Inspection on 29/04/10 for Kingsleigh

This is the latest available inspection report for this service, carried out on 29th April 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingsleigh 21/05/08

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 29/06/2010.

Key inspection report Care homes for older people Name: Address: Kingsleigh 78 Berrow Road Burnham-on-Sea Somerset TA8 2HJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Shelagh Laver     Date: 2 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Kingsleigh 78 Berrow Road Burnham-on-Sea Somerset TA8 2HJ 01278792768 01278783825 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Angels (Kingsleigh) Ltd Name of registered manager (if applicable) Miss Samantha Oatway Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 23. 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) Date of last inspection Brief description of the care home Kingsleigh is registered with the Commission for Social Care Inspection to provide care to up to 23 people over the age of 65 who require personal care. Nursing care is not provided. The home is a large, older style property located in a residential area of Burnham on Sea. Care Homes for Older People Page 4 of 28 Over 65 23 0 1 2 0 5 2 0 0 9 Brief description of the care home Accommodation is arranged over two floors with a passenger lift between. All communal areas are located on the ground floor. The home has been owned by Angels (Kingsleigh) ltd since December 2007. The registered manager is Samantha Oatway. Care Homes for Older People Page 5 of 28 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 at this inspection is 2 stars. This means that people who use the service experience Good quality outcomes. The focus of this inspection was to inspect the relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on the outcomes for people and measures the quality of the service. The inspection was carried out by one inspector over a one day period. Throughout the report the term we refers to the inspector from the Care Quality Commission. During the inspection we, the Commission, were met with people living and working at the home. We reviewed documentation relating to care, staff recruitment and training and the Care Homes for Older People Page 6 of 28 maintenance of the building. We had received an Annual Quality Assurance document prior to the inspection of the home. This AQAA gives us details about the home including their plans for the future. In this case the AQAA was quite brief in places although the manager Sam Oatway was clear about plans and challenges that lay ahead for the home. The fees for the home confirmed at the inspection were 406-500 pounds per week. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? At the last inspection a requirement was made to improve the opportunities for social stimulation and meaningful activities in the home. at this inspection we could see that action had been taken and was continuing to be developed. We saw a programme of activities, spoke with the activties co-ordinator and saw photographs of events. People confirmed that there was something to do each afternoon. People told us about enjoying cooking or crafts. There is attention to individual preferences. There were concerns at the last inspection about the assessment of people coming into the home and about the care plans. We saw an assessment framework that is satisfactory and completed assessments. The assessment documentation could be Care Homes for Older People Page 8 of 28 completed more fully however the manager was able to give a good description of the information that was not recorded. At this inspection we could see that new documentation for care plans has been implemented and that a progress has been made to make the care plans more individual. Recruitment records had improved since the last inspection. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service receive adequate information about Kingsleigh and visit the home whenever possible before they move in. Pre-admission assessments are undertaken and the documentation has been developed. Evidence: People receive information before they come to the home including a colour brochure of the home. We saw that pre-admission assessment documentation had been developed and this gave a basic overview of the persons needs. The documentation in place could be used more fully to record peoples wishes and background. The manager was able to supplement the recorded information with more information including life history and family circumstances. We could see from one assessment that the manager and deputy had visited a person Care Homes for Older People Page 11 of 28 Evidence: in hospital. Other people told us that they had come from hospital to the home. People are invited to visit the home prior to admission and are invited to stay for meals if appropriate. A lady living in the home told us that she had been coming for day care to the home and she felt that this had been a good way to ensure the home could meet her needs. People at Kingleigh have quite diverse needs however the manager confirmed that they following assessment people had settled into the home. Care Homes for Older People Page 12 of 28 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. Overall people receive a good standard of care. People have access to a range of health. There is a new system of care planning in place that should be further developed. Nutritional assessments should be completed for all people on admission. There should be closer monitoring of peoples weights. Evidence: Since the last inspection a new system of care planning documentation has been purchased with a form to cover a wide range of needs. We could for example see information relating to daily personal care, communication, cognition nad bed time preparation At the time of the inspection there was some confusion between describing what the person was able to do and what action should be taken by the care staff to meet peoples needs. We discussed with the manager the need to make actions required by staff clear within the current format. Care plans are reviewed monthly and we saw that these reviews had been signed. Care Homes for Older People Page 13 of 28 Evidence: There were indications that people received visits from GPs when appropriate. We met one of the community nurses. We were told that they had no major worries about the home. They were called to administer appropriate care and were not treating anyone in the home for pressure damage. There are regular visits from a chiropodists and opticians and regular contact with social workers when appropriate. We spoke to people during the inspection who talked about the medical care that they had received for short term events. staff in the home monitor peoples care and summon help appropriately. The medication system is safe and well managed. The home uses a monitored dosage system. Staff giving medication have received training. People living in the home felt that their privacy was respected. We saw many interactions between staff and people who lived in the home that were were polite and friendly. People looked well and were clearly encouraged to maintain their mobility. We saw that people were weighed monthly and BMIs were recorded. We saw that there was some variation in weights for some people. Family bereavement and anxiety were two reasons why people had lost weight. There is an informal approach to encouraging people to eat and additional milk,chocolate biscuits and occasional supplements are given when people are not eating. A more standardised approach should be adopted ensuring that people are have a nutritional assessment on admission and that prompt and recorded action is taken if people do lose weight. Training should be sourced to ensure all staff are confident in this area. Care Homes for Older People Page 14 of 28 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. People are able to chose how they spend their days. There is an activity programme in place. People are able to chose from a range of appetising and wholesome food. Evidence: People living at the home said routines were flexible. People told us about the different ways they spent the day according to their wishes and capabilities. One person was able to visit her home regularly, another used a scooter to visit the town centre. Since the last inspection the activities available within the home have developed. A very enthuisiastic activities leader visits the home every afternoon. On the day of the inspection people made bread and ate it with jam and cream. On other days there are craft activities or quizzes. There are also morning activities organised by care staff. These included some crafts although some people liked to join in with the vegetable preparation for lunch. There is a developing vegetable patch for those who are interested and the home has purchased an electronic activities game. (WII) People are encouraged to remain as active as possible and were seen being supported Care Homes for Older People Page 15 of 28 Evidence: and encouraged to walk to the dining room. Overall people looked well cared for with well laundered clothes. The hairdresser had visited recently. There is also a programme of organised entertainment and it is worth ensuring that all people have a copy of the schedule so they know when something special is happening. People confirmed that they could have visitors at any time and those who were able went out with their families. One person spoke of the importance of links with her friends from her old home. We observed lunch being served and could see that there was a choice of two hot home cooked meals. There is also salad available and one person said that there would always be something nice to eat. We noted that food portions varied according to preference. There is a four week menu indicating a good range of food and the daily menu is displayed. Care Homes for Older People Page 16 of 28 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 are confident that staff will listen to their concerns and appropriate action will be taken. The home should ensure that all staff have protection of adults training and are familiar with the local authority procedures. Evidence: The home has policies and procedures in place to enable people to make a complaint or report poor practise. There is a whistle blowing policy and staff felt confident about reporting concerns within the home. The home Safeguarding Adults policy does not reflect the local authority guidance and could be confusing. The home has a copy of the guidance which was accessible in the staff room. It is recommended that the manager ensures that all staff are aware of the local guidance and ensures that all senior staff would be clear about the action to betaken should this be required when the manager is not available. The home works closely with the local authority on safeguarding issues when they arise to ensure people are protected. The training matrix indicates that about half of the staff have had Safeguarding adults training in 2009 and 2010. Arrangements should be made to bring other staff up-todate. Care Homes for Older People Page 17 of 28 Evidence: People spoken to during the inspection said that they could speak to staff if they had any worries. There have been no formal complaints. The home has a system of managing peoples day to day accounts that included clear records. Care Homes for Older People Page 18 of 28 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. Kingsleigh provides a comfortable, homely environment for people who live there. The home is clean and there is a programme of planned maintenance. Evidence: Kingsleigh is a large older style property located in a residential area of Burnham. There are light spacious communal rooms that include an attractive dining room. There two lounges that enable people to find a quieter space or undertake activities. All bedrooms are now for single occupancy and people had personalised them with photographs and possessions. Whilst most bedrooms were very pleasant there are a small number on the ground floor that are very dark. This should be considered when admitting people to the rooms. On the morning of the inspection all areas seen were fresh and clean. Overall standards of decoration and furnishings were good. There is a schedule of planned maintenance and up-grading that included work on the bathroom. There is a very pleasant garden to the front of the home that can be easily accessed. Care Homes for Older People Page 19 of 28 Evidence: It should be noted that it may be necessary to undertake additional cleaning of some areas in the afternoon to ensure the home remains fresh smelling all day. Staff have received training in infection control and we saw facilities available for staff hand washing and protective clothing. Care Homes for Older People Page 20 of 28 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. People in the home are assisted by a regular qualified and competent team of staff. Training is available for staff who work in the home. Evidence: The AQAA states that the home currently employs 15 care staff and 5 support staff. We looked at the staff rotas and could see that there was a regular team of carers. We looked at two staff files and could see that the home routinely completed appropriate pre-employment checks and takes up references. Appraisal and supervision records for staff were very brief. Seven surveys returned from staff all confirmed that they felt that their induction had covered everything they needed to know to do the job. They said that the manager gave them regular support and met with them to discuss how they were working. We were shown the documentation and plans for improving and formalising the supervision and appraisal system in the home. The appraisal should identify training needs of staff and form the basis of training planned for the coming year. 75 of staff have a National Vocational Qualification in Care. 7 have a qualification at Care Homes for Older People Page 21 of 28 Evidence: level 3. This is above the required minimum standard. There is a record of staff training that indicates staff received Manual Handling updates. The matrix indicates that some staff have received training in medication administration and dementia care. Care Homes for Older People Page 22 of 28 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 registered manager has the qualifications and skills to manage the home. The home is well maintained and action is taken when required to maintain the health and safety of people who live in the home. The proposed system of appraisal and supervision of staff should be fully implemented. Evidence: The registered manager of the home is Sam Oatway. She has completed the Registered Managers Award and NVQ Level 4 in care. The manager assisted with all aspects of the inspection and appeared knowledgeable about people in the home. On one or two occasions when documentation was absent the manager was able to give full verbal accounts. There is no administration support in the home and there are many demands on the managers time. Staff and people who live in the home said they were supported by the manager. One person said that she would always sort things out. Care Homes for Older People Page 23 of 28 Evidence: The staff rotas show that there is a senior member of staff on duty on all shifts. The deputy manager has been recently employed and this appointment has been most beneficial to the home. Staff supervision and appraisal records were brief. The home sends out quality assurance questionnaires on an annual basis. Surveys are sent to people who live in the home and to professionals who visit the home. We saw the Quality Audit completed for 2010. There were many positive comments from people and their families and from Adult Social Care and Somerset Partnership professionals. Information from the audit is used to drive improvements in the home. It would be good practise if this was recorded. We could see that there is a system of planned maintenance in place. The home is taking action following a request to undertake some up-grades in the building to comply with Fire Regulations. We could see that quotes had been received and that the home was working with the Fire Authority to conclude the work required. The last inspection by the Environmental Health Authority awarded the home a five star rating. We saw servicing records for hoists and lifts and records of training for manual handling and food handling. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 Pre admission assessments 15/07/2009 must be comprehensive. They should include full details of the persons needs, interests and wishes. To ensure that the staff have the skills and experience to care for new people moving to the home. 2 7 15 (1) (2) Care plans must give clear 22/06/2008 guidelines to enable staff to give appropriate care to individuals and to monitor healthcare needs. Care plans must be drawn up and reviewed in consultation with people living at the home or their representative. Care Homes for Older People Page 25 of 28 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 8 12 There must be clear guidance for staff regarding actions to be taken if someone loses weight. Staff should be clear what action is to be taken if they note a loss in weight either using the scales or through observation. 11/06/2010 2 8 12 There must be a more robust system in place to assess peoples nutritional status on admission. . It is important to assess people nutritional status on admission as this gives base line information for all other records. It also determines whether action is to be taken immediately. 11/06/2010 3 38 13 The home must continue to 17/08/2010 implement the requirements made by Fire Authority regarding the changes requested to the building. Page 26 of 28 Care Homes for Older People 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 To ensure the continued safety of people in the home. 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 8 Staff should receive training in the use of appropriate nutritional assessment tools and should be familiar with the action to be taken in the event of weight fluctuation. The home should implement the planned staff supervision system to ensure staff are systematically appraised and support with performance and training at work. 2 36 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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. 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