Inspection on 18/01/06 for Kemp Lodge

This inspection was carried out on 18th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kemp Lodge 01/06/07

Kemp Lodge 23/08/06

Kemp Lodge 06/05/05

Kemp Lodge 14/12/04

Kemp Lodge 21/06/04

Kemp Lodge 30/03/04

Kemp Lodge 23/04/03

Kemp Lodge 19/06/02

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

CARE HOMES FOR OLDER PEOPLE Kemp Lodge Haigh Road Waterloo Liverpool Merseyside L22 3XG Lead Inspector Mrs Julie Garrity Unannounced Inspection 18th January 2006 10:30 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 Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 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. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kemp Lodge Address Haigh Road Waterloo Liverpool Merseyside L22 3XG 0151 949 0826 0151 928 0641 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) www.c-i-c.co.uk. Community Integrated Care Mrs Helen Cook Care Home 38 Category(ies) of Old age, not falling within any other category registration, with number (38) of places Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service Users to Include up to 38 (OP) One named female out of category service user, under pensionable age. The variation to cease when the service user leaves the home. One named female out of category service user, EMI Personal Care. This variation is applicable only to the named service user, should the named service user leave the home the variation will cease to apply. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 18/01/06 Date of last inspection Brief Description of the Service: Kemp Lodge Care Home is a purpose built facility that provides nursing care for 38 older persons. The home is located in a residential area in the Waterloo, Merseyside area close to local amenities and public transport, such as local buses and a train station approximately 10 minutes walk away. The Home is built on one level in grounds that it shares with a sister home next door. The grounds are well maintained and accessible by the residents. The Home is owned by a voluntary organisation Community Integrated Care (CIC) and has been operating since 1990. All bedrooms are en-suite with 24 single rooms and 7 double rooms. There are three small lounges and a dining room. There is also has a relatives area that provides drinks and a notice board that supplies information of interest to the relatives. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day The inspector arrived at the home at 10:30 and left at 16.45 .The inspector spoke with 8 staff, the manager and deputy manager, the administrator, 5 visitors and 13 residents. The inspector completed the inspection by looking at the homes records, a tour of the building, formal and informal interviews and information from previous inspection reports. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas that needed covering were done so. Feedback was given to the manager and the deputy manager during and at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Daily care is delivered to a very good standard, however written records for care planning, wound care and medicines remain poor and are outstanding from the previous report. Staff detailed that rare staff shortages had contributed to weak record keeping. There have been three incidents in which staffing levels were below the needs of the residents, staffing levels are not formally monitored in order to make sure that the home operates at safe levels. There are four requirements outstanding from the previous report and additional requirement has been made in reference to maintaining good staffing levels. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 6 Inappropriately wedging open fire doors was addressed after the last inspection but has re-occurred on this report. The manager contacted the inspector after the inspection and detailed that the issues regarding fire doors and monitoring the care of a resident with a pressure ulcer had been addressed. 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. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 7 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 Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 8 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 the following standard(s): None of the standards in this area were fully reviewed at this inspection. Standard 6 is not applicable to Kemp Lodge, as it does not provide intermediate care. EVIDENCE: All residents have copies of their initial assessments available in their records. Residents spoken with were confident that staff were more than capable of meeting their needs. One resident said “they are really good staff, they know there stuff and are well able to do a really good job” another resident described their admittance to the home and how staff were able to make her feel “comfortable” and “welcomed”. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7, 8, 9, 10 Residents are treated in a dignified manner and with respect at all times. Care plans are cumbersome and present real problems for staff to be able to keep clear records of the actions that staff need to take to meet residents needs including monitoring of specific health care needs. Little progress has been made in meeting previous requirements regarding medications. These shortfalls place the residents at risk of being given incorrect care and incorrect medications. EVIDENCE: Residents and relatives spoken with spoke very positively of the care that residents receive. One resident said “the girls are lovely, I couldn’t ask for anything better”, another resident described the care received as “exceptional” and of “really good care”. A relative spoken with said “I can’t speak highly enough about the care, staff are courteous, kind and supportive on all occasions”. The staff dealt with the residents in a respectful manner during the inspection, efforts were made at all times to maintain the dignity of residents. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 10 Two residents had care needs for which they were being treated. These needs were not described in their plans. Discussions with staff suggested that they were aware of different needs of residents and were addressing them, even though there was a lack of clear plans and guidance. Staff are aware that the present care planning arrangements are repetitive, difficult to work with and not regularly updated. They have created a schedule to make sure that all staff update the care plans and CIC have reviewed the care planning arrangements in order to find ways to decrease the repetition involved. Staff felt sure that they did provide measures to prevent pressure ulcer (bedsores) development but could not support this point of view. Staff were unable to monitor a pressure ulcer and determine if the treatment was effective or what changes in treatment may be needed. The manager took prompt action to make sure that monitoring systems were put into place within 24 hours. Review of the medications showed that medications were inappropriately stored and not consistently given in accordance with the prescription. A member of staff was observed to leave a medicine trolley open on a main corridor and unattended. Instructions on medications were unclear and not consistently followed. Not all medications could be accounted for and this is likely due to poor and inaccurate recorded keeping. This remains an outstanding issue from a previous report and a pharmacy inspection for advice and guidance was arranged. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 11 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 the following standard(s): None of the standards in this area were fully reviewed at this inspection. EVIDENCE: Residents spoken with were happy with the activities available in the home and the support that relatives receive. There is a regular relatives meeting run by relatives and the manager makes sure that their views and suggestions are used to influence the running of the home. Presentation and choice of food in Kemp lodge is exceptional, extra efforts are made to make sure that soft diets are presented in a manner that promotes residents appetites and the cook monitors the food returned and alerts the nursing staff is any particular residents are not eating well. Residents were complimentary about the food with one resident saying that the food was “second to none, plentiful with lots of choice available”. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 12 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 the following standard(s): None of the standards in this area were fully reviewed at this inspection. EVIDENCE: The home has not received any complaints since the last inspection. A relative said they have “never had any cause to raise a concern or make a complaint. This is a really good home, there would never be a reason to make a complaint. One resident was noted to have unexplained bruising an accident record had not been completed, the GP had bore been requested and the Social Workers was not contacted. Several of the staff remained in need of Protection of Vulnerable Adults training. The manager detailed on 26/01/06 that these areas had been addressed. Staff training for Protection of Vulnerable Adults will commence from May 2006 with the assistance of Sefton Social Services. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19 Kemp lodge is decorated in a homely manner, that is welcoming and in accordance with resident’s choices. The home has not been redecorated for some considerable time and areas that were previously well-maintained are now showing signs of wear and tear. EVIDENCE: Kemp lodge is a purpose built home with all bedrooms, lounges, dinning room and facilities located on the ground floor. This makes access to the home very easy for the residents. There were a four bedroom doors that were inappropriately wedged open this has been a requirement on a previous report and was rectified after the last inspection. However this poor practice has returned. The manager addressed this within 24 hours. Resident’s bedrooms are personalised as they would wish and a number of bedrooms have had flooring replaced. The carpets in the main corridors have been in usage since the home opened 17 years ago and although they have been well cared for are now showing extensive signs of staining and wear and tear. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Residents are protected by good recruitment policies. A lack of up to date training records, including the induction of new staff, not monitoring staffing levels and not replacing absent staff has lead to the perception by the staff and the residents that the home does not always have enough staff. The home has on a few occasions worked at reduced staffing levels, which places both residents and staff at risk. EVIDENCE: Residents and relatives spoken with described the staff as “hard-working”, “very busy” and “rushed”. There have been three occasions in the last six months when staffing levels were severally reduced, on one occasion three staff were of sick and not replaced. The manager explained that Kemp Lodge has never used agency staff and did not want agency staff working in the home. The staff themselves said that they did not want agency staff to work in the home. There is no formal monitoring system in place that would review the occasions when staff were under pressure and to make sure that the risks involved in reduced staff were addressed. Staff training records remains out of date and it is not possible for the home to monitor that staff have received the training they need in order to complete their jobs competently. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 15 Staffing files viewed, showed that the staff had been subject to the relevant checks such as references, police checks and Protection of Vulnerable Adults prior to commencing work. One member of staff had been in post for 5 months but had been unable to attend an induction due to staff shortages. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 The manager is registered with CSCI and is fit to be in charge. Resident’s financial interests are safeguarded. EVIDENCE: The manager has experience of working for CIC and has managed other homes within the organisation. A deputy manager is also available in Kemp Lodge as the manager is responsible for the sister home on the site. Both managers are additional to the staff needed on a daily basis, which is good practice. The manager and the deputy manager have achieved the registered managers award and the manager is undertaking an MBA (professional qualification) in management. Staff, residents and relatives meetings are held regularly, the manager intends that minutes of these meetings will be freely distributed in the future. Events such as the treatment of scabies and staffing shortages need to be reported to CSCI this did not occur. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 17 The home is appointee for small number of residents. A computer system is in place that allows the residents to know how much money the home is holding for them. Small amounts of funds can be made readily available. Large amounts of money need to be ordered before they can be made available as the home keeps very little cash on site for security reasons. The manager would try to get residents funds to them the same day if it was something urgent. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 18 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 x 3 X X X X X x x STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X x Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 18/02/06 2. OP9 13(2) 3. OP30 18 (1) (a) Pressure ulcers must have suitable records that detail nature. Treatment and progress of care. (Outstanding from the previous report). The manager detailed within 7 days that this has been addressed. 07/02/06 Medications must be given as prescribed and only to the individual indicated on the label of the medication. All handwritten Medication Administration Records must be double checked and signed by both parties. These should include the amount of medication, date that it was received and label directions. (Outstanding from previous report) Staffing levels must be regularly 07/02/06 monitored to make sure that sufficient staff are available. Replacement staff must be made available in order to make sure that on the few occasions that the home has been under staffed safe practice can be maintained. The manager must report to CSCI all occasions when DS0000017245.V279715.R01.S.doc Version 5.1 Kemp Lodge Page 20 4. OP30 18(1)(a) 5. OP38 4(a,c)(i,iii -v) insufficient staff are available. Staff training records must be updated to make sure that all staff have up to date training in particular, Protection of Vulnerable Adults, complaints, fire and medications. (Outstanding from the previous report) All fire door-guards should be checked weekly in order to ensure that they are functioning appropriately. Fire doors must not be inappropriately wedged open and proper equipment utilised as detailed by the Fire Authority. The actions detailed from the Fire officer’s report of February 2004 must be implemented. (Outstanding from previous report) The manager detailed within 7 days that this has been addressed. 18/02/06 07/02/06 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 OP19 Good Practice Recommendations The home should be reviewed and areas in need or refurbishment and redecorating should be identified. A maintenance plan should be put into place in order to make sure that these areas are addressed and residents are aware of when and how this will occur. The member of staff identified as no under-going an induction should have these arrangement put into place and afforded the same opportunity as all new staff. Review the accident records and put into place the to monitor accidents to identify if there are any particular occasions, places or residents presenting a higher risk than others. DS0000017245.V279715.R01.S.doc Version 5.1 Page 21 2 3. OP27 OP38 Kemp Lodge 4. OP38 Review the risk assessments in place and make sure that they are kept up to date and reflective of the residents needs. With particular emphasis on risk assessments for falls and smoking. Kemp Lodge DS0000017245.V279715.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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