Inspection on 06/05/05 for Kemp Lodge

This inspection was carried out on 6th May 2005.

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 18/01/06

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 L22 3XG Lead Inspector Julie Garrity Unannounced 6th May 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Community Integrated Care Helen Brook (not registered) Care Home 38 Category(ies) of OP Old Age (38) registration, with number of places Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 38 (OP) One named female out of category service user, under pensionable age. The Variation will cease once 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. Date of last inspection 14/12/04 Brief Description of the Service: Kemp Lodge Care Home is a purpose built facility that provides nursing care for older persons. 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 service users. There is a day centre on the grounds adjacent to the establishment.The Home is owned by a voluntary organisation Community Integrated Care (CIC) and has been operating since 1990, at the time of the inspection the Home did not have a registered manager, an acting manager John Pascal is in place and CIC is to recruit a permanent manager.The establishment 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 providers care for 38 service users. All bedrooms are en-suite with 24 single rooms and 7 double rooms. There are three small lounges and a dining room. The Home also has a relative’s area that provides drinks and has a notice board that supplies information regarding the Home or items of interest. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 9.30 am. The duration of the inspection was 8 hours. The manager Mrs Helen Cook represented Kemp Lodge throughout the inspection and all areas of the inspection and findings were discussed with Mrs Crook before the inspector left Kemp Lodge. Discussion took place with seven residents separately, four relatives, one visitor to the Home, eight members of staff and the manager. The inspector left residents and relatives questionnaires none were returned. A variety of records in the Home were viewed and a tour around the Home was undertaken. What the service does well: What has improved since the last inspection? The residents, relatives and staff have welcomed the appointment of a permanent manager. All individuals spoke with expressed a lot of confidence in the manager appointed and feel that her management style is very positive and encouraging to residents and staff. A new activities co-ordinator has been appointed. The activities co-ordinator puts the planned activities on the notice board for the attention of the residents and staff. The Home has had an independent quality assurance assessment and successfully achieved five stars from a five star assessment scheme, this is an excellent score. The majority of the care staff have now achieved a suitable qualification in care. Staff spoken with found the training positive experience and feel that the gained a lot of knowledge, which improves care for the residents. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 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 standard(s) 3 standard 6 is not applicable as Kemp Lodge does not provide intermediate care. There are good arrangements in place for residents admitted into the home on a permanent basis. However these arrangements do not extend to residents admitted for short stay (respite). A lack of information prior to admission prevents the staff from being fully aware of the needs of respite residents. EVIDENCE: Most residents receive a full assessment before being admitted to the Home. The assessment has good and relevant information that details the needs of the resident to be admitted. The home has an arrangement with the local Primary Care Trust for respite care. The information given to the Home before these residents are admitted is insufficient, any changes in treatment or condition is not forwarded to the Home or sought by the Home. Staff assess the resident as they return to the, but are not assessing the resident before they enter the Home and as such they are not able to determine if they can meet the needs of the resident or their impact on the other residents in the Home. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 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 standard(s) 7,8,9 There has been limited progress in improving the arrangements to ensure that the health care needs of the residents are identified and met. 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 resident’s 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: There are examples of excellent care plans, not all of the care plans are of an equal standard. Two residents had care needs 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. Informal communication is dependent of staff memories and verbal communication. Residents are at risk of not having their health care needs met if these informal systems break down. The care plans have become overly complicated and difficult to read. Residents confirmed that they rarely read their care plans or were involved in planning their care. Staff felt sure that they did provide measures to prevent pressure ulcer (bedsores) development but could not support this perspective. Staff Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 10 were unable to monitor pressure ulcers and determine if the treatment was effective or what changes in treatment may be needed. Inspection of the medications evidenced that medications were inappropriately stored and not consistently given in accordance with the prescription. One staff member explained that he had in fact dispensed a controlled drug without a witness to verify that the medication was given to the correct person. This is an illegal practice and places the resident at risk of receiving the medication incorrectly. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 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 standard(s) 12,13,14,15 Resident’s choices, decisions, needs and points of view are used to support them in making choices on a daily basis Social activities, meals and relatives support are well managed and in accordance with the residents wishes, and provided in pleasant surroundings. EVIDENCE: Residents and relatives spoken with were very happy with the Home. Relatives told that they are able to approach any staff member and discuss the care needs of their relative. Relatives have a very proactive support group that meets on a monthly basis. The Home provides visitors with their own facilities, information on the home and minutes of meetings. Residents and relatives explained that this approach encourages them to put forward their point of view and keeps them up to date with changes in the Home. The Home has carried out social assessments on residents, several were had good useful information regarding resident’s social needs and choices. However the majority of the records were incomplete. All residents spoken with were complimentary and enthusiastic about the range of activities available within the Home. There is a new Homes co-ordinator and as yet the opportunity to review the activities available to make sure they are, as the residents would like has not been taken. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 12 One resident said that “food was of an excellent standard and that he really enjoyed it”. Relatives also felt that food was of good standard and were complimentary with regards to the staff’s ability to ensure that residents were supported to have a good diet. Current menus reflect a variety of choices available. There is a menu-board available at the entrance of the dinning room so residents can be aware of what meals are offered. Menus and food requirements are frequently discussed with residents. Residents are asked on a daily basis what meals they would prefer to have from the menu. The cook also makes sure that all food items are well presented to encourage appetite. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 The home has formal complaints policies and procedures in place, however, complaints are not handled promptly, and this can lead to a lack of confidence in the service. Residents are not being appropriately protected as not all staff are aware of the means to raise any concerns that they have. EVIDENCE: There are appropriate procedures regarding the protection of adults available within the Home. Staff said that they have read these, unfortunately they have not signed the policies to say that they have read and understood. The Home has not progressed the confusion amongst the staff as to what constitutes a complaint or concern and precisely what approach is needed. There are a number of policies available. One resident spoken with was unaware of how to make a formal complaint. Several other residents felt that they would have no reason to make a complaint. CIC head office addresses resident’s complaints and this is not completed within 28 days of receipt of the complaint. Staff training records were all on individual files and as such it was not possible to determine quickly or effectively if all staff have received training in this area. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 The Home is light and airy, well maintained and pleasant to be in. Good levels of hygiene and cleanliness are provided. This is due to a good team approach from all staff. EVIDENCE: Examination of the kitchen, laundry and the building as a whole verified the resident’s point of view that the Home was clean and tidy. All of the bathrooms and toilets had soap and paper towels available to prevent cross-infection. There were cleaning schedules available for all areas that had been completed and were up to date. A number of bedroom floors have been replaced, carpets have been updated and bathrooms have new baths that the residents like. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 30 Sufficient numbers of staff are deployed to meet the needs of the resident’s, staff receive training, but this needs to be formally entered in their staff files. Additionally, there is no formal means to monitor staffing levels and a reliance on staff to say if they feel over stretched is not an effective way to ensure that resident’s needs are met. EVIDENCE: Resident’s, relatives and staff explained that there is enough staff available, to meet the needs of the residents. There is a stable staff team, the majority of staff have worked in Kemp Lodge for over 3 years. It is traditionally for the senior nursing staff to work along side care staff in care duties this allows the senior staff to undertake informal supervision of staff and to keep good relations with residents as well. The Home does not monitor the staffing levels available in order to make sure that there is sufficient staff available to meet the needs of the residents, staff and residents will say if they feel that there are not enough staff available. One resident said that “staff work very hard and that there was not always enough staff available”. Other residents explained that they thought there was enough staff in general, but mornings and evenings were very busy. Staff described a variety of training that is undertaken, however it was not possible to confirm that all staff have received the training that they need for their job roles. Staff training records did not confirm the training staff had undertaken and were not updated. There is no training plan that would clearly identify what training staff need to meet the residents needs. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 16 Given the inconsistency in care planning, medications and protection of vulnerable adults, there is a need for staff to be updated in the Homes policies and procedures. Two residents were “very pleased” with the care that they received and think the Home is “really good”. Relatives were confident that residents are “welllooked after”. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 38 A new manager has been appointed who has the confidence of the residents, relatives and staff. The lack of a permanent manager has affected the running of the Home. A good quality assurance assessment has been undertaken from which the manager will be able to plan the ways build on the strengths of the Home and to address any shortfalls. The shortfalls of inadequate risk assessments, fire doors propped open and not addressing the fire report from a year ago place residents, relatives, visitors and staff at risk. EVIDENCE: The Home has not had a registered manager for over 12 months a senior nurse undertook the role of acting manager as well as a full range of nursing duties. This arrangement prevented the acting manager from fully implementing their management duties. A new manager has now been appointed. An application form was given to the manager to complete and return to CSCI. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 18 Fire records demonstrated that alarm tests and drills were up to date. On the day of inspection the battery in the door-guard designed to keep fire doors open until the alarm sounds was not functioning. The Home should check these on a weekly basis. Four bedroom doors were inappropriately propped open. These present a serious risk in preventing the spread of fire should it occur. The Home had a fire officers visit in February of 2004, due to the lack of a consistent manager the maintenance team were not aware of the recommendations from the fire officer and subsequently that had not been done. A number of individual risk assessments in particular those for falls and smoking were out of date or inaccurate. Accidents within the Home have not been monitored and as such the manager can not identify those residents, areas in the Home or times of day that are a particular risk. Kemp lodge has undertaken an external quality assurance assessment from an external company known as RDB (Residential Domiciliary Benchmarking) from this they received top marks, of 5 stars in a 5 star scheme. A full report is produced from this review, which assists the Home in building on its strengths, and identifies areas for development. Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x 2 x x x x 2 Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 & OP 8 Regulation 15 (1) Requirement Care plans must be sufficently detailed to make sure that staff are aware of the actions that they need to take in order to deliver appropriate care. This is particularly important in relation to the two residents whose care plans were not up to date and reflective of their care needs. Pressure ulcers must also have suitable records that detail nature. treatment and progress of care. Controlled drugs must witnessed upon administration. 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) Staff must be made aware of how to deal with concerns and complaints and the policy and Timescale for action 06/07/05 2. OP 9 13 (2) 07/05/05 as agreed at inspection. 14/01/05 3. OP 9 13 (2) 4. OP 16 & OP 18 22 (1) (3) (4) 31/03/05 Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 21 5. OP 30 18 (1) (a) 6. OP 31 8 (1) (a) (b) (4) (a) (c) (i) (iii) (iv) (v) procedure reviewed to ensure that all complaints are dealt with, within 28 days. (outstanding from previous report) Staff training records must be updated to make sure that all staff have up to date training in particular, Protection of Vulnerable Adults, compliants, fire and medications. An application must be submit for registered manager. All fire door-guards should be checked weekly in order to ensure that they are functioning appropriately. Fire doors must not be inappropriatly wedged open and proper equipement utilised as detailed by the Fire Authority. The actions detailed from the Fire officers report of Feburay 2004 must be implemented. 06/08/05 7. OP38 06/06/05 as agreed at inspection. 13/05/05 as agreed at inspection. 8. 9. 10. 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 OP 3 Good Practice Recommendations All respite residents should have an assesament either in person or via the telephobe before admittance. Additional information from the main carer, either a family member, private care deliver or social services should be sought and used as part of the assessment. The manager should be satisfied that the Home is able to meet the needs of the resident before admission takes place. Review the current care planning system in order that it F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 22 2. OP 7 Kemp Lodge 3. 4. OP 14 OP 16 5. 6. OP 30 OP 38 7. OP 38 easily accessied, updated and understood by residents and staff. Up date the information availiable regarding residents choices and personal preferences regarding activities. Consideration should be made into making sure that all complaints are addressed within 28 days. Staff should sign to say that they have read and understood the policies and procedures within the Home regarding protection of residents and their rights. Formalise the momitoring of residents needs to make sure that staff availiable are sufficent to meet all the needs of the residents. Review the accident records and put into place the to mointor accidents to identify if there are any particular occasions, places or residents presenting a higher risk than others. Review the risk assessmenst 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 F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo 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. Extracts may not be used or reproduced without the express permission of CSCI Kemp Lodge F03 F53 S17245 Kemp Lodge V225001 060505 Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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