Inspection on 19/11/09 for The Kenrick Centre

This is the latest available inspection report for this service, carried out on 19th November 2009.

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

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Maple Lodge

Polesworth Group 32 Station Road

Heathlands

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Kenrick Centre Mill Farm Road Harborne Birmingham B17 0QT Lead Inspector Brenda O’Neill Key Unannounced Inspection 19th November 2009 09:00 DS0000072114.V378390.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.2 Page 2 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 The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Kenrick Centre Address Mill Farm Road Harborne Birmingham B17 0QT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 675 0900 0121 675 0901 The.Kenrick.Centre@birmingham.gov.uk www.birmingham.gov.uk Social Care and Health Ms Tina Walstrom Mr Delroy Gladstone Bonnitto Care Home 64 Category(ies) of Dementia (64), Learning disability (64), Mental registration, with number disorder, excluding learning disability or of places dementia (64), Old age, not falling within any other category (64), Physical disability (64), Sensory impairment (64) The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 64 Old age not falling within any other category (OP) 64 Mental Disorder (MD) 64 Sensory Impairment (SI) 64 Learning Disability (LD) 64 Physical Disability (PD) 54 The maximum number of service users to be accommodated is 64. 2. Date of last inspection 6th January 2009 Brief Description of the Service: The Kenrick Centre is a newly built, multi purpose care centre that incorporates 64 beds registered to provide residential care. It is located in a residential area of Harborne next to Harborne Park. The centre is easily accessed by public transport and is within easy reach of the local facilities in Harborne including shops, public houses, banks and restaurants. The centre has been built to a high standard with input from Sterling university regarding the suitability for people with dementia. The residential units are all open plan, accessed through a security door and exited by a push button system. The residential units have their own reception area, manager’s office and staff stations. The accommodation consists of sixty four single bedrooms all with en-suite facilities which include a walk in shower. Bedrooms are large enough for all the required furniture and are wheel chair accessible. Bedrooms are well equipped and include an emergency call system which allows staff to talk to the people living in the home and vice versa. The system can be extended to include other The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.2 Page 5 assistive technologies. The accommodation is divided into units of eight which each have their own lounge and dining areas. Furnishings and fittings are of a very good standard. Corridors are wide with hand rails fitted allowing people to move around easily if they have mobility difficulties or use walking aids. As well as the en-suite showering facilities there are also fully assisted bathrooms and additional toilets throughout the home available for people to use. The home has extensive landscaped gardens with seating areas and a water feature. The majority of the accommodation overlooks the garden and the park. The garden can be accessed directly from all the ground floor communal areas. There is a designated car park at the front of the centre which allows for several vehicles. The fees charged at the home are assessed by the placing social workers and are based on the assets of the people being admitted. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. This inspection was carried out over two days by two inspectors. The home did not know we were going to visit. The pharmacist inspector visited the home on a different day to inspect the medicine management in the home. The focus of inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, standards of practice and focuses on aspects of service provision that need further development. Prior to the visit taking place we looked at all the information that we have received, or asked for, since the last key inspection. This included notifications received from the home. These are reports about things that have happened in the home that they have to let us know about by law, and an Annual Quality Assurance Assessment (AQAA). This is a document that provides information about the home and how they think that it meets the needs of people living there. Three of the people living in the home were case tracked. This involves establishing individuals’ experiences of living in the care home by meeting them, observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples’ care helps us understand the experiences of people who use the service. We looked around some areas of the home and a sample of care, staff and health and safety records were looked at. Where people who use the service were able to comment on the care they receive their views have been included in this report. Because the people living here are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand their experiences. We call this the ‘Short Observational Framework for Inspection (SOFI). This involved us observing two people living in the home for a period of nearly 2 hours and another three for an hour and recording their experiences at regular intervals. During the course of the inspection we spoke with five of the people living in the home, the manager, seven staff and seven visitors to get their views on the home. We sent ten Have your Say surveys to people who live in the home and these included surveys for relatives if they wished to complete them. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.2 Page 7 Surveys were also sent to ten staff members. A total of ten were returned, five from people living in the home (some of which had been completed by relatives), one from a relative and five from staff. These views have been included in the report. What the service does well: We received some very positive comments about the service offered at the home these included: ‘Very satisfied.’ ‘The home provides quite a good care service and helps me with my needs and they keep my family informed of any changes in my health.’ ‘The standard of care is exceptional, my X is well cared for on a daily basis.’ ‘Staff are always courteous and helpful.’ ‘Usually superb care often outstanding.’ ‘Staff are lovely.’ People were provided with information about the home and were able to visit before moving in to see if they liked the home. People living in the home had access to a range of health and social care professionals ensuring any health care needs were met. The medicine management was good and the manager was keen to improve practice further. The relationships between the staff and the people living in the home were good ensuring people were comfortable in their presence. People can have visitors when they want so they can continue to maintain relationships that are important to them. The meals at the home were varied and nutritious and people were satisfied with the standard of catering. People were happy that they were listened to and that their views were acted on. The health and safety of the people living in the home were well managed ensuring their well being. The home was well managed and run in the best interests of the people living there. What has improved since the last inspection? Individual Service Statements had been reviewed and were more person centred. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.2 Page 8 Management plans were in place for any identified ensuring people were cared for safely. Complaints records were more robust showing that complaints were managed in the best interests of the people living in the home. Medicine management had improved ensuring people received their medication as prescribed. Additional aids had been obtained to ensure people could summon staff assistance when needed. The environment had been improved with the addition of pictures, ornaments and so on to make it more homely and comfortable for the people living there. Staff had undertaken further training in safe working practices to ensure they were able to work safely with the people living in the home. 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 The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.2 Page 9 order line – 0870 240 7535. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was adequate information available for people wanting to move into the home to help them decide if the home was suitable for them. Arrangements were in place so that people can be confident that their needs will be met upon admission to the home. EVIDENCE: There was a comprehensive service user guide for the home that was given to people who were considering whether the home was suitable for them. The document was available in a well laid out folder or in a more compact version. It included all the necessary information about the home and the facilities available to help people make a decision as to whether the home would be able to meet their needs. The compact version was displayed on the notice board in the entrance hall of the home. This was in large print so that it was accessible The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 12 to people with impaired vision. The manager told us that the service user guide was being updated as it needed some minor changes. There was other information on display in the home including the most recent inspection report and details of advocacy services if people wanted to access this. Several people had been admitted to the home since the last inspection. All the people had been admitted from Local Authority homes that had closed down. The files for three were sampled and these showed that extensive assessments had been undertaken by the resettlement team prior to people moving. The assessments detailed all the needs of the individuals and how they wanted to be cared for. Any issues of challenging behaviour and any known risks were detailed and included strategies to help staff minimise risks and manage any behaviours. Staff told us they had access to all this information before people were admitted ensuring they knew peoples needs and how they wanted to be cared for. Staff also told us that people visited the home before admission to see if they liked it and often stayed for a meal. This gave them some time to get to know people. Some of the staff working in the home had transferred from the same homes as the people living there. This was very good for the continuity of care of people. One of the visitors spoken with also told us she had been able to visit the home before her relative was admitted to see if she thought it was appropriate. The home does not provide intermediate care. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the 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 were receiving the support and care they needed in a safe and person centred way. Medicine management was good ensuring people received their medicines as prescribed. EVIDENCE: We tracked the care for three of the people living in the home. This involved sampling their care plans, risk assessments and daily records, speaking to them where possible and the staff. We also spent periods of time observing staff practice while supporting the people living in the home. There was an abundance of information in the home about the people being case tracked but this was difficult to track as it was kept in a variety of folders. Staff were in the process of re-organising files and on the second day of the inspection this had been done for the people being case tracked. Files were indexed and information was much easier to find meaning staff would know The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 14 where to look for guidance on how to care for people to ensure they received their care in the way they wanted. Care plans at the home were entitled Individual Service Statements (ISS). All of the individuals whose care was being looked at did have an ISS. These had been updated since the last inspection. On the first day of the inspection the ISSs seen varied considerably in detail, for example, some included very good detail of peoples’ abilities and to what extent they could self care and what support they needed. Others included less detail and had gaps in areas such as oral care and the support needed for personal care. On the second day of the inspection staff had worked hard to try and fill the gaps and include more person centred information. For example, the ISSs stated such things as ‘I am able to brush my teeth when prompted’ and ‘I am able to feed myself staff do need to prompt me with a spoon and fork.’ This information should ensure people retain some independence when having their care needs met. Staff spoken with were able to us to tell us very clearly what the needs of the people living in the home were and how people liked their care delivered. What staff told us was not always clearly documented on the ISSs. For example, one person’s needs had changed and she was now being washed while lying on the bed. Staff were able to describe very clearly how they did this so that the person was reassured at all times, everything was explained to her and how her privacy was maintained. This person’s ISS did not reflect this level of care. Two of the people living in the home did not get on well together and often argued. Staff were able to tell us about this and were seen to manage this situation well. This was not detailed in the ISS seen for one of the individuals. Some visitors told us their relative liked their bed made in a particular way and if this was not done she did not sleep. This had been done by staff but was not detailed in her ISS. The staff employed at the home had all worked with some of the individuals living there at there previous homes. This meant they knew people well and were able to care for them in the way the individuals preferred. However should there be any staff turnover this would not be the case and the lack of detail in the ISSs could mean people may not receive the care they need and prefer. The comments we received about the care people received were very positive and indicated people received the care they needed in a way they liked. These included: ‘Very satisfied.’ ‘The home provides a good care service and helps me with my needs.’ ‘The standard of care is exceptional my X is well cared for on a daily basis. ‘X’s personal hygiene has improved since she arrived the en suite is very useful.’ ‘Usually superb care often outstanding.’ The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 15 We also spoke with an advocate from Advocacy Information Services. She told us she had met the people living in the home before they moved in and then visited them post move to check if their social work care plans are being followed. For example if peoples’ preferences are being followed. She told us there had been some minor concerns but when these had been raised they had been addressed. This is another was of ensuring people are having their preferences respected. By the second day of the inspection the risk management plans for the people being case tracked were much easier to find. These generally included details of how any risks for people were to be managed by staff to ensure people were kept safe. Manual handling risk assessments were very comprehensive and included the equipment to be used and how it was to be used by staff. Staff were seen to use hoisting equipment safely. During our observations it was noted that staff needed to be mindful when helping people up that they put their supporting hands on the individual’s back rather than under their arm as this could cause injury. There were risk management plans in place for such things as wandering, trying to get out of the home and challenging behaviour. Staff were able to tell us how they managed any challenging behaviours and what they told us cross referenced to the management plans and the records that were being kept of any incidents. This should ensure people are safe but are still able to take some risks. There were systems in the home to ensure peoples’ general well being and that their health care needs were met. There was ample evidence on the records that people had access to health care professionals as necessary. Several nurses were seen to visit the home on the first day of the inspection for such things as renewing dressings, taking peoples’ blood pressure and so. One person was seen to be assessed for a special moulded chair during the inspection. This was to ensure she could be kept comfortable and safe. Some of the visitors spoken with said they were very involved with their relatives care and they took her to se the GP whenever they could. They also told us they are kept fully informed if their relative is not well. The ISSs seen stated people should be weighed monthly records indicated this was not always happening. This was generally because people were refusing to use the scales or staff were having difficulties weighing people. There was information in the home about other methods of monitoring weights, for example, arm measurements. The manager told us staff were waiting for training on how to do this and they were also pursuing different scales to make the task easier. These alternatives needed to be pursued as soon as possible so that it can be determined if people are losing weight as this can indicate an underlying health problem. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 16 On the first day of the inspection some issues were raised with the manager about peoples’ diabetes was being monitored and how any significant weight loss was followed up. On the second day contact had been made with the G.P. and new systems had been put in place to address the shortfalls. The pharmacist inspection took place on a different day to the main inspection. It lasted three and a half hours. Six peoples’ medication was looked at together with their Medicine Administration Record (MAR) charts, care plans and daily records. One team leader’s practice was observed and all feedback was given to the manager. All the medicines were kept in the person’s room. Whilst this is person centred, if the person was not in their room the medicines were transported through the home in open pots, some of which were carried in an open bucket. There would be nowhere to secure the medicines if an emergency occurred. We, the commission, were assured by the manager that this practice would cease and consideration would be given to purchasing medication trolley’s to be used to store all the medicines and to transport them to the people. This would also speed up the medicine rounds which took up to two hours and increase the time between medication rounds, which would be beneficial. Surplus medication was kept in a large metal cabinet, and the controlled drugs stored in a separate cabinet within. This did not comply with the latest regulations to correctly store controlled drugs. Further cabinets were used to store all the new medication received into the home. This room was identified to store the medication trolleys when not in use but the temperature must be monitored to ensure that it falls below 25C at all times. All the prescriptions were seen prior to dispensing and used to check the MAR chart and medicines received into the home. Most MAR charts were printed by the pharmacist but some were hand written. These contained all the relevant information but some hand written MAR charts that had been filed had missed important information, such as the date. The quantities of all the medicines received or carried over had been recorded enabling audits to take place. These demonstrated that the medicines had been administered as prescribed and records reflected practice. The manager has installed a quality assurance system where individual staff practice is assessed on a regular basis. Further training had been booked with the local pharmacist to ensure the good practice continued. The care plans contained relevant information surrounding some clinical conditions, but these were in the process of being updated to contain further information for staff to read to support the people further. All external The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 17 healthcare professional visits had been recorded, so it was possible to see why a medicine had been prescribed for instance. The home worked closely with the community psychiatric nursing team and actively sought to reduce reliance on psychiatric medicines, which was commended. They were only used as a last resort and regularly reviewed. The team leader spoken with had a reasonable knowledge of the medicines he administered and a good understanding of the clinical conditions of the people he looked after. The people living in the home were treated with respect and their rights to privacy upheld. Staff were very polite, addressed people by the name of their choice and interacted well with them. Comments received included: ‘Staff are very respectful towards her and the other residents.’ ‘There is a general air of respect and professionalism on a day to day basis.’ All bedrooms are singly occupied and all have en-suite facilities that included a floor level shower. The en-suite facilities made it much easier for staff to promote the privacy and dignity of the people living in the home. All bedrooms were lockable and all had a lockable piece of furniture for keeping personal effects. People were able to spend time in their bedrooms without being disturbed if they wished. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It could not be evidenced that all the people living in the home had the opportunity to experience a lifestyle that met their needs and expectations. The people living in the home received a wholesome and varied diet that met any special dietary requirements. EVIDENCE: The ISSs for the people being case tracked did give some information about the preferred hobbies and leisure pass times people had. For example, for one person it stated she liked playing the piano, word searches and puzzles for another she liked the radio and newspapers. Daily records did give some indication that some of these hobbies were pursued but this was not being recorded on an ongoing basis. The majority of the people living in the home that were spoken with were not able to tell us how they spent their time. It was therefore important for staff to record what people were doing to show they were leading fulfilling lives. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 19 As at the last inspection there were some activity records that detailed such things as board games, reading newspapers, listening to music, making Christmas flowers and movie evenings. There were also records to show that events were arranged for bonfire night, Halloween, Valentines Day and so on. Recently there had been a project in the home called ‘living hens’ when eggs were left in the home that people then watched as they hatched and the chicks were kept for a while. One visitor commented to us how much this had been enjoyed by people. Not all the activity records included the names of the people taking part in the activity. It was strongly recommended this was done as not all activities were recorded on daily records and staff needed to monitor that it was not always the same people taking part and that everyone received staff time. Staff had very mixed opinions about the activities in the home. Some staff told us they had time for one to one activities others told us they felt staffing levels did not allow enough time for activities particularly on a one to one basis. Comments included: ‘Stimulating activities for the service users are poor. This is not because staff don’t want to facilitate activities it is usually because of short staffing (especially at weekends).’ ‘There is always plenty of entertainment and are always ready to try new suggestions.’ ‘At times there seems to be a shortage of staff at weekends.’ One relative did comment: ‘I would like to see more activities for X and also other residents. I think they would benefit from something being organised now and then. Perhaps a sing a long or some physical activity once a week if possible by an outsider who has more time to organise this on a regular basis.’ These issues were discussed with the manager who acknowledged there had been some issues with staffing levels as staff had not been released quickly from other homes but this had been now been resolved. There appeared to be adequate numbers of staff available throughout the days of the inspection and some activities were seen to be facilitated, for example, singing and dancing. Staff levels should be monitored on an ongoing basis to ensure they do not impinge on the availability of staff to facilitate activities with the people living in the home. During the inspection we observed two people living in the home for a period of nearly 2 hours and another three for an hour making recordings at five minute intervals to assess the state of being, level of interactions and engagement for them. After analyzing the data collected it was shown that the people being observed were in a positive state of being for the majority of the time. Overall the interactions by staff were very positive. One negative The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 20 interaction was observed and this was when staff discussed an individual’s previous home life with them and they clearly became distressed about this. The staff member did stop immediately and changed the subject. Staff needed to be mindful that they did not ignore people when relatives were in the area, but rather include them. Staff actions could be seen as dismissive of individuals, for example, staff pulling up a chair as if they were going to sit with an individual and then leave the chair in front of her and go and talk to visitors and other people without saying anything. During the observations it was evident staff were readily available to assist people with their care when needed. People were supported to maintain relationships that were important to them. Several visitors were seen coming and going from the home and many were spoken with. All were made very welcome by staff. Comments received from the visitors showed they were welcome at any time, they were made welcome and were very happy with the service provided to their relatives. These included: Excellent building with happy and welcoming staff I visit every day.’ ‘Staff lovely always welcoming.’ There was a four weekly menu in the home. The menus indicated that cultural diets could be catered for where necessary. There were extensive choices on the menus and the staff were seen going around and asking people to choose what they would like to eat. One person told us he was asked what he would like for dinner but had forgotten. The observations made during lunchtime showed that staff were available to offer assistance where needed. People appeared to enjoy their meals. One person asked what had happened to her carrots and the staff immediately addressed this. The food seen during the course of the inspection was nicely presented. Staff told us they thought the food served in the home was very good. They told us people could have their meals at whatever time they wished. The visitors we spoke to who had seen the food being served were satisfied that it was of good quality. Two of the visitors spoken with told us they took their relative to the on site restaurant to eat with them on a regular basis. Staff were keeping records of the food served to people but these were not always fully completed. These were needed to evidence that people were receiving a varied and nutritious diet on an ongoing basis. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to listen and act on peoples’ views and to safeguard them from harm. EVIDENCE: The complaints procedure was in the service user guide and all the people living in the home had a copy of this in their bedrooms. The document was also on display in the home making accessible to anyone who may wish to raise any concerns. We had not received any complaints about the home. Two complaints had been raised directly with the home since the last inspection. The records for these were seen. There was clear documentation about the nature of the complaint and the actions taken by the home to resolve the issues. The recording of the outcome of complaints had improved since the last inspection showing these had been managed in the best interests of the people living in the home. There were very good relation ships between the staff and the people living in the home and their relatives. This should give people the confidence to raise any concerns they may have. We spoke with an advocate and she told us issues she had raised with the staff in the home had been addressed. Two The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 22 relatives also told us they had raised some minor concerns about such things as laundry and these had been addressed. This showed people could be confident that they are listened to and their concerns acted on. The policies and procedures for adult protection and whistle blowing were not seen at this inspection but have been seen before and are known to be robust. The senior staff at the home have recently made one safeguarding referral in relation to a medication error. This shows staff are aware of who and when to make referrals to, to ensure people are safeguarded. The training matrix for the home showed that staff received training in adult protection issues. Staff also confirmed they had received this training. Some staff had also received training in the Deprivation of Liberty Safeguards and the mental capacity Act. These govern decision making on behalf of adults and applies when people lose mental capacity at some point in their lives or when they have had an incapacitating condition since birth. The manager told us he had not made any referrals under this legislation but that he had spoken to the deprivation of liberties safeguarding team about one of the people living in the home for advice to ensure he was acting in their best interests. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26. People using the 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 provides the people living there with a high standard of accommodation that meets their individual needs. EVIDENCE: The care home was registered in July 2008. It is a new building and therefore meets all the needs of the people living there. At the time of this inspection only parts of the ground floor was looked at as this was the only part of the home occupied. There had been many more people admitted to the home since the last inspection. The home had much more of a ‘buzz’ about it and people were clearly very comfortable. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 24 The residential accommodation was divided into four units of eight bedrooms. Each of the units had their own dining areas and there were four lounge areas. One of the lounge areas was the designated smoking area for the people living in the home. A lot of effort had been made to make the home more homely with the addition of numerous pictures, ornaments, flowers, books and some sensory mobiles. These gave the people in the home some interesting and stimulating objects to look at and talk about. The people living in the home had access to very well laid out landscaped gardens. The garden included seating areas and a water feature. All communal areas and bedrooms looked out onto the garden and several also looked out over the park located to the rear and side of the home. All the bedrooms had en-suite facilities of toilet, wash hand basin and floor level showers. One person told us how having an en-suite facility had helped her relative improve her personal hygiene. The home also had fully assisted bathrooms for those who preferred to have a bath. The assisted bathrooms were fully equipped efforts had also been made to make these more homely and domestic in appearance so that people would feel more comfortable. The home had a variety of aids and adaptations to help people with any mobility difficulties including, hand and grab rails, assisted bathing facilities, free standing hoists and corridors were wide and accessible to people in wheelchairs. The home still needed some additional signage indicating where facilities were as this may be beneficial for the people living in the home who have dementia and may find it difficult to find their way around. This was discussed with the manager and we were shown some proposed signage which looked appropriate but this had not been put up. There was an emergency call system in the home. We were told that since the last inspection some wrist bands and neck pendants had been purchased that incorporated the call button. This ensured people could summon help at all times. Bedrooms were large enough to accommodate some personal furnishings if the occupants wanted some of their personal effects. Bedrooms seen were personalised and reflected individual tastes, gender and preference. Furniture provided by the home was a good quality and included a wardrobe with see through panels, dressing table with drawers that could be sat at and a bedside cupboard. All bedrooms included a lockable facility. The people living in the home could lock their bedrooms doors if they wished to ensure their privacy. One person told us he had his own key for his bedroom. At the time of the inspection we were told that people could not control the temperatures of their bedrooms. Information received from the manager after the inspection The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 25 indicated that there were thermostats in each bedroom which enabled people to vary the heating. During the course of the inspection it was noted that there was a supplementary heater in use in one of the corridors on the first day of the inspection and in a bedroom on the second day of the inspection. The heaters had very high surface temperatures. The manager told us people were not at risk from these. However if these are to be used they should be risk assessed and the outcome recorded to ensure they are safe and the people living in the home will not burn themselves on them. Staff did comment to us that parts of the home could be cold and that the under floor heating was inadequate. They told us that the en suite facilities could be cold for people when they were showering. Although the home had some car parking spaces to the front of the home these were clearly inadequate for the size of the Centre and the amount of people that would be coming and going. Several cars were parked in the adjoining roads and this had caused some issues with neighbours. Consideration should be given to further allocated parking for the Centre. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the 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 people living in the home are supported by staff who receive training to ensure they have the knowledge to meet their needs. Recruitment procedures are robust which should ensure people are safe. EVIDENCE: As mentioned earlier in the report staff had mixed views on the staffing levels in the home particularly in relation to facilitating activities. Some staff told us they thought staffing levels were adequate others felt they were not. The manager did tell us there had been some issues in the past as staff had not been released from their former posts very quickly but this had been resolved. Staffing levels had been increased as the numbers of people living in the home had increased. The rotas indicated that the majority of the time there were a minimum of six care staff on duty throughout the waking day plus a senior member of staff. There were occasions when this dropped to five but this was usually due to unforeseen sickness. There were three staff on duty during the night. Staff were visible and available to the people living in the home during the The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 27 inspection and there seven care staff on duty on both days. These numbers should be adequate to meet the needs of the people living in the home. There were good relationships evident between the people living in the home and the staff and manager. During our observations we saw some very positive interactions. Staff were being very respectful to the people living in the home and treating them as individuals at all times. Some of the compliments received by the home and comments received by us showed that people thought the service offered by the staff was good. These included: ‘I have found the staff and managers very polite and supportive and when I have passed on concerns over practice feel the management act on these concerns.’ ‘Total joy to visit both the building and the people.’ ‘The standard of care is exceptional.’ ‘The staff are always courteous and helpful.’ ‘Management and care staff are positive and hardworking.’ ‘Staff are lovely.’ Staff spoken with were very positive about how well the team worked together for the benefit of the people living in the home. Some issues were raised with us about the role of team leaders, the availability of rotas and as mentioned staffing levels. The manager was aware of these issues and was working to resolve them so that they did not affect staff morale and the running of the home. Staff spoken with and the surveys returned to us indicated staff were very satisfied with the training they received. Staff told us about the training they received prior to the centre opening. Topics included, team building, dementia care, manual handling and health and safety. Staff told us they were receiving on going training in adult protection, use of the hoists, fire procedures, NVQ (National Vocational) levels 2 and 3 and so on. All the staff at the home have either NVQ level 2 or 3. Training matrixes had been developed since the last inspection which also showed staff had received an abundance of training which should ensure staff have all the knowledge and skills to care for people living in the home. We were told that all the staff employed at the home had transferred from other Local Authority homes. It is known that the Local Authority has a robust recruitment process which should ensure people are safe and only the appropriate people are employed to work with them. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 38. People using the 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 and run in the best interests of the people living there. EVIDENCE: The home has two registered managers however only one of these was carrying out the manager’s role at the time of the inspection. The other registered manager had been employed to manage an interim care unit on the first floor of the centre but this had not been set up. We spoke with the registered manager and the centre manager, who supports the registered manager. Both are very experienced in the running of The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 29 residential homes and appropriately qualified. During discussions with the registered manager it was evident he had a good knowledge of the people living in the home. There had been some improvements made since the last inspection in such things as care plans, risk assessments and management plans for the people living in the home. There had also been some improvements to the environment making more homely for the people living there. Staff were very positive about the management of the home saying managers were approachable and they could talk to them if they had any concerns. There was a quality monitoring system in the home which was quite extensive and audited the service over seven outcome areas that looked at all the National Minimum Standards. The audits were undertaken by staff at the home and staff from another home also. All the audits had been completed once and the outcomes had been analysed. A development plan had been drawn up for the home that detailed how the service was to be improved for the benefit of the people living there. As a result of the audits the manager had introduced surgeries for relatives so that they could arrange time to go and see him to raise any issues and make suggestions as they wanted more access to him. Part of the quality monitoring system was sending out satisfaction surveys to interested parties. Some of these were sampled and the comments made were generally very positive people were clearly happy with the service the home was offering. Regular meetings were held with the people living in the home to get their views and listen to any suggestions they may have to improve the service. The minutes for these meetings showed people were listened to. For example, people had raised additional garden furniture and this had been addressed, people wanted a film night and this had been done. This showed that people were listened to and their views acted on. There was system in place for keeping some money on behalf of people if they wanted to use it. The records for this were sampled. Each person had an individual record and receipts were kept for expenditure which matched the entries on the records. All the balances checked were correct this means peoples’ money was being held safely. Health and safety of the people living in the home and the staff were well managed. Numerous in house checks were being undertaken to ensure people were kept safe including, fire alarms, fire extinguishers, emergency exits, emergency lighting and water temperatures. There was evidence on site that the vast majority of the equipment used in the home had been serviced to ensure it was functioning correctly and safe to use. No evidence was found to show that the hoists and baths lifts had been serviced since the guarantees The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 30 ran out. Copies of these should be forwarded to us so that we can be assured they are safe for the people in the home to use. We had received very few regulation 37 notifications from the home. These are reports about the things that have happened in the home that they must tell us about. The records in the home showed us that there have been incidents and accidents in the home that we should have been notified about to ensure they are being managed in the best interests of the people living there. The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 32 Are there any outstanding requirements from the last inspection? NO. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP25 Regulation 13(4)(c) Requirement Any supplementary heating appliances must be risk assessed and guarded if necessary. This will ensure people do not burn themselves. Timescale for action 30/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Individual Service Statements should detail all the current needs of the people living in the home and how these are to be met by staff. This will ensure people receive person centred care. Systems should be in place to ensure peoples’ weights can be monitored as weight loss can be an indication of underlying health concerns. It is recommended that a controlled drug cabinet is purchased and installed that complies with current regulations. It is recommended that medication trolley’s are purchased DS0000072114.V378390.R01.S.doc Version 5.3 Page 33 2. 3. OP8 OP9 4. OP9 The Kenrick Centre to speed up the medicine round and to reduce the risk of harm as there would always be somewhere to safely secure the medicines during the medicine round. 5. OP12 It is strongly recommended the names of the people taking part in activities are recorded on activity sheets. This will ensure staff are able to monitor if the same people are always taking part and that everyone receives staff time. Staffing levels should be monitored to ensure they do not impinge on the activities available to the people living in the home. Food records should show that people are receiving a varied and nutritious diet on an ongoing basis so that it can be determined their nutritional needs are met. Consideration should be given to enhancing the parking facilities at the home. The Commission should be notified of any events in the home that affect the well being of the people living there. This will ensure incidents are managed in the best interests of the people living in the home. Evidence that the hoists and bath lifts have been serviced should be forwarded to the Commission. This will ensure the equipment is safe to be used. 6. 7. 8. 9. OP12 OP15 OP19 OP38 10. OP38 The Kenrick Centre DS0000072114.V378390.R01.S.doc Version 5.3 Page 34 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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