Inspection on 21/06/10 for Kingswood Care Centre

This is the latest available inspection report for this service, carried out on 21st June 2010.

CQC 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.

Other inspections for this house

Kingswood Care Centre 27/02/06

Kingswood Care Centre 27/09/05

Kingswood Care Centre 30/03/05

Kingswood Care Centre 23/10/04

Kingswood Care Centre 09/08/04

Kingswood Care Centre 22/03/04

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Fairfields Country Rest Home

Queensmount

Poldhu

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 08/06/2011.

Key inspection report Care homes for older people Name: Address: Kingswood Care Centre Wotton Road Kingswood Nr Wotton-under-edge Glos GL12 8RA     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: Adam Parker     Date: 2 1 0 6 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 26 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 26 Information about the care home Name of care home: Address: Kingswood Care Centre Wotton Road Kingswood Nr Wotton-under-edge Glos GL12 8RA 01453844647 01453520281 kingswood@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Centres Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 47 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 47. The registered person may provide the following category of service only: Care home with nursing - Code N 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 Kingswood Care Centre is part of the Southern Cross Care Centres, and provides personal and nursing care for the elderly. The Home itself is an extended listed building sited in grounds shared by its sister home. Kingswood Care Centre however, has its own car park and gardens. Accommodation is provided across the building on Care Homes for Older People Page 4 of 26 Over 65 47 0 Brief description of the care home two floors and divided into units. The home has undergone refurbishment and redecoration to improve the environment for the residents. Current fees levels were not checked at this inspection. The home makes information about the service, including inspection reports available to residents and their representatives through a service user guide and statement of purpose available in the entrance of the home. Care Homes for Older People Page 5 of 26 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 judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection was carried out by one inspector over one day in June 2010. The home was last inspected in June 2007. We (The Commission) requested an Annual Quality Assurance Assessment (AQAA). This was received on time and provided information about what the service feels they do well and any areas they are looking to improve on. The AQAA also contained numerical information called a Dataset. The visit to the service included a tour of the premises, examination of documentation and medication systems and discussions with, staff and management. Three residents were spoken during the inspection visit to gain their views on the service provided. Two members of staff were also spoken to. Care Homes for Older People Page 6 of 26 We received six survey forms from residents at Kingswood Care Centre, completed by them with help from a relative or the activity coordinator. We also received seven survey forms from staff working at the home. Care Homes for Older People Page 7 of 26 What the care home does well: What has 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 8 of 26 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 9 of 26 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. The homes admission procedure ensures that residents move into the home following a full assessment of their needs, so that they can receive the care that they require. Evidence: The assessment documentation for two residents who had recently moved into the home was looked at. The home had conducted their own assessment of the prospective residents needs recorded on a comprehensive pre-admission assessment document. In addition copies of assessments and care plans produced by funding authorities had been obtained as well as information from a hospital. All information had been obtained and assessments completed before a resident moved into the home. The home does not provide intermediate care and so Standard 6 does not apply. Care Homes for Older People Page 10 of 26 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. The home works well to meet residents health and personal care needs and uphold their privacy and dignity. Evidence: Care plans for three residents were examined, although some contained vague actions for staff to follow, others were more detailed and individualised. Some care plans included prompts for staff as to when referrals should be made to health care professionals and when appropriate medication should be given. Care plans had been reviewed on a monthly basis. Risk assessments had been completed for pressure areas, nutrition, continence and falls. The home was also using a recognised malnutrition screening tool. There was evidence of residents receiving input for health needs from visiting professionals such as general practitioners and chiropodists. Medication storage arrangements and administration records were in good order. Storage temperatures for the refrigerator and the medication storage room were being monitored and recorded and had been maintained at the correct levels. Liquid medication and eye drops had been dated on Care Homes for Older People Page 11 of 26 Evidence: opening as an indication to staff of the expiry date. Medication administration records (MAR) had no gaps in recording and any handwritten entries had two staff signatures and had been dated. The MAR chart folders also contained guidelines on medication administration as well as photographs of residents to aid recognition for staff. In addition there were individual protocols for the administration of medicine on an as required basis. Medication audits were being carried out on a monthly basis. Staff were treating residents with respect and up-holding their privacy. Care plans contained actions for staff to follow to maintain residents privacy where personal care was being given. The home had a dignity champion as part of a scheme initiated by the registered provider, there had been a number of developments in the home to promote dignity such as signs on doors showing when residents should not be disturbed. One resident spoke about how she had been asked if she had a preference for the gender of carers giving personal care. We received six survey forms from residents at Kingswood Care Centre. Five of them indicated that they Always received the care and support they needed and one indicated Usually. One resident commented They look after me well. Care Homes for Older People Page 12 of 26 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. The home takes an active role in encouraging residents contact with family, friends and parts of the local community. This provides a good degree of social contact, however some attention is needed to areas relating to residents meals. Evidence: Information about planned activities and photographs of past activities were displayed on a notice board in the home. Among the activities on offer were bingo, table skittles and gardening with a sunflower growing competition taking place. Since the previous inspection a small garden had been developed adjoining the older part of the home. During the inspection one resident was watering the raised vegetable bed. Trips out of the home have been organised to local attractions as well as a boat trip. The activities coordinator spends time with individual residents with such activities as card making. Musical entertainers had been visiting the home and there had also been visits from the Pat a Dog scheme where pet dogs are brought into the home. The home had linked up with a local community arts group which had resulted in residents having the opportunity to take up painting. The results were on display in the home and had also been exhibited locally. At Christmas local schools have visited the home to perform Carols. A service suitable for most Christian denominations is held in the home once a Care Homes for Older People Page 13 of 26 Evidence: month. In the entrance of the home there is a large amount on information for residents and their relatives including information on advocacy services. Lunch was observed being served in a number of locations in the home. Some residents eat in the main dining room while others who have a preference or need individual assistance take their meals in their rooms. It was noted that residents eating in their rooms had drinks available with their meals. Menus are displayed on a notice board near the kitchen. Two choices of main course are given at lunch as well as two choices of dessert. Supper offers a choice of sandwiches or other snacks such as salad. One resident was following a vegetarian diet, arrangements had been made for this although no record of the meals provided had been made, this would provide information so that checks could be made that a balanced, nutritious and varied diet was being provided. Care Homes for Older People Page 14 of 26 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. Information is available if any resident or their representative should wish to make a complaint and the homes approach to training staff should ensure that residents are protected from abuse. Evidence: The home has a register for recording complaints. The procedure for complaints is that on receipt, a letter is sent and following investigation a response is given within 28 days. The documentation and responses to recent complaints was looked at. Information about how to make a complaint is available in the entrance to the home. All members of staff who completed survey forms indicated that they knew what to do if someone had concerns about the home. The home had received a recent complaint which we had been informed of by the complainant. The complainant was a relative of a resident and was in the home during the inspection visit. The complaint and the response by the registered manager of the home was discussed with them. The complainant was looking for further information following the response by the home and was intending to contact a representative of the registered provider. In relation to residents legal rights, the home has information on the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). In the AQAA document we received from the home, the training of staff in these areas had been identified as an area for improvement. Care Homes for Older People Page 15 of 26 Evidence: The home has a policy for protecting residents from abuse as well as a whistle blowing policy. These are available in the administration office for easy access for staff. On examination, the adult protection policy did not include the specific contact details for relevant agencies. Although these were available elsewhere in the home they should be added to the policy for ease of use. Training in protecting residents from abuse has been given to all of the staff employed in the home. There have been no reported incidents of abuse in the home. The home had obtained information from the Gloucestershire County Council Adult Protection Unit in the form of their Alerters Guide. Staff spoken to during the inspection visit were able to recount what they had learned in training about where any suspected abuse to a resident would be reported. Care Homes for Older People Page 16 of 26 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. Residents have the benefit of living in a well maintained and clean, environment with personalised individual rooms. Evidence: A tour of the premises was conducted. All areas of the home inspected were found to be clean and well maintained with appropriate and attractive decoration. There are a variety of communal rooms and lounges available for residents throughout the home. These include a reminiscence room, and a music lounge equipped with a piano. Since the previous inspection there have been some developments in the older part of the home to improve communal rooms for residents as well as work to provide a small kitchen for residents to use and a small garden with raised beds and a rockery. Outside there are well maintained gardens to the side and front of the home. The garden at the side of the home has raised garden beds and a fish pond. One resident commented on a survey The laundry was rather cramped and the ironing board had been set up in such a way that the hand washing facilities were not readily accessible, this was the same situation found at the previous inspection. The laundry worker was able to access hand washing facilities nearby although ideally these should be available within the laundry. The issue of the laundry was discussed with the registered manager and the Care Homes for Older People Page 17 of 26 Evidence: maintenance man who outlined proposals for improving the facility by making use of an adjoining room. An odour was noted in the corridor near the front entrance and this was brought to the attention of the registered manager. One resident commented on a survey form Improve the smell in the entrance corridor. In a recent complaint the matter of an odour in a residents room had been raised by a relative. During the tour of the premises the registered manager described work that had taken place in the older part of the home where an ioniser had been installed to help control an odour of an unknown source. Hand cleansing gel dispensers were situated at various points around the home. Care Homes for Older People Page 18 of 26 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. Staff are provided with training relevant to residents needs with robust recruitment practices in place to protect residents. However in order that residents are cared for by a trained staff group some improvement is needed in the number of staff with an NVQ. Evidence: Staffing arrangements in the home consist of two registered nurses working throughout the day with one at night. There are six care staff on the day shift with four at night. The home also provides domestic, laundry, catering, administrative, maintenance and activities staff. All members of staff who completed survey forms indicated that there were Usually enough staff to meet the individual needs of people who use the service although two commented that there should be more staff. One resident also commented on the need for more staff. A complaint to the home had raised the issue of the numbers of staff available for residents in one area of the home. This was discussed with the registered manager along with proposals to change staffing input for residents receiving personal care only. In the light of comments made and the proposals it is recommended that a review of staffing levels and the deployment of staff in the home is made with regard to residents assessed needs. The numbers of care staff trained to National Vocational Qualification (NVQ) in health Care Homes for Older People Page 19 of 26 Evidence: and social care was below 50 . Information on the Homes AQAA showed that out of 26 care staff only 9 had achieved an NVQ at level two or above. Records for recently recruited members of staff were examined. All the required information and documentation had been obtained including an employment history against which any gaps in employment could be explored. Staff had also been subject to Criminal Records Bureau checks and where appropriate, checks with the Independent Safeguarding Authority. Staff had received training in a number of areas relevant to the needs of the residents in the home. These included dementia awareness, care planing and bed rail safety. The homes AQAA gave us information that staff had received induction training in line with nationally recognised standards. We received seven survey forms from staff working in the home. All indicated that they were being given training that was relevant to their role and helped them to understand the individual needs of people. Two members of staff were spoken to during the inspection and they told us about the training they had received which was relevant to their role in the home as well as training for a change in the role of the care staff. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with a variety of quality assurance audits in operation and safety checks to ensure that the home is run in the best interests of residents. Evidence: The registered manager has been registered at the home since June 2009. She has had previous experience of managing care homes. Following the inspection we were informed that the registered manager had left the home and another manager had been appointed. Since the previous inspection the registered provider had introduced a new audit system. This involved audits completed using a key outcome inspection tool. This was a comprehensive audit against the outcome areas of the National Minimum Standards for Care Homes for Older People. The most recent audit had been completed in May 2010. Unannounced visits by a representative of the registered provider had also taken place and a short report had been produced and copied to the manager. In addition satisfaction surveys are sent out to relatives and residents and relatives Care Homes for Older People Page 21 of 26 Evidence: meetings are held. The minutes of a recent meeting were looked at where relatives had raised an issue about the availability of drinks and some drinks being placed out of reach of residents. The home has a bank account for holding residents money. Documentation relating to this was examined and found to be in order. In relation to record keeping, one resident was following a vegetarian diet although no record of the meals provided had been made. This record would provide the information so that checks could be made that the diet provided was balanced, nutritious and varied. Staff had completed training in safe working practices in fire safety, food hygiene,moving and handling, health and safety, infection control and the control of hazardous substances. The home uses a traffic light system as a way of ensuring that staff do not miss any training or training updates. Detailed risk assessments had been completed for moving and handling for residents. Regular maintenance checks are carried out and recorded on equipment in the home such as hoists, lifts, bed rails, wheelchairs and the staff call system. In addition temperatures from hot water outlets are checked and recorded and cleaning and disinfection of shower heads is carried out in line with reducing the risk of Legionella at the home and following an audit by a specialist consultant. Central heating boilers had been serviced in June 2009.The electrical wiring in the home has been checked in April 2010. Portable electrical appliances were checked in November 2009 and checks were also being made as equipment was brought into the home. Cleaning substances are stored securely and there was no decanting of substances into unmarked containers. Care Homes for Older People Page 22 of 26 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 23 of 26 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 37 17 When an alternative meal is provided for a resident this must be recorded. This will ensure that a check can be made on dietary intake. 30/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 15 15 17 Checks should be made to ensure that vegetables are cooked long enough for residents to be able to eat. Checks could be made that any special diet provided to a resident is balanced, nutritious and varied. All staff should receive relevant training in the Mental Capacity Act 2005 and and the associated Deprivation of Liberty Safeguards (DoLS). The specific contact details for relevant agencies should be added to the adult protection policy. Further consideration should be given to improving the laundry facilities. Take action to improve the situation with any odours detected in any areas of the home. Page 24 of 26 4 5 6 18 26 26 Care Homes for Older People 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 7 8 27 28 Review current staffing levels and deployment around the home in relation to the assessed needs of the residents. More staff should undertake and complete NVQ training. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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