CARE HOMES FOR OLDER PEOPLE
Kahala Court Embankment Road Kingsbridge Devon TQ7 1JN Lead Inspector
Judy Cooper Announced 13/04/05 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 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 Older People. 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. Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service Kahala Court Address Embankment Road, Kingsbridge, Devon, TQ7 1JN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01548 852520 01548 852520 Quay Court Care Centre Limited Mrs Sheena Jane Ford Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 28/09/04 Brief Description of the Service: Kahala Court is a large, detached house attractively situated overlooking the creek, less than half a mile from Kingsbridge town centre. There is an accessible, level garden area and an adjoining car parking area, and access to the home is via a steep drive. There is a large lounge and dining area and a secondary sun lounge, which is light and airy. There are nineteen single rooms and three double en-suite rooms although all are currently being used for single occupancy. All bedrooms have en suite facilities. The home’s environment is maintained to a high standard throughout the home. The home provides accommodation for up to twenty five residents who, in the main, remain mostly independent and able to take advantage of the nearby local community facilities. Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day. Several standard written feedback forms were received prior to the inspection from residents, residents’ relatives, families/friends and some other visitors to the home. Opportunity was taken to tour the premises, examine records and policies and talk with the manager, residents and staff as well as some visitors to the home. A senior management representative from the Court Group, of which Kahala Court is part of, was also present for some of the inspection. All of the residents were spoken with during the inspection. Staff on duty were also observed, whilst in the course of undertaking their daily duties, with some spoken with. What the service does well:
Kahala Court provides a comfortable, secure, well maintained environment, where residents’ individuality is encouraged and upheld. Basic residents’ rights, such as dignity, respect and privacy are also upheld and this was confirmed by the residents themselves, both in person and in written feedback to the Commission received prior to the inspection, as well as by residents’ relatives and other visitors to the home. The residents receive excellent meals, visitors are always welcomed and encouraged, various daily informal activities are made available and the local community is invited to visit the home when appropriate/desired. The home sees itself as part of the local community of Kingsbridge and the residents choose to support several local charities and worthy causes within the town. The staff team is well trained and therefore able to meet the needs of the residents, with the provision of appropriate training being constantly ongoing. One of the homes real strengths is the manager’s awareness of the need to ensure that the individual members of the resident group remain compatible with each other, and to this end the manager takes great care regarding the admission process to the home, taking into account the needs of both the current residents, as well as those of any proposed new resident. The residents confirmed that their opinions are sought in all sorts of aspects of the running of the home and that they felt very comfortable within the home.
Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 6 The standard of care is good with many of the staff members having been at the home for several years. The home, overall, has a comfortable, welcoming atmosphere, where residents are able to choose how they spend their time. What has improved since the last inspection?
The home has been successful in obtaining “The Investors in People” award (February 2005) and the manager has successfully completed her Registered Manager’s Award (April 2005). The staff training programme has been ongoing and has, so far, allowed 75 of the care staff to have successfully completed some form of NVQ training, in levels 2,3 or 4 as well as a variety of other appropriate in house and external training courses. Upgrading within the home, has continued with a further four en suite bathrooms having been refurbished, replacement of the glass dome in the sun lounge, repainting of the external window frames in the extension and a new larger television some new kitchen equipment provided. The home’s corridors have been redecorated.Some new soft furnishings generally throughout the home have also been provided, as well as new carpet to two bedrooms. Residents’ health and safety has been further protected by the provision of radiator covers in communal areas. (The Responsible Person stated that the Court Group now had planning permission to incorporate an existing attached chalet area into the existing care home. This will have the effect of creating three additional bedrooms and therefore the homes registration would then allow for twenty-eight residents to be cared for at Kahala Court). The owner, manager and staff are continually monitoring the quality of care given within this home and the named Responsible Person, or their representative, undertakes very thorough monthly quality assurance visits which is followed by a written report, confirming their findings. Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 8 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 Standards Statutory Requirements Identified During the Inspection Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 (6 is not applicable) The admission process continues to be well managed with residents’ needs explored and known prior to admission to the home. EVIDENCE: The home continues to maintain its statement of purpose and service users guide appropriately, with updated details being forwarded to the Commission, for the home’s file as any changes occur. By inspecting the records for a resident who has been admitted to the home since the last inspection, it was noted that a full and detailed admission procedure was undertaken, which ensured that Kahala Court was the appropriate home for the resident. The resident was able to confirm that they had been made to feel very comfortable. Also at the home, during the inspection, was a holiday stay resident who uses the home fairly frequently. It was noted that there were full details regarding this resident’s care needs and the resident was able to confirm that they are made welcome and felt comfortable during each stay at the home. The home does not provide for intermediate care.
Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 All residents are looked after well in respect of their health and personal care needs. The home’s medication systems are in order and the administration of medication fully accounted for. Residents are treated with dignity and respect and their individuality and independence maintained. EVIDENCE: Care plans contain all relevant details appertaining to providing for individual residents’ care. The care plans had been regularly reviewed with the resident and/or the resident’s relative or next of kin. The care plans contained full details of any medical needs of the resident, as well as any visits made by District Nurses, G.P’s or any other health professional. A district nurse was visiting during the inspection and it was noted that the District Nurse and manager had a good working relationship, with both communicating their viewpoints effectively. A G.P also visited and the same was noted. The manager and staff liaise with other professionals as required currently using the services of the Macmillan nurses and a visiting speech and language therapist.
Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 11 The home’s policies and procedures, regarding the administration of medication, were in order and the medication cupboard and medication records were found to be satisfactory. The home’s manager has recently changed the medication administration systems to a recognised monitored dosage system. It was noted that the duty manager in charge of administering medication was undertaking this correctly and signing for all medications given. There have not been any serious accidents to residents within the last twelve months. Staff are made aware of any medical updates and there was recent information, on the newly sited staff notice board, regarding feedback from a “falls” training workshop, attended by a management representative of the group. Some written comments received prior to and during the inspection included the following “No Strings, just too much good food. It is home from home. Long may it prosper. I am quite happy here”. “I/we/the family are very pleased with the treatment and care our family member receives at Kahala, everything is catered for and the staff are very pleasant and helpful, reflecting the good management”. Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Residents enjoy a peaceful, pleasant yet varied life at the home, with visitors encouraged and links encouraged and maintained at all times with the local community. Various informal daily activities, such as trips out and gentle exercise are made available and excellent meals are provided. Residents are enabled and encouraged to maintain as much independence as possible and are supported with any individual choices they wish to make/maintain. EVIDENCE: Staff undertake activities with residents both individually and as a group. Several of the current residents are relatively still independent and as such come and go as they so choose. On the day of inspection one resident was going out to a local social club. Many residents and their families used the words “excellent and happy” to describe the staff and the overall standard of their daily life. The home operates an open visiting policy and during the day several visitors came and went, some of whom I spoke with, whilst the visitor’s book clearly showed that the residents had many visitors at varying times throughout the day. The routines within the home are flexible to ensure that residents can choose how they spend their time. During the inspection a visiting hairdresser was in the home.
Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 13 There are regular residents meetings covering such agenda items as rooms, heating, handset call bells, activities, menus and gardening club etc. Most residents manage their own monies or families do this for them. The manager holds monies for five residents in a safe, and there were detailed receipts etc in respect of these, ensuring that those residents that do use this service can be reassured that their monies are being handled and kept appropriately and securely. A resident’s advocate was visiting during the inspection and she was able to confirm that the resident she visited was very satisfied with the home. All residents spoken with complimented the standard of food saying it was always of a high standard. The cook has been at the home for six years and has an awareness of all residents’ individual preferences. Any specific dietary needs are also well catered for. Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Arrangements for protecting residents and responding to their concerns are satisfactory. EVIDENCE: Residents’, visitors’ and staff’ comments confirmed that people feel comfortable discussing any concerns they may have with the manager and felt confident they would be addressed. The home’s complaint procedure was clear and was displayed in a prominent communal area of the home. It included the Commission’s name and address. The home has not received any complaints within the last twelve months and none have been made to the CSCI. The home continues to maintain appropriate, updated adult protection policies as well as a “Whistle Blowing policy” for staff and to which staff have easy access. Staff training in this area is provided during a staff member’s initial induction training within the home followed by regular updated training sessions. Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 Kahala Court is very comfortable, clean, warm and well maintained accommodation for the residents. EVIDENCE: My tour of the building showed that the accommodation continues to be maintained to a high standard, and as such presented as comfortable, well maintained, clean and welcoming. The owner continually maintains an upgrading programme that allows the home to provide a high standard of accommodation. Bedrooms had been personalised as desired with residents able to bring in personal items with them if they wish to. There are two lounge areas (one being a much used sun lounge area at the front of the home) and a dining room, which is currently sited on two levels. The Responsible Person informed me that it is her intention to provide a chair lift to four steps within a corridor running parallel with the dining room and open up a door that is not currently used, to allow additional easy access to the lower part of the dining room. The manager maintains the home’s fire precautions in line with the requirements of the local fire department. The local environmental health department recently visited the home and the manager stated that the visiting
Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 16 officer had been satisfied with the results of their inspection. The residents’ bedrooms looked very comfortable and had been individually furnished according to individual residents’ wishes, as residents had been able to bring items of their own furniture and possessions with them. The owner stated that the home would provide a suitable lock if requested by a resident, but that they are not provided as standard on admission. This is documented this within the home’s statement of purpose. The home has an Infection control policy and all areas of the home were odour free. The staff at the home have received praise from local District Nurses in relation to successfully treating a resident who contracted an infection whilst in hospital and is now free from the infection. Staff observe infection control policies in their day-to-day work with the residents, such as ensuring hand cleansing is a regular part of the care provided with hand cleansing materials easily and prominently available. The home’s laundry room is very clean, having appropriate laundry equipment to ensure that the home can cater for the laundering needs of the residents. There is a named responsible person in charge of ensuring residents’ laundry is laundered and returned to individual residents. Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Staff at the home are well trained and supported, and employed in sufficient numbers to meet the residents’ needs. EVIDENCE: Staffing levels were seen to be in sufficient numbers to ensure that residents’ needs could be met at all times of the day and night and it was noted that there were sufficient staff to both care for, and spend some time generally helping or talking with, the residents. Residents confirmed that they felt well looked after and that staff were always available if needed. Positive feedback was received from both the residents and their relatives as to the standard of care received, and the manner the care was delivered. Training continues to be well planned and supports the staff in providing for the varied needs of the residents. 75 of staff within the home hold an NVQ training award (level 2,3 or 4) and on the day of inspection five members of staff on duty had such a qualification with their experience reflected in the very positive comments received from residents during the inspection such as: “I’m well looked after, staff always help if I ring for help”, “I couldn’t be anywhere better”, “they have looked after me in every way, they have been so good”. A visitor also stated that her relative is well looked after and that the staff at the home ”really care”. Written feedback was received from 2 NVQ assessors who verify the staffs’ course work within the home. One stated “excellent home, very well managed, staff are also very friendly and caring” whilst the other stated “excellent home with very friendly staff. Always polite and helpful”.
Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 18 The staff file, in respect of the last member of staff to be appointed at the home, was looked at and evidenced that a full and detailed staff recruitment programme operates within the home, ensuring that staff appointed are deemed suitable to work with the residents. Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,38 The home is managed efficiently and well, with the manager being easily available and approachable. The home is providing a mostly safe environment for the residents. However to ensure that residents are fully protected from the risk of sustaining a burn from hot surfaces, the programme already in place to cover all such surfaces, needs to be completed. EVIDENCE: Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 20 The registered manager has been in post many years and is well acquainted with the day to day running of Kahala Court. She is respected and approachable, with all residents spoken to, saying how confident they were with her management of the home, one resident stated the manager is “top class”, whilst another said “the manager and her staff are excellent”. The home had an annual development plan, which had been made available to all staff, a copy being placed on the staff notice board. Health and safety issues are well managed within the home with the required records being made available with all being seen to be up to date, which confirms that residents are cared for in a mostly safe and secure environment. The home’s hot water supply is regulated where there are full bathing facilities. Risk assessments are in place for any other areas i.e. hand washbasins. These measures currently ensure that the current residents are free from the risk of scalding. Not all hot surfaces, accessed by residents, are yet protected although there are risk assessments in place, and radiators within communal areas are now guarded and it is the owner’s intention to cover the remaining radiators/hot surfaces in residents’ rooms, on a priority basis. Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4
COMPLAINTS AND PROTECTION 4 x x x x x x 4 STAFFING Standard No Score 27 3 28 x 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 4 x 3 x x 2 Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 22 yes Are there any outstanding requirements from the last inspection? 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 38 Regulation 13 Requirement The registered person must continue to ensure that all pipe work and radiators to which service users have access are risk assessed and guarded or have low temperature services.(Previous timescale of 29/03/05 not yey fully met). Timescale for action 13/10/05 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 Good Practice Recommendations Kahala Court D54-D07 S3726 Kahala Court V210786 130405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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