CARE HOMES FOR OLDER PEOPLE
Kathryn`s House Kathryn`s House 43-47 Farnham Road Guildford Surrey GU2 5JN Lead Inspector
Chris Bowman Unannounced Inspection 24th September 2007 11:00 X10015.doc Version 1.40 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 Kathryn`s House DS0000013687.V348515.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 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. Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kathryn`s House Address Kathryn`s House 43-47 Farnham Road Guildford Surrey GU2 5JN 01483 560070 01483 301490 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) Mrs Z Z Merali Mrs Denise Hoare Care Home 29 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (29), of places Physical disability over 65 years of age (1), Sensory impairment (2) Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. Of the 29 residents accommodated, up to 10 may fall within the category DE (E). Of the 29 residents accommodated, up to 1 may fall within the category PD (E) Of the 29 residents accommodated, up to 2 may fall within the category SI(E), as registered partially sighted. The age range of Service Users will be 65 Years and over. Date of last inspection 4th May 2006 Brief Description of the Service: Kathryn’s House is a large terraced house in the town centre of Guildford. The service provides care and accommodation for up to 29 older people, ten of whom have dementia. The accommodation is on four floors with a lift to access the upper floors of the home. The lower ground floor is accessible only by a staircase and therefore accommodates residents who are fully mobile. The home has an outdoor area at the rear, which has benefited from investment to enable residents to sit outside in safety and comfort. There is also a small area set aside for parking. Fees range from £380 per week for a shared double bedroom to £420 per week for a single bedroom. Hairdressing is charged at various rates and chiropody is a set charge of £8 per person. Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced site visit was conducted as part of a key inspection using the Commission’s ‘Inspecting for Better Lives’ (IBL) process. The site visit took place over six hours commencing at 11.00 am and ending at 17.00 pm and was undertaken by Ms Christine Bowman, regulation inspector. The registered manager, Mrs Denise Hoare was available throughout the day to assist with the inspection process. The providers, Mr and Mrs Merali were spoken with and the staff on duty were spoken with briefly and observed carrying out their caring duties. Introductions were made to a number of residents and throughout the day residents were spoken with and observed as they relaxed in the lounges, ate lunch and called in to the manager’s office to speak with her. Some residents were attending day centres, appointments with healthcare professionals and out for the day with relatives. Since the previous site visit, a major building work project had been planned to extend the home and improve the facilities for the residents. It was still at the planning stage, but a major investment of resources had been allocated to the project and an adjoining house had already been purchased. If the plans are approved the residents will benefit from specialist facilities, a safe garden, and a generally much improved environment purpose-built to suit their needs. A copy of the plans had been sent to the Commission for Social Care Inspection local office and this was viewed in conjunction with the site visit. The files of two people, who live at the home, were inspected including their assessments and care plans, risk assessments, medical information, activity schedules and menus. The recruitment process of two staff members was inspected and their training and development logs viewed. Staff rotas and the overview of the staff training, health and safety certificates and records and the complaints and compliments logs were sampled. A partial tour of the premises was undertaken and improvements to the environment carried out since the previous site visit were viewed. The atmosphere within the home was calm, the staff were cheerful, friendly and helpful and the residents’ demeanour was one of contentment. Eleven surveys completed by relatives, carers or advocates, eight by healthcare professionals and twelve by residents were returned and comments from these sources have been included in the report. The Annual Quality Assurance Assessment completed by the home and other information received and recorded on the inspection record since the previous site visit were also used in compiling this report. Thanks are offered to the management, the staff and the residents of Kathryn’s House for their assistance and hospitality on the day of the site visit and to all those who completed comment cards for their contribution to this report.
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
The home has looked at way of improving the introduction to the home to prospective residents by making sure that the person who completes the initial assessment is the same as the person, who introduces them to the home and is on duty when they move in to encourage the building of relationships. The maintenance issues in the laundry and downstairs toilets had been reviewed and remedial action taken in that the flooring in the laundry room and downstairs toilet had been renewed and was impermeable. Hygiene facilities had also improved in that moisturised anti-bacterial hand wipes were provided in the toilet and the laundry room was clean and hygienic. A lock had been provided to the toilet door to enable the residents to maintain their privacy and dignity.
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 7 The outdoor area had been refurbished to provide safe, accessible and pleasant surroundings where residents could enjoy fresh air and sunshine. Gates prevented traffic from driving past the dedicated space to the carport beyond making the area safe. An area of decking with large pots containing plants, hanging baskets, and garden furniture had been created for the residents to enjoy. A bedroom identified as having an offensive odour had been thoroughly cleaned, including the carpet, a new mattress had been purchased and pillows had been replaced. The manager stated that despite all efforts this problem continued to persist at times but the situation was much improved. Newly recruited staff whose files were sampled had received clear preemployment checks from the Criminal Records Bureau prior to taking up employment to safeguard the residents and their names had also been checked against the Protection of Vulnerable Adults list to ensure they could safely care for vulnerable people. Where a new member of staff had not received the Criminal Record Bureau check before taking up employment, a Protection of Vulnerable Adults First check had been carried out and the rules had been followed as set out in the Care Homes Regulations 2001(amended). The formal and documented supervision of the care staff had improved and evidence was viewed to confirm the manager was giving this support to the staff and also appraising their performance annually. Since the previous site visit the manager had received training to support this aspect of her role. The annual quality assurance audit now includes surveys to all stakeholders including relatives and healthcare professionals and relatives and representatives are invited to residents’ meetings. The responsible individual carries out regular monthly visits to the home and makes a report of the findings of the visits for the continuous improvement of the service. A new refrigerator had been purchased to ensure that the chilled food, which required refrigeration at or below 5 degrees centigrade, was safely stored. The window leading from the laundry room to the kitchen had been sealed to ensure there was no risk of infected material from the sluicing facility entering the kitchen via the window and an external fan had been installed in the laundry room for ventilation. A new lift had been fitted for the convenience of the residents. What they could do better: Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 8 The complaints procedure in the Welcome pack should inform the complainant better by including timescales for acknowledging the complaint and for when the complainant should receive a response. More information is also required to inform current and prospective residents about the charging and paying of fees as required in the Miscellaneous Amendments of the Care Homes Regulations, which came into force in July 2006. A review of the individual resident’s recreational, fitness and training needs taking into account their preferences and capacities and with particular consideration given to those residents with dementia, other cognitive impairments and mobility needs should be undertaken to ensure more satisfaction in this area. The environment had been adapted creatively but was not well suited to its purpose in that corridors were narrow, access was not well-adapted for people with mobility needs, some bedrooms were shared and did not have en-suite facilities and there were no spaces set aside for private visits with relatives or visiting professionals at the present time, however plans were in place to rectify this matter and major investment, including the purchase of the adjoining dwelling and professionally completed plans, had been set aside to facilitate this project. The use of commodes in shared bedrooms should be reviewed with respect to the privacy and dignity of the residents. A full employment history, an explanation of gaps in employment, reasons for leaving situations which have involved the care of children or vulnerable adults should be information required on the application form to ensure the right people are employed for the protection of the residents. An audit sheet containing relevant information with respect to the contents of the staff personnel files, the date of the commencement of employment, dates letters were sent and received and checks completed would be helpful in tracking the recruitment process. The Criminal Record Bureau website should be accessed for guidance on the recording, storage and destruction of CRB checks to ensure this sensitive information is only kept as long as necessary. The practice of wedging open fire doors must cease to protect the residents from potential harm. 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. Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supplies sufficient information to enable prospective residents to make a choice about the suitability of the service to meet their needs. Assessments are carried out prior to the offer of a placement to ensure the home is able to meet the needs of the prospective resident. The home does not offer intermediate care. EVIDENCE: All residents receive a Welcome pack, which includes the Statement of Purpose and the Service User Guide to inform them of how the home is run. The home is planning to include comments from current residents in the Service User Guide, to make it available in large print so that it is easier to read. The pack contained colourful photographs of the home and details of terms and conditions. Fees were also included, but details need to be more specific to comply with the amended regulation with regard to the service user guide. The complaints procedure in the Welcome pack should inform the complainant better by including timescales for acknowledging the complaint and for when
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 11 the complainant should receive the response. Eight of the twelve residents who completed surveys confirmed they had received sufficient information about the home before they moved in to decide if it was the right place for them. One resident commented, ‘I came to look at the home before deciding to move in.’ The manager in all cases carried out pre admission assessments. The preassessment form included some information with respect to equality and diversity including religion and food forbidden by the prospective resident’s religion cultural or other beliefs to enable the home to be prepared to cater for the individual’s needs. Prospective residents were asked about their nationality, but given the multi-cultural nature of British residents; the ethnic background of prospective residents might provide a clearer picture of the prospective resident and their possible diverse needs. Opportunities were provided for prospective residents and their relatives to visit the home prior to making a decision. The home intends to improve and to adapt the initial assessment form to take into account the Mental Health Capacity Act. The home has looked at ways of improving the introduction to the home to prospective residents by making sure that the person who completes the initial assessment is the same as the person, who introduces them to the home and is on duty when they move in to encourage the building of relationships. Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal care needs are well documented and plans are in place to ensure they are met. Safe arrangements are in place for dealing with medication to protect residents and staff. Every effort is made to ensure the resident’s privacy and dignity is respected but the limitations of the present premises prevent this standard from being fully met. EVIDENCE: Care plans in place on resident’s files were entitled person centred plans. Although they contained some of the personal information taken from the initial assessment, they were not written from the point of view of the resident and did not give details of how they specifically preferred to receive their care, their goals or their aspirations. Generalised instructions were included for the staff on how to carry out personal care tasks. The care plans could be more person-centred by including the details of how the resident’s social needs are to be met at the home including their individual access to leisure interests, hobbies, cultural and religious needs and how contacts with family and friends are to be maintained. Records showed that care plans had been reviewed
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 13 regularly each month and changes had been documented. A key worker system was in operation to give continuity of care to the residents and a point of contact for relatives and friends. One resident whose first language was not English and, who liked to converse in her first language, was supported by two staff members who also spoke and understood her first language and the manager stated, ‘this made her very happy’. 50 of the residents who completed surveys confirmed they always received the care and support they needed and 40 thought they usually did. One resident felt, ‘they didn’t often need any’, and another resident stated they sometimes received the support they needed, ‘but it was pretty good’ Appointments with health care professionals were documented in resident’s files and there was evidence of appointments with dentists, chiropodists, opticians, the community mental health nurse, district nurses and General Practitioners. The manager stated that the home had good relationships with health care professionals and that she never hesitated to seek advice from them. Five of the six health care professionals who returned surveys confirmed that the service always sought advice and acted upon it to manage and improve individual resident’s healthcare, and one thought they usually did. Comments included, ‘The care home manager or the staff request a district nurse to visit if they are concerned about wound care, frailty or poor health,’ and, ‘the home is good at requesting assistance for continence related issues.’ A relative commented, ‘The home is very good at keeping relatives informed about important issues and the manager was so helpful when my mother was admitted to hospital recently.’ Senior staff, who had received training, administered medication, which was mainly received in blister packs from a local pharmacy with whom the home have developed a good relationship, the manager stated. Controlled drugs were stored appropriately with accurate records kept, including a running balance and two signatures confirmed all movement of these drugs. The home kept good records of medication received and returned to the pharmacy, which were appropriately signed. The resident’s medication administration records were accurately completed, however there were no photographs of the residents to identify them. This would improve the system although it is acknowledged that only the senior staff, who have all worked at the home for a considerable length of time and, who know the residents well, administered the medication. The Skills for Care Common Induction Standards were used to inform newly appointed staff of their duties and to guide them on how to ensure the privacy and dignity of the residents is respected. Five of the six health care professional, who completed surveys, thought the care service always respected the individual’s privacy and dignity and one thought they usually did. Comments included, ‘The way the residents are brought to me and taken back after their treatment is done in a very caring manner,’ and ‘Where possible, the staff respect the individuals privacy and dignity but, due to the layout of
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 14 the house, this is difficult. We have requested on many occasions that a treatment room be installed to enable us to ensure the privacy and dignity of the residents’. One relative explained in his survey that, ‘All my mother’s clothes are clearly marked and it is annoying when some items of clothing’ go missing’ for months on end. It is even more upsetting to find my mother is wearing somebody else’s clothes which presumably were incorrectly delivered to her wardrobe.’ Another relative stated, ‘ the service could be improved by providing a private room where you can go to have private company and quality time to spend with the resident on their own.’ Two of the six shared bedrooms were viewed on the tour of the premises and both had been provided with curtains to draw across the room to screen the residents from view, but private conversations could easily be overheard and commodes were in use in shared bedrooms. The home cannot fully comply with this standard until the proposed new build has been completed. Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Efforts by the home to provide a programme of recreational activities do not suit all residents or satisfy their relatives. Contact with family and friends is encouraged and supported, and residents are 100 satisfied with the food provided. EVIDENCE: The weekly schedule of activities was posted on the notice board in the entrance hall and was accessible to everyone. The manager stated that a staff member, who was not working on the day of the site visit, was responsible for organising the activities and that discussions were held on a regular basis in resident’s meetings about the activities on offer. Skittles, softball, painting, manicures, bingo, dominos and card games, hairdressing, one–to-one time, attendance at day centres and religious services were included in the schedule. ‘One evening each week is set aside for sherry, nibbles and reminiscences, Sundays evenings often included a sing-a-long and one resident likes to play the harmonica, after Sunday lunch and an afternoon video or television’, the manager stated, ‘Seasonal and birthday celebrations take place regularly and at the moment ideas for the Halloween Party were in the process of being gathered. Last year there had been apple bobbing, ghost stories and dancing’.
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 16 Religious services were held at the home and some residents also attended places of worship in the community. ‘Relatives sometimes arrange birthday celebrations in the home and provide a birthday cake’, the manager stated, ‘and the dining room can be set aside, however, relatives are often very kind and like to include the other residents.’ Relatives also take residents out and one resident was spending a day in town with her sister on the day of the site visit’, the manager stated, ‘and one resident regularly visits his special friend who resides in a local nursing home.’ Of the twelve residents, who returned surveys, one thought activities were usually arranged by the home for them to take part in and eleven thought there sometimes were. Comments included, ‘ I don’t like joining in activities’, ‘I join in sometimes’, ‘I go to a day centre every day from Monday to Friday’, ‘I do my own artwork/hobbies,’ and ‘I don’t enjoy all activities.’ One relative commented, ‘Because of her physical condition, my mother is very sedentary. I still feel there are insufficient activities taking place to stimulate the less ‘active’ residents,’ and another relative wrote, ‘I would like my father to have the opportunities to take up new hobbies and activities. I am aware that he requires a lot of encouragement to partake and motivate himself.’ Relatives were welcomed at the home and a relative commented, ‘They look after the residents very well and they also make you feel very welcome when you visit the home.’ Another relative stated, ‘ the service could be improved by providing a private room where you can go to have private company and quality time to spend with the resident on their own.’ The cook had recently completed a National Vocation Qualification at level 2 and had learnt a lot about healthy eating, which had been incorporated into the menus, the manager stated. The residents had put forward the suggestion that cooked breakfast would be nice sometimes and this had been added to the menu. 100 of the residents who completed surveys confirmed they always liked the meals at the home. One resident stated, ‘They are very good.’ Lunch on the day of the site visit was toad in the hole, vegetables and potatoes followed by rice pudding. Residents observed eating lunch stated they were enjoying it. Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives and representatives are listened to and confident their complaints will be taken seriously and that the home will act upon them. Training and policy guidance inform the staff of how to protect the residents from abuse. EVIDENCE: 100 of the residents who completed surveys stated they always knew who to speak to if they were not happy and how to make a complaint. One resident commented, ‘I would speak to the manager, and another resident stated, ‘I don’t feel the need to complain.’ Six of the eleven relatives, who returned surveys, confirmed they knew how to make a complaint about the care provided by the home should they wish to do so. One relative commented, ‘I would go directly to the manager, who has always been very helpful and accommodating,’ and another relative stated, ‘I don’t think we need to use the complaints procedure as my father-in-law is very happy there.’ 70 of the relatives, who completed surveys confirmed the care service always responded appropriately if they or their relative raised concerns about their care. One relative commented, ‘I have raised concerns about my father’s care to the manager on one occasion and the manager responded quickly and appropriately. I have never made a formal complaint.’ Two complaints had been recorded by the home since the previous site visit and records confirmed they had been dealt with appropriately. The Commission for Social Care
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 18 Inspection had received no complaints about this home over the previous twelve months. The home held a copy of the local authority safeguarding adults procedures and a local policy had been completed following this guidance. The manager had not yet attended the local authority multi-agency training and was recommended to do so to ensure the home is up-to-date with local policy and procedures and aware of the roles of all the professionals. No referrals had been made since the previous site visit. Staff training records confirmed that the staff had access to the Protection of Vulnerable Adults training to inform them of how to safeguard the residents in their care. Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Present facilities adequately fulfil the needs of the residents in that the environment is well maintained and comfortable in most respects and plans are in place to radically improve the facilities to a much higher grade. The home is clean and hygienic. EVIDENCE: The home had originally consisted a row of Victorian terraced houses on a busy road leading to the centre of Guildford town, which had been adapted for use as a care home. Three floors high, with an elevated entrance, bedrooms in the basement, narrow corridors, shared bedrooms, no en-suite facilities or suitable private spaces for entertaining guests or to receive treatment from visiting professionals, the environment was not well-suited to its purpose especially for residents with dementia. However, the providers had consistently improved the facilities, had a programme of redecoration and renewal and had complied with requirements from previous site visits. Since the previous site visit, a major
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 20 building work project had been planned to extend the home and improve the facilities for the residents. It was still at the planning stage, but a major investment of resources had been allocated to the project and an adjoining house had already been purchased. If the plans are approved the residents will benefit from specialist facilities, a safe garden with an area laid to lawn and flowerbeds, and a generally much improved environment purpose-built to suit their needs. A tour of the shared facilities confirmed the home was well maintained and three dedicated sitting areas and a dining room were provided with comfortable and domestic furnishings and lighting. The two lounges at the front of the building had large windows and high ceilings, which made the rooms light and airy. Widescreen televisions and video equipment were provided in the sitting rooms and a number of residents were relaxing in all the rooms. One sitting room was dedicated to music and housed a piano, which, the manager stated, one of the residents enjoys playing. All the communal rooms were on the ground floor. If the building plans go ahead, plans show there will be communal rooms on all floors for the convenience of the residents, an activity room, a room for hairdressing and other treatment and a quiet room in which residents will be able to entertain their guests in private. The outdoor area had been refurbished to provide safe, accessible and pleasant surroundings where residents could enjoy fresh air and sunshine. Gates prevented traffic from driving past the dedicated space to the carport beyond making the area safe. An area of decking with large pots containing plants, hanging baskets, and garden furniture had been created for the residents to enjoy. The new lift, which was in the process of being fitted at the previous site visit, was in operation. Two of the six double bedrooms were sampled and curtains were in place to ensure privacy visually. The manager stated that positive choices had been made by residents to share bedrooms. However, commodes were in use in bedrooms and, whilst protecting the residents from some risks in seeking out toilet facilities at night, they are not conducive to comfortable living in shared bedrooms. Proposals in the new plans were for single bedrooms with en-suite facilities, with the exception of one double room with en-suite facilities. A bedroom identified as having an offensive odour at the previous site visit had been thoroughly cleaned, including the carpet, a new mattress had been purchased and pillows had been replaced. The manager stated that despite all efforts this problem continued to persist at times but the situation was much improved. The maintenance issues in the laundry and downstairs toilets had been reviewed and remedial action taken in that the flooring in the laundry room
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 21 and downstairs toilet had been renewed and was impermeable. Hygiene facilities had also improved by the provision of anti-bacterial hand wipes in the toilet. 50 of the residents who completed comment cards thought the home was always clean and fresh and 50 thought it usually was. One resident commented, ‘It is generally clean,’ and ‘They try hard to keep the home clean.’ The manager had completed an in-depth infection control course and this information had been handed on to all the staff. Comments from relatives included, ‘we are all very satisfied with the home. They could benefit from more space, but a major conversion will be starting soon,’ and, ‘I am pleased the care home are in the processes of trying to refurbish and develop and update the home’. A health care professional stated, ‘The staff are very caring to their clients, but the building is difficult, and it is not always appropriate for some client’s needs.’ Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Much improved recruitment procedures protect the residents, but more information is required at the recruitment stage to confirm the right people are subsequently employed. Adequate training and appropriate induction provide the staff with the skills to care for the residents. EVIDENCE: Staff rotas posted on the notice board showed that five staff members were on duty in the morning and four in the afternoon and two waking night staff were on duty overnight. The manager stated that the Residential Forum matrix had been used to calculate the required number of staff to residents ratio. The home also employed a cook, a relief cook and other domestic staff. The Annual Quality Assurance Assessment completed by the home confirmed that at least 50 of the staff held a National Vocational Qualification at level two or above. Newly recruited staff had completed the Common Induction Standards to ensure they were well prepared for the caring role. Newly recruited staff whose files were sampled had received all the preemployment checks prior to taking up employment to safeguard the residents and their names had also been checked against the Protection of Vulnerable Adults list to ensure they could safely care for vulnerable adults. Where a new
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 23 member of staff had not received the Criminal Record Bureau check before taking up employment, a Protection of Vulnerable Adults First check had been carried out and the rules had been followed as set out in the Care Homes Regulations 2001(amended). Personnel files sampled included two references, which had been received prior to the taking up of employment. The staff personnel files were bound to ensure the confidential documents were safe and the Criminal Record Bureau checks were recorded and stored separately, the CRB website should be accessed with respect to the destruction of these sensitive documents. An audit sheet containing relevant information with respect to the contents of the file, the date of the commencement of employment, dates letters were sent and received and checks completed would be helpful in tracking the recruitment process. The application form did not provide sufficient space to ensure important information with respect to new recruits was gathered. A full employment history should be required and reasons for leaving positions, which involved the care of children or vulnerable adults, should be recorded. Employment contracts and job descriptions were viewed on staff personnel files. The manager was aware of equal opportunities legislation with respect to recruitment and carried out the process fairly. Individual staff training and development logs confirmed mandatory training had been accessed in a timely fashion. Moving and Handling, Health and Safety including the Control of Substances Hazardous to Health, fire training, food hygiene and the Protection of Vulnerable Adults had been booked for all staff. The manager confirmed that staff do not deal with food until they have had the food hygiene training and do not use the hoist until they have received training and are confident in its use. The senior staff had completed medication training, First Aid and Infection control. Copies of certificates were held on staff files and some were framed and hung on the office walls. Some specialist training had also been accessed including Bereavement Care, Continence and Dementia. Eleven of the twelve residents who completed surveys thought the staff listened to them and acted on what they said. Seven thought the staff were always available when they needed them, three thought they usually were and two that they sometimes were. One resident commented, ‘I don’t usually need the staff’. A relative stated, ‘my mother is deaf. This makes communication difficult, but this is exacerbated when some of the care staff do not speak clear English.’ The manager was asked about the possibility of English lessons for staff, whose first language was not English and she stated that this problem was no longer relevant as the staff referred to have moved on and the home only recruits staff with good spoken English. Another relative commented, ‘my father has said he likes the staff at Kathryn’s House. I would assume from his comments that he feels comfortable with the staff and that they are helpful and assist him appropriately. Other comments included, ‘They are very caring and are very good at respecting the individuality of their residents,’ ‘They have a good personal relationship with the residents and they smile a lot,’ and ‘They look after the residents very well and they also make you feel very welcome
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 24 when you visit the home.’ ‘From my experience, staff seem caring and kind to my mother.’ ‘They do everything well’ A health care professional commented, ‘some of the care staff require training in pressure relief, catheter care and general skin care. The staff are all very kind and caring.’ Another health care professional stated, ‘I believe they do their best in sometimes difficult circumstances,’ and ‘the staff are kind and patient and the clients seem happy.’ ‘An overall caring and helpful staff team,’ was another comment from a health care professional. . Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 25 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed in the best interests of the residents. Their financial interests are safeguarded and their health, safety and welfare promoted with the exception of one area, which requires attention. EVIDENCE: The manager stated she had almost completed the Registered Manager’s Award and had attended training on the Mental Capacity Act, Non-abusive Psychological and Physical Intervention, Mental Health, Infection Control, Dementia and Appraisal since the previous site visit. Good support was available to her from the registered provider and the responsible individual, who also completed the statutory monthly visits and ensured the financial resources were available for complying with requirements set at the previous site visit, which had all been completed.
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 26 The annual quality assurance audit now includes surveys to all stakeholders including relatives and healthcare professionals and relatives and representatives are invited to residents’ meetings. The responsible individual had carried out regular monthly visits to the home and made a report of the findings of the visits for the continuous improvement of the service. Improvements, which had been made as a result of listening to the people who use the service included, more choice of activities, changes in the décor in lounges, the exterior improvement of the recreational area and requests to staff not to speak in their native languages in front of residents. Residents’ meetings identified that they would like porridge/cooked breakfast, which they are now enjoying. A resident stated that he would like to lay the tables for meals, which he is now doing and this has made a huge difference to him because he feels useful. Changes planned as a result of listening to the people who use the service was the acquisition of the site next to the home with a view to extending and totally upgrading the whole home to provide a garden area, better facilities, lounges on each floor, wider corridors and an activities room. If planning permission is agreed the work will be carried out in three stages so as not to disrupt the resident’s lives. One resident continues to control their own money, the manager stated, but most of the residents had support from their relatives and representatives in this respect. Secure facilities were available for the home to store money and valuables on behalf of residents, with records kept, and lockable facilities were available to residents in their bedrooms should they require them. The formal and documented supervision of the care staff had improved and evidence was viewed to confirm the manager was giving this support to the staff and also appraising their performance annually. Since the previous site visit the manager had received training to support this aspect of her role. The health and safety issues identified at the previous site visit had been rectified. A new refrigerator had been purchased to ensure that the chilled food, which required refrigeration at or below 5degrees centigrade, was safely stored. The window leading from the laundry room to the kitchen had been sealed to ensure there was no risk of infected material from the sluicing facility entering the kitchen via the window and an external fan had been installed in the laundry room for ventilation. However it was observed that fire doors in the corridors were being kept open with wedges, which is not safe practice. The manager stated that the recent inspection by the fire service had recommended attachments, which enable the doors to remain open but which automatically ensure closure at the sound of the fire alarms and that the home were waiting for the order to come through. Residents and visitors with mobility needs could only access the building through a side door leading through one of the sitting rooms and by the use of a small removable ramp, which is not ideal for those residents using the room or for those requiring to use it to access the building. The Control of Substances Hazardous to Health
Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 27 store cupboard was locked and the Annual Quality Assurance Assessment confirmed that Health and Safety maintenance checks had been carried out in a timely manner. A resident commented in the survey they completed, ‘The manager listens well,’ and a relative stated, ‘The manager is always helpful and approachable.’ Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation Requirement Timescale for action 22/10/07 2. OP10 OP13 3. OP12 4. OP19 5(1)(e) 22 The Service User Guide should 5(1)(bbinclude more information about bd) the charging and paying of fees and timescales for responding to complaints to inform current and prospective residents. 23(2)(i) Suitable facilities should be 17/03/08 provided to enable residents to meet with their visitors in private accommodation, which is separate from their own bedroom. 16(2)(n) A review of the individual 17/12/07 resident’s recreational, fitness and training needs taking into account their preferences and capacities and with particular consideration given to those residents with dementia, other cognitive impairments and mobility needs should be undertaken to ensure more satisfaction in this area. 23(2)(a) The physical design and layout of 17/03/08 the building in its present form does not meet the needs of all the residents. The elevated entrance to the home and the narrow corridors should be
DS0000013687.V348515.R01.S.doc Version 5.2 Kathryn`s House Page 30 5. OP21 OP10 12(1)(a)( 4)(a) Schedule 2 6. OP29 6. OP38 12(1)(a) reviewed to enable better access and movement for those with mobility needs. The use of commodes in shared 17/12/07 bedrooms should be reviewed with respect to the privacy and dignity of the residents. A full employment history, an 22/10/07 explanation of gaps in employment, reasons for leaving situations which have involved the care of children or vulnerable adults should be information required on the application form to ensure the right people are employed for the protection of the residents. The practice of wedging open fire 24/09/07 doors must cease to protect the residents from potential harm. 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 OP29 Good Practice Recommendations An audit sheet containing relevant information with respect to the contents of the staff personnel files, the date of the commencement of employment, dates letters were sent and received and checks completed would be helpful in tracking the recruitment process. The Criminal Record Bureau website should be accessed for guidance on the recording, storage and destruction of CRB checks to ensure this sensitive information is only kept as long as necessary. Kathryn`s House DS0000013687.V348515.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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
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