Inspection on 15/04/08 for Kacee Lodge

This inspection was carried out on 15th April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kacee Lodge 24/04/07

Kacee Lodge 27/04/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Kacee Lodge Ivy Lodge Road Great Horkesley Colchester Essex CO6 4EN Lead Inspector ‘Diana Green Unannounced Inspection 15th April 2008 10:00 Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kacee Lodge Address Ivy Lodge Road Great Horkesley Colchester Essex CO6 4EN 01206 272108 01206 273867 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) Clearwater Care (Hackney) Ltd Craig Lee Williamson Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1), Physical disability (8), of places Physical disability over 65 years of age (1) Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability and who may also have a physical disability (not to exceed 8 persons) One person, over the age of 65 years, who requires care by reason of a learning disability and who also has a physical disability, whose name was made known to the Commission The total number of service users accommodated in the home must not exceed 8 persons 24th April 2007 2. 3. Date of last inspection Brief Description of the Service: Kacee Lodge is a care home for adults with physical and learning disabilities. The property is situated in the Essex village of Great Horkesley, approximately 2 miles from Colchester Town Centre. The home is a detached bungalow with parking to the front. There is a bus route close by. All service users access local community amenities and activities, with the home providing transport and escorts. Bedrooms comprise of six single rooms and one shared double room. There is one assisted bath, one walk in shower room and two toilets. Communal accommodation is comprised of a lounge/ dining room, a sensory room and an activity room. The kitchen and laundry are comparable with those found in a normal household. The fees range from £999.80 and £1,430.80 weekly. Additional costs apply for chiropody, toiletries, hairdressing and newspapers. This information was provided to the CSCI in April 2008. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection lasting 6.5 hours. The inspection process included: discussions with the support manager, operational manager, senior care assistant and two care staff, the activities coordinator and feedback in completed surveys from relatives, staff and health and social work professionals; a tour of the premises including a sample of residents’ rooms, bathrooms, communal areas, the kitchen and the laundry an inspection of a sample of policies and records (including any records of notifications or complaints sent to the CSCI since the last inspection). Information received from the home’s AQAA (annual quality assurance assessment) has also been included in this report. Twenty-six standards were inspected and eleven requirements (including two repeat requirements) and ten recommendations made. The home was undergoing a transition since being taken over by the new organisation. The registered manager had tendered his resignation and was not present and a deputy manager had recently left employment. Access to some information was therefore compromised. The management and staff were however welcoming and helpful throughout the inspection. What the service does well: Kacee Lodge provides residents with a friendly and homely type environment. The standards of personal care were observed to be good and residents appeared well cared for. Staff work well as a team and displayed a caring and sensitive attitude with residents. There is good liaison with health and social care professionals and good access to healthcare services. Positive comments were received in completed surveys from health and social care professionals. One said ‘service users are always seen as individuals and needs met accordingly’; and another told us ‘the health care is exceptional’. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based on inspected standards 1 & 2. People planning to live at Kacee Lodge can expect the home to have information on their needs but cannot be assured their aspirations and needs will be fully assessed on admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a Statement of Purpose and Service User Guide that were comprehensive documents. The Statement of Purpose had been reviewed on 4/03/08, was viewed as part of the inspection and met regulatory requirements. The Service User Guide was last reviewed on 1/07/06 and should therefore be updated. There had been only one admission since the previous key inspection that had been admitted as an emergency placement. Care files were viewed and confirmed that a hospital discharge plan and community care plan had been provided from the local authority prior to admission. However an assessment and care plan undertaken by the manager was dated nine weeks following admission and did not provide full guidance for staff in all areas of need. This did not therefore ensure that care staff had sufficient information on the care needs of the individual to enable them to provide appropriate care. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based on inspected standards 6, 7 & 9. People living at Kacee Lodge can expect to have their care needs met but not to be supported by a person centred care plan or to fully make independent decisions about their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents’ care plans were viewed during the inspection. All included personal care needs of each resident, with separate procedures for different elements of care (bathing, moving and handling, brushing teeth, hair brushing, getting dressed, feeding and managing continence. Individual risk assessments had been undertaken for each resident (aggressive behaviours, managing aggression, out in the environment, spa pool). However the risk assessments did not demonstrate how the risk was minimised and had not been regularly reviewed. There was evidence of a full care review having been undertaken with a social worker for one resident in September 2007 and for a second resident during April 2007. A care manager who completed a survey stated that ‘care reviews are undertaken regularly with the home manager’. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 10 The care plans were not person centred, for example one resident was prone to seizures but there was no plan for management in the event of a seizure. The senior care assistant explained that a separate file was maintained with a seizure monitoring form for all residents that was monitored by a Specialist Epilepsy Nurse. Daily records were maintained by care staff who recorded brief details of problems/events on a daily basis for each resident, but not necessarily the action taken. For example, it was stated that one resident had been scratching and broken their skin, but the record did not include detail of where the skin was broken or what if any action had been taken as a result. From discussion with care staff it was clear that all residents had a key worker and they were informed of individual residents’ needs but had no experience of writing care plans and had not received adequate training in record keeping. The senior manager who had been recently appointed stated that she was aware of the issues and had recently undertaken an audit of care plans and planned to provide training for all care staff on the subject. All current residents had a family representative to manage their affairs and none of the care plans sampled contained evidence that advocacy services were arranged on their behalf. The senior care assistant reported that there had been instances where advocates had previously been arranged (during 2006) for individuals in liaison with a social worker. Complex difficulties and needs around communication meant that no people living at the home were able to communicate their experiences of the home. The senior care assistant explained that each resident had a separate purse for his or her personal allowance that was stored securely in a safe and a computerised record was kept of expenditure. However the key to the safe was not available and systems could not therefore be checked. Following the inspection, information was received from the home that a safeguarding alert had been raised by the senior manager on behalf of two residents’ finances. This had been referred appropriately in line with local Essex procedures and was under investigation by the local authority. Individual risk assessments (for example use of minibus, use of spa pool and trampoline, out of chair) were undertaken in each of the resident demonstrating that they were supported in taking responsible risks. Residents were enabled with staff support to have experiences outside their usual routines such as going on holidays and outings. Photographs were seen of one resident who had visited Disneyland in the previous year and staff discussed visits to spa pools, hydrotherapy and Tropical Wings. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based on sampled standards 12, 13, 15, 16 & 17. People living at Kacee Lodge can expect to be supported to take part in activities in the home but inadequate staffing levels sometimes compromise this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to the complex needs of people living at Kacee Lodge none were able to enjoy employment or educational opportunities. There were none currently who attended day centres, although the senior care assistant reported that the manager was investigating day centres for residents to attend. The home had an activities co-ordinator who planned activities and outings on behalf of residents. There was no formal programme of activities available but from discussion with the co-ordinator it was evident that various activities and outings (shopping, swimming, hydrotherapy, hand massage) Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 12 were arranged but were dependant, due to staffing levels or sickness, on staff availability for a staff member on duty who was able to drive the minibus. The home had a sensory room and a dedicated activities room containing a spa pool. As reported in the previous key inspection the spa pool had not been used for some time and the activities room was being used for storage and was cold and untidy. Two residents records were viewed. For one resident the last recorded activity was dated 15/04/08 (10 days earlier) and various activities provided over the previous months had included nail manicure, hand massage, bouncing, swimming and shopping. Activities provided for the second resident included hyrdrotherapy, physiotherapy, hand massage, trampolining and out for tea. The activities co-ordinator reported that two residents had been taken on holiday since the previous key inspection to Centre Parks and to Yarmouth and photographs were also seen of the trips. One resident’s care record stated that they enjoy roll and stretch, gym ball karaoke, spa pool, arts and crafts, music, cookery, sensory room, massage and aromatherapy, but they were only observed walking on knees. Concerns were raised in a completed survey received from a care professional that they felt residents did not receive sufficient stimulation & interaction with staff. One resident was seen to have a snoozelum session with a staff member’s support. However the room door was left ajar enabling another resident to view the resident during the session, compromising their privacy and dignity. It was evident from comments received from health and social care professionals in completed surveys that staff enabled resident to meet their religious and cultural needs: one stated’ I have observed carers support a specific service user using their faith & cultural beliefs’. Visiting was open access and the home’s statement of purpose referred to the visiting policy. Feedback received from relatives indicated they were always welcomed into the home and could visit at any time. One relative told us ’I have never had any problems in regard to visiting or taking my relative out of the home for weekends. Another relative told us they visited on a regular basis and kept in touch with their loved one. The home’s daily routines were observed to be rushed at key times, for example prior to mealtimes and when staff were required to undertake other duties, such as cooking meals and domestic tasks in addition to personal care. All residents’ individual rooms had locks but none had their doors locked, but it was not clear if this was through their choice. The records confirmed that staff addressed residents by their preferred name and they were observed to engage with them in a friendly and respectful manner. The home had a menu that was rotated on a four weekly basis. Menus showed that a variety of nutritious food was provided and choices were offered to the people living at Kacee Lodge. A copy of the nutritional guidance for learning disabilities was available for staff to follow. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 13 Residents’ care plans viewed confirmed that a nutritional assessment was undertaken on admission and food and fluid intake was monitored as appropriate. The care records viewed included details of advice and guidance having been obtained from a dietician as needed. One resident had swallowing difficulties and the training records seen confirmed that care staff had received basic food hygiene and dealing with swallowing difficulties since the previous key inspection. A staff member was seen to deal competently with an incident when the resident choked on some food, demonstrating their skill. Meals were served in the dining room/lounge, whilst one resident who was fed by PEG tube chose to remain in their room. The lunchtime meal was observed. Several residents needed assistance with eating and staff were observed to assist them with sensitivity. However the tables were not laid with tablecloths or condiments to enhance their appearance and help make it an enjoyable experience, and staff appeared to be pressured having to cook the meal, undertake personal care as well as domestic cleaning. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based on inspected standards 18, 19 & 20. People living at Kacee Lodge can expect to have their personal and healthcare needs met but cannot be assured their privacy and dignity will be respected at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents had their own key worker who was responsible for taking care of their general needs. Care professionals who completed surveys stated ‘the staff respect the needs of individuals at all times and promote choice’ and ‘service users are always seen as individuals and needs met accordingly’ and when asked ‘does the service provided support individuals to live the life they choose?’ another care professional stated: ’always’. From the records viewed and in discussion with staff it was evident that advice and support was obtained from physiotherapists, occupational therapists, speech and language therapists and dieticians. From discussion with staff and the records viewed there was evidence that some individuals attended the local GP practice that supported the home and GPs also attended the home on request. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 15 Residents were seen regularly by health care professionals (for example occupational therapist, physiotherapists, specialist nurses, chiropodists, and dentists). Arrangements were also made for residents to attend hospital outpatient appointments as necessary. Care professionals who completed surveys stated that ‘the health care is exceptional and ‘I am impressed with the level of care provided by all staff ….A family environment exists amidst a professional approach to service delivery’. Comments were received from four relatives who completed surveys. One stated ‘ I have never witnessed anything but care and consideration for all the clients needs’ and another stated when asked what the service does well ’ making sure everyone has a quality of life and respecting their feelings makes for a happy home environment’. The medication systems for the home were discussed with senior care assistant. The support manager reported that the home’s medication policy and procedures were under review and none were available for staff guidance. Medication was stored in a lockable medication storage cupboard that was secured to the wall situated in the dining room/lounge. The kitchen domestic type refrigerator was used for storage of medicines such as eye drops and insulin that required cold storage. Medication was supplied through a local pharmacy in monitored dosage boxes and individual containers. Prescriptions were seen by the home for checking and were returned to the pharmacy for dispensing. Senior staff with appropriate training (confirmed from the training records) administered all medication. The medication for two residents was checked and found to be correct. However there were several omissions in the records that had not been followed up or the reason recorded. Some prescribed creams were kept in bathrooms and their administration recorded intermittently. The medication records viewed indicated that one cream was not available for 4 days; the senior care assistant stated this had been referred to the GP practice, however there was no record to confirm this. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good based upon inspected standards 22 & 23. People living at Kacee Lodge can expect to have their concerns and complaints listened to and acted upon and to be protected by safeguarding adult procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints policy and procedures that included timescales for a response. The procedure was included in the statement of purpose and was displayed in the entrance hall of the home but needed review to clarify the CSCI’s role in receiving complaints and the new telephone number of the commission. No complaints had been received by the home or the CSCI since the previous key inspection. Three out of the four relatives who completed surveys said they knew how to make a complaint and one said ‘Kacee Lodge has always strived to listen and take on board any concerns that we the relatives have had over the years’. The home had a protection of vulnerable adults policy and procedures and a whistle blowing policy. Regular updated training was provided for all staff on safeguarding vulnerable adults and confirmed from the training schedule seen. A care professional who completed a survey stated that there was ‘always a prompt response to any concern’ and another said the service always responded appropriately if any concerns were raised’. From discussion with senior staff it was evident they were proactive in ensuring that residents were protected by safeguarding procedures. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 17 An allegation of financial abuse had been made with regard to two residents following the inspection and had been referred appropriately in line with the homes’ and Essex local authority safeguarding procedures and the CSCI notified. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor based upon inspected standards 24, 26 & 30. People living at Kacee Lodge can expect to have a physical environment that is appropriate to their needs but cannot be assured their health and well being will be protected by health and safety, infection control practices or domestic cleaning arrangements. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some decoration of the premises (activities room, kitchen, lounge) had been undertaken but there were several items of equipment left in the activities room and a radiator cover had been removed leaving the room looking untidy. As the radiator was switched off and the room was not currently in use for residents this did not pose a problem with regard to safe surface temperature. The premises were wheelchair accessible throughout the home and gardens with ramps were provided as needed. The home had a minibus to enable access to local amenities and outings. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 19 The fire safety records were viewed and it was noted that the fire alarm was last tested three weeks previously on 24/03/08 and a full evacuation undertaken on 4/01/08 did not include the names of the staff that were present. The records viewed confirmed that regular maintenance of hoist equipment had been undertaken as required. A tour of the premises was made and communal and some residents’ rooms inspected. There were seven bedrooms, including one shared room and all had washbasins. Most rooms were personalised with residents’ own furniture (subject to space and small items including photographs etc. Several had been recently decorated and new carpets laid. However there was no light shade in two of the rooms and no blind or curtains in one room that was overlooked by a neighbours’ house, compromising the resident’s privacy and dignity. One resident’s bed had a torn mattress cover that was badly creased and evidently uncomfortable for the resident to lie on. The premises were free from odour apart from a musty smell evident in one resident’s room. However several areas had not been cleaned to a satisfactory standard. A shower room had the drain cover left off, there was no plug for the sink for residents’ use and the shower head was dirty and needed descaling. An extractor fan was noisy and clearly in need of service. A shower chair was rusty and needed to be replaced. Paper towels and liquid soap were available for staff hand washing but staff were not following safe practice by adhering universal precautions and were using a cotton towel and a bar of soap. The staff toilet had no paper towels and the bin was not foot operated. Wall hooks provided for storage in the hall were being used for staff coats next to hoist slings, posing a risk of infection. Linen was inappropriately stored on the floor of the linen cupboard. The laundry room was domestic in size. There was one washing machine that had the capacity to carry out sluice cycles and one tumble drier but there were no staff hand washing facilities or waste bin. The procedures for dealing with foul linen were discussed and it was evident that systems were not in place to minimise the risk of infection via the use of red bags for any laundry soiled by body fluids to be placed directly in the washing machines. The infection control policy and procedures were reported to be under review, however there was no guidance available for staff. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based upon inspected standards 31, 32, 33, 34 & 35. People living at Kacee Lodge can expect to be cared for by sensitive and caring staff who have been robustly recruited but cannot be confident they have received appropriate training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: From the records inspected and from discussion with staff it was evident that staff had clearly defined job descriptions and understood the main aims and values of the home. The records included evidence that residents had a key worker and staff spoken with were able to demonstrate their detailed knowledge of each resident’s needs. However staff were not supported by the home’s policies and procedures (some were being updated) and some were not familiar with them. One spoken with was not aware of the Social Care Council and therefore the standards of conduct and practice set down by them. Comments were also received from health and social care professionals that indicated staff were aware of their limitations, which is positive: ‘If in doubt staff always act/ err on cautious side and contact medical staff as appropriate’. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 21 The staff qualifications were discussed and the records inspected and confirmed that there were nine staff with NVQ level 2 qualification or above. A further five staff were working towards NVQ level 3 qualification. This was more than the 50 needed to meet the National Minimum Standard. None of the eight surveys completed by staff included a response on training and one stated they had not received sufficient information on residents’ needs during their induction. There were seven residents at the home. Staffing levels comprised of one senior care assistant and 3 care staff. The registered manager who had recently tendered their resignation was on sick leave, having had an accident the day previously. The support manager was also in attendance and a senior manager attended later during the day. It was explained that care staff undertake laundry duties, cooking and domestic cleaning in addition to care. Maintenance and repair was contracted externally. Comments were received from four relatives. One stated that ‘sometimes the staffing levels are not so high’. And another said staffing levels ‘Varies up sometimes and then can dip again’. Comments were also received from health and social care professionals. One stated ’on occasions additional activities have been cancelled due to staffing levels’ and another said the standard of care ‘often depends on staff levels and quality of helpers’ attitude to clients. Comments were received from eight staff that completed surveys. Three said that more staff were needed to meet residents’ needs. One said ’staff levels need to be improved to allow service users to gain access to more activities and days out’. Comments received from health and social care professional indicated that staff were not adequately supported through supervision and handover between shifts. One stated ‘hand over between shifts occasionally has been poor’ and ‘Perhaps handover needs to be led, supervised by more senior staff ‘. The recruitment records for one recently recruited staff member was inspected. Relevant checks had been undertaken prior to employment (two satisfactory references, Identification, full employment history, Criminal Records Bureau Disclosure (CRB) and POVA first check). However induction records were not available and it could therefore not be confirmed if induction was provided to Skill for Care standards. A schedule of training was viewed. This confirmed that training had been provided for some staff in medicines administration, moving and handling, fire prevention, safeguarding adults, first aid, food hygiene, health and safety, infection control and death, dying and bereavement since the previous inspection. The training records for the three staff were inspected. All three had attended a two-day course that had covered health and safety, fire safety, food hygiene, and infection control. This did not include sufficient time to adequately cover all subjects. One had attended a level 2 medication-training course and another had attended monitored dosage system (MDS) training since the previous key inspection. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 22 Moving and handling training had not been provided annually as required: the last recorded for one being 2005 and another January 2007. Comments were received from health and social care professionals in completed surveys. One stated ‘some staff appear very skilled, while others are very inexperienced & need help to develop skills’ and comments received from another indicated they lacked competence despite having received specific training on communication. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate based upon inspected standard 37, 39, & 42. People living at Kacee Lodge can expect to live in a homely environment but cannot be assured that prompt action will always be undertaken to address health and safety and maintenance issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were informed that the registered manager had tendered their resignation and was on sick leave following an accident the previous day. Interviews had taken place and a new manager had been recruited. The deputy had also recently left employment. However a support manager had been recently appointed and was present at the home. An operational manager was also providing support and attended later during the morning of the inspection. A senior care assistant provided assistance throughout the inspection. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 24 Information received from the home indicated that since the previous inspection the home had developed the quality assurance system to include consultation with representatives of residents through written questionnaires as well as holding regular residents meetings. The AQAA stated that the manager undertook regular internal audits and the operations manager undertook regular visits. Reports were also available as required under regulation 26 and confirmed from those viewed. Comments received from relatives when asked if they were kept informed about important issues stated ‘this has never been a problem’‘ The home had a health and safety policy and procedures for staff guidance. The records viewed confirmed that all staff received health and safety training and regular updated training was provided. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities (e.g. gas, electricity certificates, hoists, annual PAT testing etc.). However fire alarms had not been tested weekly as required and whilst fire evacuations had been undertaken there was no record of the staff who had attended. The staff training records viewed indicated that not all staff had received updated moving and handling training annually (last recorded for some staff being January 2007 and February 2007. Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 1 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 X 3 X X 2 X Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 YA7 Regulation 13(6) Requirement The systems for managing residents’ personal allowances must ensure they are protected from abuse and records are available at inspection. The home must be conducted in a way that respects the privacy and dignity of the people living there. Timescale for action 31/05/08 2. YA18 12(4)(a) 31/05/08 3. YA20 13(2) This is a repeat requirement with an original unmet timescale of 30/04/07. 31/05/08 1.Medication must be available for all residents as appropriate to ensure they receive it as it has been prescribed. 2.Ommissions in administration records must be followed up to ensure medication is given as prescribed. 3.Policies and procedures for the safe ordering, storage, administration, recording and disposal must be available to ensure staff have appropriate DS0000066717.V362435.R01.S.doc Version 5.2 Page 27 Kacee Lodge 4. YA24 guidance. 4. Room temperature monitoring must be undertaken to ensure medication is stored within recommended levels and residents do not receive medication that has deteriorated. 13(3)23(2)(d) 1.All parts of the care home must be kept clean and reasonably decorated and free from mould. 2. Action must be taken promptly address maintenance and repair of the home to ensure there are no risks to residents. 31/05/08 5 YA26 12(4)(a) 6. YA30 13(3) This is a repeat requirement with an original unmet timescale of 30/07/07. Residents’ bedroom windows 31/05/08 must have curtains or blinds to ensure their privacy and dignity is upheld. To ensure the risks of 31/05/08 infection are minimised: 1.Staff must adhere to safe infection control practices by use of alginate bags for laundering of foul linen. 2. Hoist slings must be regularly laundered and stored separately from staff clothing and other items. 3. Liquid soap and paper towels and foot operated pedal bins must be provided for staff hand washing in toilets, bathrooms, the laundry room and where personal care is provided. 4. Infection control policies and procedures must be available for staff guidance. 5. Torn mattress covers must DS0000066717.V362435.R01.S.doc Version 5.2 Page 28 Kacee Lodge 7. YA33 18(1) 8. YA35 18(1) (c)(i) 9. YA37 8(1) & 13(6) 10 YA42 13(4) 11 YA42 13(4) be replaced. 6. Arrangements for domestic cleaning must be reviewed. To ensure residents have their personal and social care needs appropriately met: 1.Staffing levels must be kept under review and increased to meet dependency levels. 2.Handover must be improved to ensure staff are kept fully informed. Staff must receive training in care planning and record keeping to ensure residents’ care plans are sufficiently detailed with individual care needs. To ensure the home is well run: 1.A registered manager must be appointed to the home. 2. Policies and procedures must be available for staff guidance. To ensure risks to residents and staff are minimised: 1.Fire alarms must be tested weekly 2.A record of staff attending fire drills must recorded. 3. Clinical waste bins must be kept locked. To ensure risk of injury to staff and residents are minimised all staff must attend updated moving & handling training annually. 30/06/08 31/07/08 30/05/08 30/05/08 30/07/08 Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 29 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 2 3 4. 5. 6. 7. 8. Refer to Standard YA1 YA2 YA6 YA7 YA9 YA12 Good Practice Recommendations The service user guide should be reviewed to ensure prospective residents have accurate information about Kacee Lodge. A full assessment of needs should be undertaken within 48 hours of admission to ensure residents’ care plans can be developed and their individual needs met. Residents’ care plans should provide clear guidance to care staff to ensure they have sufficient detail to enable them to fully meet their needs. Residents should have access to independent advocates to ensure their views are upheld. Risk assessments should demonstrate how risks are minimised to ensure residents’ safety is protected. Residents should be supported in attending day centres to ensure they can partake in fulfilling activities outside the home Links with the local community should be strengthened to ensure residents are part of the local community. Tables should be laid with tablecloths and condiments at mealtimes to enhance the appearance and help meals be a pleasant experience. Residents’ bedrooms should have light shades to enhance the appearance and protect their eyes from direct light. Staff should receive training in care of the deaf and blind to ensuite the specific needs of residents are met. YA13 YA17 9. 10. YA26 YA35 Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kacee Lodge DS0000066717.V362435.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!