within seven days of our visit to the home. We have subsequently received notification that all staff have undertaken such training and measures have been put in place to make sure that staff receive further drills at appropriate intervals.

CARE HOMES FOR OLDER PEOPLE Kingland House 24 -30 Kingland Road Poole Dorset BH15 1TP Lead Inspector John Clarke Key Unannounced Inspection 16th January 2009 10:00 X10015.doc Version 1.40 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 Kingland House DS0000060603.V373812.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 Older People. 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. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingland House Address 24 -30 Kingland Road Poole Dorset BH15 1TP 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) 01202 675411 KINGLAND30@aol.com Buckland Care Ltd Mrs Lesley Jayne Brock Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) The maximum number of service users who may be accommodated is 40 18th January 2008 2. Date of last inspection Brief Description of the Service: Kingland House is a care home registered to provide accommodation and care to a maximum of 40 older people. It is situated within Poole Town centre and is close to local shops and public transport services. There are views of nearby Poole Park with its picturesque lake and level walks. The home has off-road parking for 6 cars; on-road parking is available but local restrictions apply. Resident accommodation is on the ground and first floors. The home has been tastefully refurbished and each room now has en-suite facilities. During 2004 the home was registered to Buckland Care Limited, which owns a number of other care homes in the south west of England. The general manager of the company is Mrs Pownall. Current fees are £550-£600. Dependent on level of care needed. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Kingland House DS0000060603.V373812.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 two star. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of an inspection. We looked at a range of documents relating to the care being provided in the home. These included pre-admission assessments, care plans, staff recruitment and training and those relating to health and safety. We also looked at the arrangements for the administering and managing of medication. There was also an opportunity to talk with a number of individuals who love in the home about their experience of living at Kingsland House. We also spoke with a group of staff about working in the home and their views of the quality of the care they provide. As part of this inspection we sent Have Your Say questionnaires to the home we received responses from 9 individuals who live in the home and 7 members of staff. As part of this inspection the manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA and questionnaires has been used to help make a judgement about the quality of care provided in the home. What the service does well: It is clear from the comments we received from individuals who live in the home and others that there is a good degree of satisfaction with the quality of care received. The arrangements for providing activities are especially noted with a wide range of stimulating and fun activities taking place not just with groups but also importantly with individuals. Individuals spoke highly of the staff and the commitment they show to the care they provide. “Everybody is so helpful and friendly” “I’m very pleased being here” “whole place is good” “didn’t expect to be as good as this” (from individuals who live in the home.) “The support of the manager and staff has been outstanding. Its wonderful to find somewhere where they truly care” “I always find the staff to be kind, caring and professional” “the carers are extremely conscientious, kind and attentive we have the highest opinion of them” (from relatives) Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 6 The environment of the home is of a high standard reflecting the updating and refurbishment that has taken place over the past two years. The identifying and provision of care is clearly set out in the home’s care plans and provide a sound basis for providing quality care to meet the needs of individuals who live in the home. The shortfall reflected in this report and resulting requirement do not in the inspectors view indicate that care is not being provided to a good and satisfactory standard which accounts for the quality rating that has been given. What has improved since the last inspection? What they could do better: This inspection identified a number of areas, which must be addressed, to build on the improving practice and care provision that has already taken place since the appointment of a new manager. The identifying of risks to health is an area the home has addressed however it was noted that this needs to be consolidated further to make sure risks to health are not identified but clear specific instructions are given to staff and that recording of action and changes are indeed recorded regularly. The administering of medication must be recorded more robustly where there are variable doses to fully protect the welfare of individuals and there is a clear audit trial of medication that has been given. This also applies where changes are made namely that these changes are not only recorded but staff members evidence the change of dose or medication so that there is accountability and again a audit trial available if so needed. Whilst it is acknowledged that there is generally a good level of training provided to staff and it is noted the training provided outside of what is seen as “mandatory” i.e. Dementia, End of Life Care staff must undertake this mandatory training. This will ensure all staff has the required level of knowledge and skills to fulfil the needs of their post. As noted in the report an Immediate Requirement was made regarding all staff undertaking fire drills and practice. Evidence has been requested of staff having undertaken these drills within seven days of our visit to the home. We have subsequently received notification that all staff have undertaken such training and measures have been put in place to make sure that staff receive further drills at appropriate intervals. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 7 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. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose provides the required information about the home, the facilities, staffing arrangements, admission procedure and aims and objectives of the home so that individuals can make an informed choice about the suitability of the home. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: The homes Statement of Purpose sets out in a clear way the service that individuals can expect. Information is given about the environment and facilities, staffing arrangements, Social Activities. The home’s complaints Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 10 procedure is set out giving information as to the rights of those who live in the home to make a complaint and if not satisfied to make their complaint to CSCI. The Philosophy of Care: We place the rights of service users at the forefront of out philosophy of care. We seek to advance those rights in all aspects of the environment and the services we provide and to encourage service users to exercise their rights to the full. All those who responded to the questionnaire and live in the home said they had received enough information about the home before they moved to the home. We looked at a pre-admission assessments they provided comprehensive information about the care needs of the individual, medical and physical conditions, routines. There was no information about the mental health of the individual. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of residents are met. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: A number of care plans were looked at and they gave good information about the care task needed for the individual. Information is provided about health, personal care, mobility (with moving and handling assessments completed) skin condition (Waterlow risk assessments completed). Reviews of care needs had been completed on a regular basis. Care plans signed by individual. No nutritional assessments completed for individuals. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 12 For one individual an occupational therapist had completed moving and handling plan and district nurse visited regularly to review care needs. Speech and language therapist had completed Safe Swallowing Plan. Bed rails risk assessment had been completed. Care records recorded for one individual poor skin condition but not reflected in care plans with the required tasks to address skin condition. For another individual risk assessment identified high risk of skin breakdown but over period of two weeks only one recorded entry of how this had been cared for and action taken to improve or reduce the level of “risk of breakdown on pressure areas”. There was however no evidence that this has led to deterioration in the individuals skin condition. Records relating to the administering of medication were looked at and showed that where given the correct recording had been entered and there were no gaps in the recording records. In one instance there was change of medication but this had not been signed on the record sheet, for another individual who received variable dose of medication the amount given had not been recorded. Where controlled drugs had been given these are recorded in a controlled drug register and records were competed as required. There were two individuals who are managing their own medication and risk assessments had been completed. Records showed that the home has good contact with community health services such as chiropody who visits 6-8 weekly or as required. The inspector spoke briefly to the chiropodist who was visiting the home on the day of our visit and they spoke very positively of the care provided and how staff “always follow instruction I give and will contact me if they have any concerns”. As noted above the home has made referrals to other specialists such as Speech and Language therapist where this is needed. The home also involves the community nurses in the care of individuals and a comment we received said, “the district nurse has been visiting regularly and the doctor is summoned when it is needed” and another comment was that “the home arranged for me to see a consultant”. Individuals who live in home and responded to our questionnaire said they “always” 8 “usually” 1 Receive the medical support I need. We spoke to a number of individuals about the approach of staff all spoke highly of staff “marvellous” “talk to me as I would want to be spoken too always respectful”. Staff were observed during our visit and they always spoke in a respectful and supportive manner to individuals. It was also noted that when assisting individuals this was done in a sensitive and supportive way. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home EVIDENCE: The home employs an activities organiser for 30hrs a week and this clearly has resulted in an imaginative range of activities. A monthly dairy of activities is made available and for January this included: Keep Fit, Ball Games, Making Jewellery, Cardingo (a form of bingo played with playing cards) and outside entertainers. Importantly the activities organiser spends time with individuals who may not participate in group activities. On the day of my visit one individual was being taken to the local shops by the activities organiser. The home also organises trips out to local amenities and places of interest. We spoke with the activities organiser and it was evident that she has a real Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 14 commitment and enthusiasm to providing stimulating and meaningful activities. She has received training in providing activities and has attended a number of courses about providing activities in care homes. We spoke with one individual who lives in the home and they said how much they “enjoyed the activities” and said they were “very good”. Another individual we spoke with said they felt “there was always something going on”. Responses to the questionnaire from individuals who live in the home said there were “Always” 4 “Usually” 4 Activities arranged by the home that I can take part in? The home policy on Visiting And Visitors states “to promote an open ethos whereby all bona fide visitors are made welcome and comfortable during their visit and are treated with courtesy and respect… residents may receive visitors at any time that are acceptable and reasonable to them and no general restrictions are imposed”. We spoke with individuals who live in the home and they said how they felt their “visitors always made welcome” “staff very friendly” “I can see people when I want” “always good with visitors”. We also spoke with a relative who told us that they are “very much made to feel welcome” “staff are very helpful”. A letter received by the home said “your staff always made us welcome at whatever time we visited and we were so impressed by the staffs cheerfulness, friendliness and positive approach.” The home has also made part of the conservatory a private seating area that can be used when individuals have visitors. We spoke to a number of individuals who live in the home about the meals provided they said “its always good “always a choice”. One individual said, “They will always give me something different if I ask. There is a daily choice of main meal. The menus showed a varied and appetising range of meals being provided in the home. We spoke to the chef who has recently started work in the home he said how he tries to “talk with residents about their meal and will always try to offer alternatives if the choices are not to the individuals liking.” The home has also introduced full English breakfast, which has proved to be very popular, and again offers a choice of breakfast to those that wish it. We spoke to some individuals at lunchtime and they all said how much they enjoyed the meals provided in the home “its all well cooked and looks nice”. Certainly the meal on the day we visited looked appetising and well presented. The home has introduced two “sittings” for lunchtime because some individuals felt there was too much noise and also this enables staff to concentrate on those that need assistance. Staff were observed providing assistance with feeding in an appropriate and sensitive manner. The home has undertaken a questionnaire around the catering in the home and is looking at ways of improving mealtimes and making it a more social occasion. Respondents to the questionnaire said they “Always” 5 “Usually” 3 like the meals in the home. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures in place enabling individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible individuals who live in the home are protected from harm by having a policy and procedure about the Protection of Vulnerable Adults and providing training to staff in this area. EVIDENCE: The home has a complaints procedure in place and this is displayed and given to individuals when they move to live in the home. All respondents to the questionnaire said they knew how to make a complaint. We spoke to some individuals about making a complaint or what they would do if they were unhappy about the care they were receiving. All we spoke with (4 persons) said they would speak to the manager or “member of staff” one said they “had never had the need to complain about anything” but importantly would “definitely” do so and felt confident “something would be done about it” other individuals we spoke with said they believed staff listened to “what we have to say” “always do something if we are unhappy about anything they do their best to put it right”. A relative we spoke with said they had made “suggestions” about the care provided to their relative and these had been Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 16 acted on. Another relative told us she had made a complaint “and that matter was dealt with immediately and to my complete satisfaction”. Since our last inspection there have been three complaints made to the home we looked at these and found they all had been responded too professionally within the homes complaints procedure. Action had been taken to improve practice in one instance re-enforcing with staff the policies and procedures of the home in relation to the matter of complaint. The home has a Adult Protection policy and procedure in place which clearly states the actions the manager would take in the event an allegation of abuse was made including the suspending of staff member if allegation is made regarding their behaviour or practice. Staff have received training in Safeguarding Adults. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and hygienic environment for the residents and staff. EVIDENCE: During our visit we walked around the home and looked at a number of individuals personal accommodation. All areas seen were clean and well maintained. During the past year the sitting room and hallway have been redecorated and the garden has been landscaped since the last inspection. It was noted that one bathroom would benefit from furnishing to make it more inviting. All respondents to the questionnaire said that the home was “Always” fresh and clean. One individual we spoke with said the home was “always lovely and clean”. A comment we received said “the cleanliness in this home is Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 18 outstanding room always fresh and clean so is the rest of the home no smells lovely!!” The home has a Communicable Disease and Infection Control policy in place and staff receive training in infection control as part of their induction and staff we spoke with confirmed that they had undertaken this training. Hand washing facilities and alcohol based hand rubs are available as well as protective clothing. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of individuals who live in the home can be met in an efficient way with care being provided by skilled and competent staff. However the skills and knowledge of staff would be improved if all complete the necessary “mandatory” training. Where staffing is set at specific level i.e. 3 waking night this must be implemented or re-assessment undertaken to identify whether this level of staffing is still required and therefore can be reduced so that staffing reflects the nightime needs of individual who live in the home. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: We looked at staff worked rotas for a period of four weeks. They showed that generally there were 6 care staff on duty 8-2, 5 2-8. Rota showed 3 waking night staff however there were a number of nights (15) when only 2 were on duty. Respondents to the questionnaire said that staff are “Always” 5 “Usually” 3 available when we need them and all respondents said they “Always” receive the care and support they need. One individual we spoke to about the response of staff to request for assistance said they “always come quickly when I call”. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 20 The home’s AQAA advised that of 85 of staff have completed NVQ professional qualification at Level 2 or above. We looked at the recruitment records for a number of staff and found that the required procedures and practice had been followed. All perspective employees had POVA 1st and Criminal Record Bureau checks before commencing employment. Full application had been completed which included full employment history and two references had been obtained. We looked at training records for 3 members of staff and were also provided with a copy of the home training matrix which shows all training undertaken and due to be completed by staff. All other then one individual (domestic) had completed the “mandatory” areas of training; moving and handling, first aid, Safeguarding. Other training completed by these members of staff included Dementia, Management of Pressure Injuries, Diabetes and Medication. From the training matrix Domestic and Catering staff had not completed Safeguarding or Moving and Handling training. It is noted that by February 2009 all care staff will have completed Safeguarding training. In addition 5 care staff had not undertaken moving and handling or health and safety training and of these 4 had not completed fire safety training. Of the 7 staff that responded to the questionnaire 6 said they received training relevant to their role with one saying they did not receive such training. There are currently 6 members of staff undertaking End of Life Care training. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for residents and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff are protected. The frequency of formal supervision to staff needs to improve so that management can review and monitor practice, look at performance and give staff the opportunity to express any concerns and discuss their professional development. Individuals and those that work in the home are potentially put at risk through the failure to make sure all staff receive regular fire training and drills. EVIDENCE: Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 22 The manager was registered by CSCI in November 2008 she has extensive experience of working a care setting and has previously been a manager of a care home. She was deputy manager for a nursing home and has the Registered Managers Award. In talking with individuals who live in the home they spoke of her as someone “who takes an interest in us” “comes and sees me most days to see how I am” and someone “would talk to if I had problems”. A relative said that “her door is always open…. always willing to listen and open to suggestions”. Staff also commented that the home has improved since her appointment in early 2008 “is understanding and here for caring for the residents” “change for the better” “wants the best”. However some staff commented in their returned questionnaire that communication could be improved, more frequent staff meetings (again to improve communication). Staff we spoke with on the day also said that the frequency of staff meeting could be improved, as could supervision. Records showed that there is inconsistent formal supervision of staff. Quality assurance questionnaires have been put in place the latest being in December to look at the catering arrangements in the home and changes have been made as a result of comments made by individuals who live in the home. The manager advised the inspector that this is to continue and also to implement residents meeting which currently do not take place. One individual said, “It would be helpful to have meetings to keep us up to date with what is happening”. The manager maintains accident records and also had completed a Falls Audit that has resulted in changing night care staffing arrangements. Policies were seen relating to a range of procedures: Hygiene And Food Safety, Health & Safety, Manual Handling and Fire Safety. We looked at records relating to health and safety and found that fire drills had not taken place since the appointment of the manager though staff had previously attended fire safety training that included a drill. An immediate requirement was made regarding this matter. We were subsequently advised that all staff had undertaken the necessary training. Fire alarms tests take place weekly and emergency lighting monthly. A Fire Risk Assessment is in place. Records showed that equipment in the home such as hoists, lift had been serviced regularly since the last inspection. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X 3 X X X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 3 2 Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 ((4) c) Requirement Timescale for action 15/02/09 2. OP9 13 (2) The manager to make sure that unnecessary risks to the health or safety of individuals are identified and so far as possible eliminated. This refers to the need to identify specific care tasks recorded in individuals care plans to address risks i.e. skin breakdown The registered manager to make 15/02/09 sure there are suitable arrangements for the recording, handling, safe administration of medicines received into the home. This refers to making sure any changes in medication are signed and witnessed on medication records and where variable doses are given this is recorded as to the actual dose given to the individuals. Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 25 3. OP30 18 (1) [c] (I) 4 OP36 18 (2) The manager to make sure that persons employed to work in the care home receive training appropriate to the work they are to perform. This refers to “mandatory” training as identified in this report and that all staff receive safeguarding training. The manager to make sure that persons working in the home are appropriately supervised. This refers to the need to have regular formal supervision for all members of staff. 30/04/09 30/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations Staffing in the home to be based upon actual care needs of individuals and any changes or reduction should only take place when it is clearly identified that care needs have changed to warrant change in numbers of staff on duty. This to be clearly assessed and evidenced perhaps through the use of dependency scoring. (This relates to the number of instances noted where there had been a reduction of night staff on duty) Pre-admission assessment should include information as to the individual’s mental health and well being. 2 OP3 Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kingland House DS0000060603.V373812.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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