Inspection on 02/02/10 for Katherine House Rest Home

This inspection was carried out on 2nd February 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Katherine House Rest Home 17/09/08

Katherine House Rest Home 26/09/07

Katherine House Rest Home 14/02/07

Katherine House Rest Home 28/02/06

Katherine House Rest Home 24/09/05

Katherine House Rest Home 05/03/05

Katherine House Rest Home 17/08/04

Katherine House Rest Home 18/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Random inspection report Care homes for older people Name: Address: Katherine House Rest Home Cote House Lane New Cote Rest Home Westbury On Trym Bristol BS9 3UW two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Paula Cordell Date: 0 2 0 2 2 0 1 0 Information about the care home Name of care home: Address: Katherine House Rest Home Cote House Lane New Cote Rest Home Westbury On Trym Bristol BS9 3UW 01179873540 01179873631 acollins@merchantventurers.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : The Cote Charity care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is: 40 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 category: Old age, not falling within any other category - Code OP, maximum number of places: 40 Date of last inspection Brief description of the care home Katherine House Rest Home is managed by The Cote Charity and is registered by us to provide personal care to forty people, both men and women, aged 65 years and over. The home is set in secluded grounds a short distance from Durdham Downs in Bristol. Katherine House is purpose built and was opened in December 2009 with the people Care Homes for Older People Page 2 of 15 Brief description of the care home transferring to the new building from an older building on the same site. Previously the home was called New Cote Rest Home. The home is accessible with rooms split over two levels with a lift to the first floor. All bedrooms are single and have an ensuite. Katherine House is situated close to major bus routes and amenities. The City Centre is also a short distance away. The homes aims to provide a good, affordable, accessible care and services for elderly people. There vision of the future is to build on their current high standards of care maintaining a flexible, holistic and care for life programme respecting the independent lifestyle of elderly people. The range of fees is currently £404.96 to £550.45 per week and extra charges are made for chiropody, hairdressing, and toiletries. Care Homes for Older People Page 3 of 15 What we found: The purpose of the visit was to review the care to the individuals living at Katherine House Rest Home as concerns had been forwarded by a member of staff anonymously to Bristol City Council Safeguarding team in respect of general care, medication and training of staff. The visit was conducted over eight hours by Miss P Cordell regulation inspector, Mrs S Fuller a pharmacy inspector with the Care Quality Commission and Ms T Churchward a Contracts and Compliance Assistant for Bristol City Council. During the visit we spoke with people using the service, staff, the manager, the responsible person and the chairman of the New Cote charity. In addition we sampled care documentation for five people, staff records and other records relating to the running of a care home in accordance with the National Minimum Standards and the Care Home Regulations. The last inspection to the home was the 17th September 2008. This was a key inspection and the service was rated good. The Care Quality Commission completed an Annual Service Review in September 2009 and this further confirmed the service was continuing to provide good outcomes for people living in the home. A further visit was conducted by the Care Quality Commissions registration team as a major variation was submitted to extend the numbers of occupancy from 24 to 40 and for the individuals to move to a new purpose built building on the existing site. The outcome was the new build was registered on the 1st December 2009. During this period the service changed the name from New Cote Rest Home to Katherine House Rest Home. Individuals from the existing service moved into the new building on the 2nd December and they were joined by a further 16 people from a neighbouring care home on the 11th December 2009 which was closing. At the time of the visit there was 33 people accommodated in the home. One of the complaints raised was that individuals personal hygiene was not being attended too. Five individuals were spoken with during the visit. All were positive about the care and support that they were receiving including personal care. Individuals made positive comments about the new ensuites that were available to them and the bathrooms situated throughout the home making the delivery of personal care easier. All individuals seen appeared well cared for. Staff described the routine of the home both in the morning and the evening and it was evident that individuals were being offered a bath, shower or a wash in the morning and then a wash prior to bedtime. Records relating to personal care were not informative to fully demonstrate what was being provided. Care planning documentation had not been updated or reviewed since the move to the new home. Individuals that had moved from the service that had closed were using their previous care plans and associated risk assessments which did not take into account the change of environment or their changing care needs. One of the fundamental changes was that the previous homes were smaller. The Care Homes for Older People Page 4 of 15 complainant said that many of the individuals were being assisted in wheelchairs where previously these were not required. This was discussed with the manager and staff. From the conversations it was evident that this was the case for some of the less mobile people due to the size of the building and the distance of some of the bedrooms to the dining room. However, it was evident that individuals were given choice on how they moved around the home and encouraged to walk as far as they were able. It was not about making individuals dependent on staff but for the persons health and wellbeing. One person said that staff assist them using a wheel chair part of the way to the dining room and then they encourage them to walk. The person said they can move freely around their bedroom with the use of a zimmer frame and staff always make sure the zimmer frame is accessible. It was noted from the record of accidents there have been a number of falls for a few of the people living in the home. New risk assessments must be developed to assist in minimising risks to the individuals in respect of falls. Three of the risk assessments seen made reference to commodes being in bedrooms but this was no longer the case with the new ensuites. The provider confirmed in a response to this report that in fact three individuals have chosen to retain a commode in their bedroom however we spoke to one person where this was not the case as they were very happy with the ensuite. Another complaint raised about the care of the individuals was that those that were non verbal were being put to bed at 3.30pm. This was discussed with all staff on duty and the manager. It was evident from the conversations that no one is put to bed at this time unless they are unwell or choose too. However, staff spoken with said three of the individuals are assisted into their night wear at this time and generally go to bed about 7pm. This practice must be reviewed to ensure that it is appropriate and clearly documented in the plan of care where the individual or their family has made this choice. From talking with staff and people who use the service it was evident that individuals can choose when to get up and go to bed. Individuals spoken with during the course of the visit were positive about the transition to the new home. It was evident that they liked their new home and had found it more comfortable. Comments received about the manager and the staff were equally as positive. There was a lack of documentation to support the assessment process for the individuals transferring from the home that closed. The manager said that she had met with individuals prior to them moving to Katherine House and spoke with relatives and staff. Two relatives confirmed that they had met the manager prior to the 11th December 2009 but the move was completed very quickly due to the closure of the home. The manager said that some of the staff had transferred from the home that had closed with the hope that this would offer the individuals continuity of care. However, three of the eight staff have since left or had period of absences which has meant that the transition has been difficult. The staff shortages has meant that there has been a particular high use of agency and the manager and senior team leaders working on the floor providing care. There were no updated local authority care plans and assessments in respect of the move and it was not clear if a four week review had been completed by the placing authority. This will be followed up by the Bristol City Contracts and Compliance Assistant. The menu was seen during the visit as concerns were raised about the evening meal having little choice for more vulnerable people with tea consisting of a banana and a yogurt. The menu provided evidence that there was a healthy diet available and choice Care Homes for Older People Page 5 of 15 for breakfast, lunch and tea. The evening meal consisted of a light cooked tea (jacket potatoe, pasta, beans on toast etc), soup or sandwiches, fruit and yogurt. Staff were asked how they made the decision for individuals who were more vulnerable and want people had. It was evident from conversations with five staff that there was plenty of choice for individuals that need a soft diet. There were no individual records detailing what individuals were eating other than the menu which made it difficult to fully clarify. However, five people living in the home commented positively about the food. One person said there is always plenty and the cook is very good. Another said that this has got better since the move, and they have three courses including cheese and biscuits. The cook said there is always alternatives to the menu and she regularly speaks to people living in the home to ensure the menu is suitable. Part of the complaint was about the lack of hoists and manual handling training for staff. Two hoists were seen in the building that were in good working order, a third was being serviced on the day of the visit. All staff spoken with confirmed that there were sufficient aids to assist with manual handling and they had received training. Two new members of staff were spoken with and they confirmed they had received instructions on the use of the hoist and guidance given that this must only be used with two staff. Staff training records were viewed for five members of staff there was a lack of documentation to demonstrate that they had received manual handling training annually. For some staff this had lapsed for a period of two and three years. An opportunity was taken to speak with the manual handling instructor who said they provide training annually to all staff and was planning to complete this with the new staff including staff who transferred from home that closed. Better records must be maintained to fully demonstrate that manual handling training is completed. Generally the level of training was good and staff had attended a number of courses relevant to their roles and the care of the individuals. However to extract the information you had to look at individual staffs training records there was no overview to determine what training had been attended or what required updating. It is strongly recommended that a training matrix is developed as part of a quality assurance mechanism. Concerns were raised about the lack of staff numbers, induction, manual handling and fire training. The home was adequately staffed on the day of the visit. Staff said there is always a minimum of five staff working in the home. The manager and the responsible individual stated that this would be increased to six when the home is fully occupied. Due to high levels of sickness it was evident that the manager and senior care staff were covering much of the periods of absences along with agency staff. Two staff said that this has recently improved with the recruitment of new staff but it has been a difficult period for the home and the manager. From the conversations staff have felt let down by colleagues at very short notice but said the manager has been very supportive during this time. One member of staff said that some colleagues have found the transition from a smaller to a larger home difficult and the increase in people they support. The senior management team were aware of these difficulties and addressing them. Records were viewed randomly for five members of staff in relation to training and three in respect of recruitment. Whilst it was evident that the manager had completed a thorough recruitment process, records of induction were not being maintained for the staff that transferred from the home that had closed or for two newly appointed staff. The National Minimum Standards state that staff should be inducted in accordance with the Care Homes for Older People Page 6 of 15 National Training Organisation Workforce within six weeks. Some of the staff have worked in the home for six weeks and others three weeks. There would be an expectation that records were being maintained of what had been covered thus so far. Staff confirmed that they had received an induction on the care needs of the individuals, fire equipment, call bells, manual handling equipment and some policies and procedures. Two newly appointed staff were impressed with the support of the manager and her staff team and this was echoed by two of the staff that transfered from the home that closed. Manual handling training has previously been discussed. Fire records were viewed to determine training that staff have completed. There was no evidence of fire drills or training since the home opened in December 2009. Although this had been competed at regular intervals when the staff were employed in New Cote Rest Home. The manager said that fire training is being organised for all staff and they were waiting for a date from an external provider. An immediate requirement was left with the manager to address this in light that the building is new to all staff and that the lack of knowledge could potentially put individuals at risk. Routine checks had been completed on the fire equipment with records maintained. A tour of the home was completed. All areas were clean, comfortably furnished and homely. Individuals had been supported to personalise their bedrooms. On the day of the visit the responsible individual was meeting with the Building Contractors to discuss issues that have arisen since opening. It was evident that the Charity was committed to providing a good quality environment which is home for the individuals. There was a strong odour in one of the ground floor toilets which must be addressed. Domestic staff are employed to assist with the cleaning enabling the care staff to concentrate on supporting the people living in the home. It was noted during the tour of the building that cupboards storing chemicals for cleaning were unlocked again this was mentioned by the complainant. These were situated near the kitchen. This must be risk assessed to ensure that it does not pose a risk to the people living in the home. The cook immediately locked the cupboards to reduce the risk. Work on the gardens is still being completed which includes landscaping and developing a car park and a new drive way. Presently access is via a residential area. One of the existing buildings on the site was being demolished which would enable better access and a private drive way. From talking with the individuals and the staff it was evident they were looking forward to the summer and making full use of the outside space and the decked area to the rear of the building. This is accessed via large patio doors from the dining and lounge areas to the rear of the property and extends the full length of the building. One person commented that they would like a bedroom with a larger window and it was evident from talking with the manager that this was discussed with the family. During the tour of the building it was noted that the one of the aids to assist with toileting was not appropriate as it did not raise the toilet sufficiently for the individual. This was discussed with the manager who has agreed to make a referral to an Occupational Therapist. During our conversations with individuals one person said they were in pain but had not mentioned this to staff as they felt it was part of getting older. With the individuals consent this was discussed with the senior team leader and must be followed up with their GP to review their medication for pain relief. Care Homes for Older People Page 7 of 15 One individual said staff are very busy and respond when called but do not sit with them and chat. They were not over concerned as they had regular contact with family and friends. However, the person said an activity coordinator visits regularly and completes hand massages and nail care. Throughout our visit it was observed that the home had lots of visitors. The pharmacist inspector looked at the handling of medicines in the home due to concerns raised. People living in the home are registered with a number of local doctors practices. Medicines are supplied using a monthly blister pack system. At present no-one living in the home looks after their own medicines. Staff told us that people can choose to look after their own medicines if they wish to and are able to do so safely. We saw a policy for this.We spoke to one person who told us they were happy with how staff looked after their medicines. This person did look after their own prescribed cream so that they could use it when they needed it, sometimes helped by staff. We saw some medicines being given at lunchtime. A medicine trolley is available for each floor of the home so that medicines can be taken around the home securely. We saw staff asking people if they needed medicines that had been prescribed to be given when required. Staff signed the administration records when the medicines had been given. We were told that staff giving medicines had received training for this and that they are intending to access further training from their new pharmacy. However there is no clear system for checking that all staff involved with giving medicines are using safe practice and it is recommend that this be introduced. We saw that when medicines are given at night two people sign the administration record. The pharmacy provides printed medicines administration record sheets for staff to complete. In some cases a photograph of the person was also available to help ensure that medicines are given to the correct person. Action should be taken to make sure photographs are available for everyone. We saw that the administration records did not always demonstrate that medicines had been given as prescribed by the doctor. An immediate requirement was made concerning this to make sure that peoples health is protected. Some handwritten additions to the administration record sheet were of a poor standard. They were not signed or dated by the person writing them and had not been checked by a second person. One did not record the medicines strength or dosage instructions. Another was for some eye drops to be used twice daily but the preparation was an eye ointment and the label said to be used three times a day. This meant that the medicine was given incorrectly. Some medicines, particularly those for pain relief, had been prescribed with a variable dose but the amount actually given was often not recorded. This means that it is not clear from the records how much medicine the person has needed and received. In one case the medicine would not normally have a variable dose. Staff told us that the dose had been reduced from two to one and this is what they always gave. Action must be taken to ensure that the prescription is updated to ensure that this medicine is always Care Homes for Older People Page 8 of 15 given correctly. We also saw frequent gaps in the administration records particularly for creams and ointments and food supplements that had been prescribed by the doctor. Staff told us that the food supplements were often not needed because people were eating a better diet. For the creams and ointments it was not clear whether these were used, but not recorded, or whether they were no longer needed and not used at all. Several medicines prescribed to be given regularly for pain relief had frequent gaps in the record because they were given when required. One inhaler prescribed to be given twice a day was only signed once a day. The strength of the inhaler available was lower than the strength recorded on the administration record sheet. This means that this person may not be having adequate treatment. Ear drops prescribed for one person to be given three times a day were only signed as given twice a day. When medicines are prescribed to be given regularly, a reason must be recorded when they are not given. Codes are available to use for this purpose. Records for one person prescribed eye drops at night showed that they had been given in the morning on a number of days. Another person had been prescribed antibiotics three times a day for a week but these were sometimes refused and had been recorded as given every morning for 19 days. Staff told us that a nurse had advised them to give the medicine in this way, and they had recorded this in the daily record. However this instruction had not been written on the medicines administration record, signed by the nurse or checked with the prescriber. Records are kept of the receipt of medicines into the home and of their disposal. A treatment room is available for keeping medicines however we saw some poor practice. One cupboard containing medicines had no lock. A small cupboard, containing medicines needing additional security, had not been attached to the wall and was not locked. These medicines were moved to another locked cupboard during the inspection. Two medicine trolleys are used to store medicines and transport them safely around the home. These could not be secured to the wall, when not in use, because staff were waiting for the builders to attach suitable wires to the wall. The room itself was not always locked. This means that some medicines have not been kept securely and action must be taken to ensure that medicines are kept securely at all times. A medicines fridge is available. Staff told us that they had been advised to replace a cupboard used to store medicines needing additional security. We recommended that they first seek advice from the cupboards manufacturer to check its suitability. In conclusion areas of the complaint have been upheld in respect of medication, fire drills and training which could potentially put individuals at risk. However, feedback from people living in the home and relatives was extremely positive about the care, the environment and the smooth transition to the new home. It was evident that the service had grown very quickly. This was in part in response to supporting a local care home closure ensuring the individuals had a place to live. The timescales for growth were dictated by the closure. As well as moving the individuals from the home they also offered staff employment. It was hoped this would ensure continuity. However staff absence has made the last six weeks very difficult. The Care Homes for Older People Page 9 of 15 manager was aware that the documentation had slipped during this time and was in the process of developing a plan to address the shortfalls. Conversations with staff were positive although they acknowledged that the transition had been difficult due to staff sickness and absence. The manager and responsible individual said that this was being addressed and new staff were being employed. We will continue to monitor the service by following up the requirements. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 10 of 15 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 11 of 15 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered manager 09/02/2010 must ensure that medicines are administered as prescribed and that accurate records are kept of all medicines given by staff. If a regular medicine is not given a reason must be recorded. This is to ensure that medicines are administered safely and that peoples health is protected. 2 38 23 A plan must be devised 09/02/2010 demonstrating that fire drills will be completed with all staff within the next seven days and fire training within the next month. To protect peoples health in the event of a fire. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered manager must ensure that individuals are reassessed in respect of the move to Katherine House. Ensuring the information is current and updates the plan of care. 30/03/2010 Care Homes for Older People Page 12 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 2 6 15 For care plans and risk assessments to be updated to reflect changing needs. Ensuring care needs are being met, improve communication and ensure an open and transparent service is being provided. 30/04/2010 3 9 13 The registered manager must ensure that medicines are stored securely at all times. To protect the health of people living in the home. 15/02/2010 4 26 24 Ensure the home is free from 18/02/2010 odour. Investigate and take acton to address the odour in a ground floor toilet. Ensuring the home is free from odour. 5 30 18 To ensure that all new staff complete an induction with records maintained. Ensuring staff have the knowledge and the skills to complete their role. 11/03/2010 6 38 13 For staff to receive manual handling training with records being maintained. Ensuring people are safe and protected from harm. 18/03/2010 Care Homes for Older People Page 13 of 15 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 For staff to receive guidance in respect of what is recorded in daily records so that it fully captures the well being of individuals, what care and support was given. A daily record of care should be maintained. It is recommended that a system be introduced to check that all staff involved in giving medicines in the home are using safe practice. Action should be taken to ensure that medicines supplied in standard packs can be easily audited to check that they have been given correctly. Photographs of people should be available with their medicine administration records to help ensure medicines are given to the correct person. It is recommended that a matrix/over view of all staff training is developed to enable better quality monitoring and for the planning of future training needs. 2 9 3 9 4 9 5 30 Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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