Inspection on 20/10/09 for Kingsmead Care Centre

This is the latest available inspection report for this service, carried out on 20th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingsmead Care Centre 21/03/07

Kingsmead Care Centre 09/11/05

Kingsmead Care Centre 18/07/05

Kingsmead Care Centre 25/05/04

Similar services:

Wingham Court

Old Hastings House

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Kingsmead Care Centre Crawley Road Roffey Horsham West Sussex RH12 4RX     The quality rating for this care home is:   one star adequate 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: Val Sevier     Date: 2 0 1 0 2 0 0 9 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 32 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) 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. 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Kingsmead Care Centre Crawley Road Roffey Horsham West Sussex RH12 4RX 01403265335 01403269944 kingsmead@sussexhealthcare.org sussexhealthcare.org Mr Shiraz Boghani,Dr Shafik Hussien Sachedina Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Eunice Mundopa Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 34. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) the maximum number of places 25 Physical disability (PD) the maximum number of places 9. Date of last inspection Brief description of the care home Kingsmead Care Centre is a mixed care home registered to offer health, personal and nursing care to up to 34 service users in the categories specified above. The Care Homes for Older People Page 4 of 32 Over 65 34 0 0 34 Brief description of the care home establishment is located in the village of Roffey, on the outskirts of Horsham, West Sussex. It comprises of a two storey main building in which 25 residents are accommodated. Accommodation in the main unit is provided in twenty-one single rooms and two double rooms. There is a ramped access to the ground floor and a passenger lift provides access to the first floor. Several rooms on the ground floor have direct access to a garden area. Facilities include an activities room and a two lounge /dining rooms. A smaller attached unit, Kingsmead Haven accommodates 9 residents with physical disabilities aged 18-65, in single well-equipped rooms. Sussex Health Care Group owns the service. The responsible individuals on behalf of Sussex Health Care are Dr S. Sachedina and Mr S Boghani. The Registered Manager is Miss Eunice Mundopa. Fees range from #593 to #3000 based on assessed needs of people who live at the home. Care Homes for Older People Page 5 of 32 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: one star adequate 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 1 Star. This means the people that use this service experience Adequate quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The visit was carried out on the 20th October 2009 between the hours of 09:00 and 3:30 pm. Prior to the visit to the home we reviewed, previous inspection reports and information received from the home since it was last visited in October 2007. The Annual Quality Assurance Assessment (AQAA) was returned to the Commission by the due date before we visited the home. The AQAA is a document that we send to a service once a year, in it they are able to comment on improvements they have made, any barriers to improvement to meeting the standards and how they feel the service is Care Homes for Older People Page 6 of 32 meeting the needs of people who live at the home. Miss Eunice Mundopa is the registered manager for the home and the providers are Sussex Health Care. We met with three visitors and there were five people who use the service involved in the inspection visit. We looked at five pre admission assessments, six care plans, medication records, staff files and training records and fire prevention testing and training records. We sent out surveys to people who use the service, staff and professionals at the time of writing the report we have had twelve surveys returned from people who use the service three professionals and three staff. This home has two parts, one offers a service to individuals with a physical disability which offers a well equipped environment, spacious rooms with mobility aids such as tracking hoists, and where care is person centred which is demonstrated in meeting needs in an individualised way according to specific needs and wishes. The other half of the home is a noticeable contrast where those who are older people, who may have dementia care needs, do not have person centred care planning or clear choices or control over their lives, or support to meet individualised needs and wishes. The environment is less spacious and less equipped and appears to have had less investment than the side for people with a physical disability. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care plans must reflect all identified needs of individuals and there must be a record of what staff should do to support those needs. This includes care for wounds and pressure areas. Medication records must be kept reflecting the action staff have taken to meet instructions given by the GP to maintain peoples health. The registered persons must ensure that all staff are in receipt of all mandatory training and any other training which staff need to support people who live at the home. Monies that are looked after on behalf of individuals must be kept in a safe manner with appropriate record keeping. Care Homes for Older People Page 8 of 32 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 32 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 32 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 that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process, which involves other professionals or family as needed. Evidence: The AQAA for the home said: We carry out pre admission assessments to ensure that we are able to meet the needs of the service user and to ensure that they will be suitable for our home. The pre admission process usually involves a family representative or the service user themselves coming to the home to view. We issue all prospective service users or their families with a brochure for the home. We have service user guides in each room to keep service users informed about the home. We use person centred care plans. We offer respite care that can become long term care if the service user would like to stay or come back in the future. We looked at four preadmission assessments for people who had moved to the home Care Homes for Older People Page 11 of 32 Evidence: in the last twelve months. We saw that there was information on individual needs based on their present and past medical history for example, communication and personal care. The assessment offered choices and space for individual issues to be written. For example needs assistance at present I eat a liquidised diet and fed using teaspoon. I can pick up a beaker using my left hand. We saw that where someone was not able to communicate because their first language was not English for example, that the family had given the home information about care; lifts arm when had enough food. We noted that although the home is one registered service and that staff move between the different age groups, the assessment records were not as informative on the older persons part of the home as they were on the younger adults side. Visitors spoken to on the day said they felt they had had enough information when they were looking for a home for their relative. They acknowledged that someone from the home had come to see their relative and they had been able to visit the home. The surveys we received also indicated that people had been visited and or had come to the home to decide if the home was for them. Care Homes for Older People Page 12 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of information in the care plans is very different across the home some do not have detail of the needs of the individual and support staff are to give, whilst others are very detailed and hold the individual at the centre of them. The medication records and administration within the home do not always show that this is carried out in a safe manner to protect the people who use the service. Staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. Evidence: The homes AQAA told us that: Regular updating of person centred care plans to reflect service users changing needs. Palliative care using the Gold Standards Framework. We document the service users care plans to their individual requirements when it comes to their personal care and encourage all our staff to read and understand them. Personal and intimate care, adult protection, infection control and abuse training are part of the induction training. New Staff are mentored by a senior member of the team who knows the service users wishes well. We have good working relationship with G.P surgeries in the area and can access a G.P when needed. All our Care Homes for Older People Page 13 of 32 Evidence: service users are registered with local general practitioners and she or he visits regularly, they get to know the service user well and can refer them to the local appropriate service should they require further support. We have link nurses in the home with regards to palliative care and wound care Each service user has a personal assessment carried out by the physiotherapy team, which includes handling and transferring, risk assessments, these are reviewed on a regular basis, and any specialist equipment that may be required for that particular service user is then purchased, i.e. specialist slings for moulded wheelchairs. We have policies and procedures with regards to the administration and dealing with medication. We looked at care plans for six individuals living at the home and all documents associated with their care and support. The home has implemented the key worker system where named staff have responsibility for ensuring that the care plans are implemented and updated for a certain number of people. On the first plan we saw that there was information on family and social support. There was information on how staff should support the individual. For example: how I communicate with you, with detailed descriptions of verbal and non verbal actions such as frown and grind my teeth or clench both of my hands, with examples of what this might mean and for staff to offer support to find out what the individual wants. Offer me a drink, or I am bored take me for a walk or put my music on. We saw assessments for risk, moving and handling, nutrition, and tools used to monitor individuals pressure areas and support needs such as Barthel and Waterlow. These documents had been reviewed monthly and as needed. There were also assessments regarding mental capacity. There was information on what was important to the individual with the addition of likes and dislikes these included environment and activities as well as food. There was information about how the individual was supported to have a holiday earlier this year. For the second care plan we saw that the individual had difficulty in expressing their needs although they could communicate. We saw that there was a book with information about the individual, how to communicate with them, likes, dislikes, strengths, support, routines and a list of signs to use with them. This book is to remain with the individual at all times so that no matter where they find themselves someone will know how to support them. We saw a member of staff supporting this individual to move around the home in their wheelchair, to go to their room to choose a cardigan. We observed how the staff member did this verbally and physically and it appeared to match the information in the care plan. The third care plan we saw was for an individual who had recently moved to the home Care Homes for Older People Page 14 of 32 Evidence: on 8th October 2009. Their first language was not English and with their mental health needs, they had difficulty in communicating. The care plan did not detail how staff would know when this person needed support, with the only detail being how to assist the person with their meals. Staff told us that there was a list of words in the language the person spoke; we asked if they could respond how staff would know what they were saying. Staff did not know. The care plan was incomplete with the home waiting for the family to help them complete it. On the fourth care plan we saw that the individual had discussed their needs with staff and had signed the care plan. There was information about their spiritual needs and what they like to wear. We did see in the daily notes that a swab was taken in September to see if there was an infection we could not see that this had been followed through or that any action had happened regarding the treatment of the area. In the fifth and sixth care plans we saw that the individuals were receiving care for pressure areas and ulcers on their feet, both were diabetic and needed support both physically and mentally. Both wound care plans indicated that dressings should be changed every three days. We could not see in the daily notes that staff had carried this out. For one person we saw that they had been to the hospital in September and staff there were happy with the progress. When we looked at the notes it was not clear how often care was given to the affected areas. The times of the dressing change ranged between three and eight days. We spoke with the manager and deputy manager about this and they said that the registered provider, provided support and training in wound care. That the individual who did this from the company liked to monitor the wounds and they waited for them to come in. They did say that they changed the dressings without them sometimes. Comments from those we spoke with on the day were about the staff, included reference to staff accents. One person said the staff are lovely and helpful. One individual and their family said that they felt that other than the staff there were not many people to interact with and that Food was good however the activities were not. We looked at the medication storage and administration records (MAR charts). We saw the medication records for 5th October 2009 to the day of the visit. There are two medical rooms at the home each with a medical trolley with the medication in them. One was secured to the wall. We saw several notices around the home referring to Oxygen. In one medical room two cylinders were to have been collected in April 2009. We saw that the home keeps a record of the room temperature due to storing Oxygen Care Homes for Older People Page 15 of 32 Evidence: in them. Each medical room had a fridge and a record was kept of these temperatures. We did not see on any MAR charts or medication guidance a reference to using Oxygen. One side of the home had no medication stored as a controlled medication however there were facilities in the medical room if needed. We looked at the Controlled Medication book and saw the total number of tablets written in the book matched the stock in that there was none, all recently used controlled medication had been discontinued, used or returned. On the older persons side the home has Fentanyl and Buprenorphine patches stored as a controlled medication and these were kept locked in cupboard in the medical room. We looked at the Controlled Medication book and saw the total number written in the book matched the stock. We found envelopes with money, jewellery, pens, padlocks and keys, cash tin with money and pantomime tickets in the controlled drug cupboards. We saw that where medication was prescribed to be given as required, for example Paracetamol one or two up to four times a day there was not always an amount recorded or effect of decision to give the medication. We saw that one individual had had their medication altered from once a day to twice a day. We saw that following that change, for five days there was a signature to indicate that it had been given in the morning, there was no signature to indicate that it had been administered at the second time. We saw that there was no record of whether creams and lotions that had been prescribed had been administered. We saw that staff could read guidelines and policies on medication administration, errors, household remedies, prescription terms, and generic abbreviations. Medication had been booked into the home and there was a record of the amount the home had received. We saw that monitoring was carried out for those individuals who were diabetic. Care Homes for Older People Page 16 of 32 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. Some people who use the service participate in activities appropriate to their age, peer group and cultural beliefs as part of the local community; however this is not true across the whole home. Dietary choices and preferences are not always well catered for. Evidence: The AQAA for the home said that:We provide a wide range of activities for our service users and these are tailored to their needs. We enable our service users to attend college, outreach services and clubs in the community. Activities are person centred and take into account service users likes and dislikes, choices and wishes. We have activity reviews as a part of care plan reviews and amend activity plans as needed to suit the needs of the service user. Looking at the information given in the AQAA, visiting the home, seeing the care plans and activity records and speaking with those that use the service, we found that the AQAA seems mainly to refer to the services as experienced by the younger people at the home. We saw that the care plans for the younger people had details on college, day care, social activities, meals out, shopping and swimming for example. Whilst we were there we saw that younger people who had not gone out for the day were in Care Homes for Older People Page 17 of 32 Evidence: their activities room. One individual was having physio, some were reading or looking at books and magazines, some were playing games and there were three staff interacting with them. On the other side where the older people live, although there was an activity room, people we spoke with, visitors and those that live there said that there was little activity for them to join in and in one case someone went to play bingo and they were the only person who turned up. One survey from a health professional suggested that there could be more activities. The younger adults in the home had indicated that they wanted more days out at college and care centres and more time with their carers perhaps one to one. Following our last visit we made a requirement regarding support by staff at mealtimes and that meals must be varied, appealing, wholesome and nutritious. The kitchen manager said that the meals are visually pleasing when they leave her kitchen for example when foods are liquidised they are done so separately offering a visual sense of colour. However she said that does not mean that staff do not mix it up when they are assisting someone. People who were able to comment said that the meat that day had been hard and not cooked long enough. There seemed to be enough staff available on the day we were there assisting with meals as needed. The meal on the day of our visit was steak and ale pie, fresh swede and frozen vegetables, or salmon and broccoli fishcakes, rhubarb crumble and custard. People who go out for the day and who are able to manage one, have a packed lunch. We spoke with the kitchen manager who said that there is a list of allergies and dislikes on a board in the kitchen; to ensure safety she does not have nuts at all in the kitchen. We had found on one care plan that an individual was allergic to nuts. Some people we spoke with on the day suggested that the meals were not always good, that the food served was often frozen not made at the home, and that meals are dished up at the kitchen and delivered on a hot trolley, they sometimes received food on their plate that they do not like, despite having told staff. Several surveys we received where people had been assisted to complete them by staff we saw comments about more choice in puddings and better food. We saw a report from Environmental Health in March 2009 stating that there was excellent standard of food hygiene, food safety awareness and management. Care Homes for Older People Page 18 of 32 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 who use the service are protected through the open complaints process and the staffs knowledge and understanding of safeguarding and protection issues. Evidence: The AQAA for the home said: We use all complaints as an opportunity to improve our service. We respond to all complaints in a timely manner. All complaints are recorded in our complaints folder. We display Complaints Notices around the home to ensure that the complaints procedure is clear and available to all. Complaints are treated seriously and are dealt with accordingly. We have a tiered system for complaints, our complaints policy lists CQC and the Parliamentary and Health Service Ombudsman as a way in which to escalate complaints which the complainant may feel have not been dealt with satisfactorily within the home. Statements of service users personal expenditure are available to the appropriate person monthly, i.e. relatives, solicitors, appointees. We saw that the home has a complaints procedure, which is outlined in the Statement of Purpose and Service User Guide and on display on a notice board above the visitors signing in book. The homes safe guarding adults policy was observed to have been regularly updated and included the West Sussex Multi Agency Safeguarding Adults flow chart on how to Care Homes for Older People Page 19 of 32 Evidence: report suspected abuse. We saw that there was information relating to Mental Capacity Act and guidance on Deprivation of Liberty. Five of the fourteen surveys returned had ticked that they did not know how to make a complaint and that that there was not always someone they could speak to informally either. We saw that the statement of purpose and service users guide for the home were hanging in the bedrooms. In those that we saw for the younger adults the contact address for the commission was incorrect. In the documents we saw for the older adults at the home it gave the correct contact information. Care Homes for Older People Page 20 of 32 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 who use the service have a living environment which is homely and continues to have ongoing redecoration and refurbishment to improve it. Evidence: The AQAA for the home said: We provide our service users with their own bedrooms that are furnished and decorated to their particular tastes. We have sufficient bath and shower rooms to meet the daily needs of the service users. We have overhead track hoisting in the bedrooms and bathrooms. We also have a Liko manual hoist. Service users have ensuite facilities or basins in their bedrooms. The dining rooms are large areas with plenty of space for service users and staff at mealtimes. Service users are encouraged to help around the home with small daily tasks if they wish to do so, i.e. folding laundry, cleaning, getting the dining room ready for meal times, putting out gloves, wipes into the bedrooms. We have fulltime domestic and a fulltime laundry staff. The home was seen to be very clean throughout, with some malodour in one part of the home. When we walked about the home we saw that rooms are centrally heated, all radiators and pipe work are covered. Windows are fitted with restrictors where necessary and emergency lighting is provided throughout the home. We saw that equipment was available for use where needs indicated that with ceiling Care Homes for Older People Page 21 of 32 Evidence: hoists in part of the home and specialist nursing beds. Laundry facilities are sited away from areas where food is prepared and stored. Policies and procedures were seen to be in place regarding the control of infection. The home is checked as the regulations indicate to ensure that the machinery, electrics, plumbing for example are all in a safe working order to avoid any risk to them or the staff that use them. Individuals commented to us that they were happy with their accommodation. Some had ensuite facilities where the toilet and wash basin are behind a moveable screen others preferred not to have that, as bathroom facilities were situated next to their room. Care Homes for Older People Page 22 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current recruitment practices at the home help to protect the people who use the service. Whilst staff have received training to help them meet specific needs they have not received all the mandatory training that is expected each year, which may leave both people who use the service and staff at risk. Evidence: The AQAA for the home said: Well staffed home, within the minimum standards. Friendly and experienced staff. Low staff turnover. All staff are CRB and POVA checked. All staff undertake induction training at head office. Staff supervision and appraisals are carried out regularly with all staff. There is close liaison with the University of Surrey to offer placements for student nurses and also ONP students. Staff training is ongoing and continuous with compulsory training in manual handling and fire training for all staff, adult protection training throughout the year. Staff are encouraged to undertake NVQ level 2 and 3 training. Staff are suitably trained in the care of service users with special needs. Ther is extra specific training provided as and when the need arises. Sussex Health Care carry out extensive checks when employing new staff i.e. CRB, permit to work, 2 written references must be obtained, photographic identification and proof of address. At the time of the visit there were thirty one people living at the home. The staffing structure at the home consists of the registered providers, area manager, the Care Homes for Older People Page 23 of 32 Evidence: registered manager, deputy manager, nursing staff, care staff, kitchen staff, and housekeeping. We saw on the rota that on one side of the home there were six staff, the rota indicated that the days following our visit there would be five and four respectively. It was not clear how many staff were on the other side of the home we saw four. This included the activity coordinator who told us she was also working as a member of care staff and a person who provided physiotherapy. Staff spoken with on the day of inspection indicated that they were aware of the needs of the people who live at the home. We sampled two staff files for people have been employed to work at the home recently who were new employees to Sussex Health Care. We saw that there were two references, there was evidence that a CRB had been received or applied for and that a POVA First check had been carried out for those seen. The documents were dated before the employee commenced work at the home. We saw that the individuals had commenced an induction process. Supervised placements take place before the employee has begun work, and after recruitment checks have been returned. All staff information is kept at the home in locked drawers in the managers office. The manager said that there were quite a few new staff to the home she and her deputy were two examples, however many of the new staff at Kingsmead Care Centre had been transferred from other homes the providers have. We saw the manager had begun a training plan for staff for the years 2009 to 2010, we could see what staff had done and what was planned. In one part of the home we saw a pile of certificates for staff training we saw that staff had undertaken training in dementia awareness, infection control, catheter care, moving and handling and fire. A wound update was planned for November 2009. We looked at other training records for staff and saw that one record indicated that a staff member had last had fire training in 2006, three others in 2008 and four in February 2009. We saw that six staff had either not had training in moving and handling or that they had not been updated in one or two years. We left a requirement for action by the home regarding the training in these two areas. The new staff undertake induction training which includes an introduction to Sussex Health Care. The individual works through a pack with questionnaires on areas such as the home, safeguarding and their own personal development. In the surveys returned by staff when we asked are there enough staff to meet the individual needs of all people who use the service? One responded never, one always one sometimes and seven usually. For the question do you feel you have Care Homes for Older People Page 24 of 32 Evidence: enough support, experience and knowledge to meet the different needs of people who live at the home? staff responded with: two usually, one always. Comments from other professionals who visit the home included staff care for individual needs in an atmosphere of calm, homely and professional way to the best of their ability given staff constraints. More staff needed to ensure the highest quality of care. Care Homes for Older People Page 25 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Kingsmead Care Centre provides two distinct types of service for older persons and young adults physical disability. Inconsistency in care across the home in the areas of care planning, medication, and staff training needs to be addressed to ensure all needs are met. Evidence: The AQAA for the home said: All paperwork is maintained in an accurate and timely manner. Records are kept updated. Training records are maintained. Quality Audit Questionnaires used to monitor and improve services. Person centred care plans are updated regularly. Caring and approachable management team. Regular staff supervisions and appraisals carried out. There registered manager for the home is Miss Eunice Mundopa, who is a registered learning disability nurse and has achieved the registered managers award, a degree in epilepsy and a Masters in management. Care Homes for Older People Page 26 of 32 Evidence: We saw that the certificate related to the homes registration was displayed in the hallway and displays the details of the core registration for the home. We saw that there have been staff and resident meetings. The residents commented on food and activities. We also saw in the AQAA that people who live at the home, professionals and relatives have completed surveys about the service provided at Kingsmead Care Centre. The registered person told us that they manage personal monies for people living at the home using an accounting system. We highlighted the monies and personal effects kept in the CD cupboards. The commission was informed in the AQAA that the servicing of all utilities and equipment used in the home has taken place. We saw the policies available to staff and that new ones have been introduced or updated as necessary. We looked at the records for fire safety training and monitoring of equipment we saw records that indicated that fire safety equipment has been tested regularly. The training was not up to date for all staff. Care Homes for Older People Page 27 of 32 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 28 of 32 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 1 38 13 13 (5) 06/11/2009 The registered person must ensure that moving and handling training is in place for new staff and undertaken regularly by all staff. To ensure that people who use the service are assisted safely. 2 38 23 23 (4)(d) The registered person must ensure that fire safety training is in place for new staff and undertaken regularly by all staff. To ensure that people that use the service are protected. 23/10/2009 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 15 15 Sch 3 (1)(b) The registered person must ensure that all people who use the service have clear individual care plans describing the support that staff give to meet identified needs. 04/12/2009 Care Homes for Older People Page 29 of 32 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 So staff can support people in the way they wish and all needs can be met. 2 8 15 15 sch 3 (m) 20/11/2009 The registered person must ensure that staff respond to the care plans which have details of action to be taken with regard to pressure areas, and ulcers. A record must be kept of action taken by staff This must be done to ensure that a progress can be monitored and any difficulties managed. 3 9 13 13 (2) 20/11/2009 The registered person must ensure that lotions and creams are administered at the times and in the amount that it has been prescribed, and that a record is kept. This will ensure that the individual receives the correct medication and helps to monitor their health. 4 35 20 20 Sch 4 (9) 20/11/2009 The registered person must ensure that monies that are looked after on behalf of individuals are kept in a safe manner with appropriate record keeping. Care Homes for Older People Page 30 of 32 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 protect the property of people that use the service. 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 Care Homes for Older People Page 31 of 32 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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