Inspection on 14/11/08 for Kenbrook

This inspection was carried out on 14th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kenbrook 18/12/07

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kenbrook Kenbrook 100 Forty Avenue Wembley Middx HA9 9PF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ram Sooriah     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Kenbrook 100 Forty Avenue Kenbrook Wembley Middx HA9 9PF 02089045818 Telephone number: Fax number: Email address: Provider web address: kenbrook@mha.org.uk Name of registered provider(s): Name of registered manager (if applicable) Marian Frances O`Hara Type of registration: Number of places registered: Methodist Homes for the Aged care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 52 Date of last inspection Brief description of the care home Kenbrook was built in the 1960s and used to be a rest home for retired British Transport employees. The home has been run by Methodist Housing Association from the 5th December 2007. The home is found on Forty Avenue and is easily accessible by car and by public transport. There is a bus service, which passes in front of the home. The nearest underground station is Wembley Park. There are shops at about five minutes walking distance from the home and one can catch a bus into Wembley Care Homes for Older People Page 4 of 32 Over 65 52 0 Brief description of the care home for a wider variety of shops and for local amenities. The building is spread over a relatively large area and consists of two floors. There are maintained gardens on all sides of the homes and there is a car park in front of the home. The living accommodation is found on two floors along long corridors with rooms on either side. Each resident has a room, with a washbasin and a small area for personal care. Toilets and bathrooms are communal and are found on each floor. T The home has changed its category of registration and is now registered to provide nursing care in all its beds. Previously there were a number of beds for residents with personal care needs. The home is run as a main unit, but the number of residents is divided into three groups, each of which is looked after by a team of care staff supervised by the nursing staff. The fees charged by the home is 550 pounds to 780 pounds depending on the needs of the residents. At the time of the inspection there were 42 residents in the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The previous key inspection took place on the 18th December 2007. This unannounced key inspection started on the 14th November 2008 at 1015 to 1730 and continued on Monday 17th November from 1015 to 1445. During the course of the inspection we spoke to eight residents, four visitors to the home, and seven members of staff. We toured some of the premises, looked at a sample of records that the home keeps, observed care practices and discussed the findings of the inspection with the manager and the deputy manager. The manager completed an Annual Quality Assurance Assessment (AQAA) about the service. The content of this document has been used where possible to inform this Care Homes for Older People Page 6 of 32 report. She also kindly provided the results of a satisfaction survey that was conducted by MHA in August/September 08. We would like to thank all the residents for their contribution and the manager and all her staff for their support and assistance during the inspection. What the care home does well: What has improved since the last inspection? The home has a statement of purpose and a service users guide that accurately reflects the ethos and aims and objectives of the service and of the organisation. The quality and content of the care records has improved. The previous computer records system has been abandoned and the care plan system of MHA has been adopted over the home. The home now uses a comprehensive format for the assessment of the needs of residents. This includes looking at the psychological and cognitive needs of residents. The assessment of needs also has a section to record the cultural and religious needs of residents. The records that are kept about the management of pressure ulcers are comprehensive and provides an accurate view about how the pressure ulcers are being managed. The home has to some extent improved the management of medicines. There are regular audits and medicines that have expired are promptly discarded. In cases when a variable dose of a medicine is prescibed, the actual amount of the medicine that is administered is recorded. The social and recreational needs of residents are appropriately assessed and recorded. Activities are provided in the home by staff who are now much more attentive to this Care Homes for Older People Page 8 of 32 aspect of the care of residents, than were noted during previous inspections. The home has a totally new call bell system that is clearly audible to staff when activated. The previous system was not very audible when it was activated. The home now uses the comprehensive MHA induction package which incorporates the common induction from Skills for Care. It has also implemented the quality management system of MHA to monitor the quality of the service that is provided in the home. The home had an up to date health and safety risk assessment at the time of the inspection. The standard of cleanliness in the home was also good. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives have the necessary information about the service to make an informed decision about moving into the home. Residents needs are assessed to make sure that the home only accept people whose needs can be met in the home Evidence: We had the opportunity to see the service users guide (SUG) and the statement of purpose of the home. These documents are produced by MHA and are individualised by the manager of each home to reflect the individual circumstances of the home. The SUG was on the whole comprehensive and a list of prices is also attached with the SUG and offered to residents or to their representatives. Residents, who we spoke to, told us that they have received information about the service and that they were given a service users guide. Care Homes for Older People Page 11 of 32 Evidence: We asked to look at the homes contract/statement of terms and conditions for residents. We were informed that not all residents have a contract yet and that the home has been addressing this issue by preparing the MHA contracts to send to all residents or to their representatives. The home uses the preadmission format for MHA. These have been completed for all new residents and were on the whole comprehensive and covered all the needs of people who were referred to the home including their mental health needs and the cultural and spiritual aspects of their lives. The preadmission assessments were carried out by the manager or by one of the senior member of staff when they visited residents prior to admission to assess the needs of the residents. The needs assessments that were carried out by the funding authority were available in the files of residents on most occasions. Residents who were in the home at the time of the inspection had primarily older people care needs and staff did not anticipate any difficulties in meeting the needs of the residents. The home has recently changed its category of registration to admit residents with nursing needs to all its beds. There is therefore an expectation that the number of residents with higher dependency needs will increase in the home in the long run. This however should not pose a problem to the home, as staff are suficiently experienced in this area. Residents in the home come from the Wembley/Willesden area and represent the multicultural population of the area. Staff also comes many different cultures and ethnic group, but is under represented in term of the white British population. However this is a fact of the current labour market for the care sector in London. Feedback from residents and members of staff however suggests that staff understand the cultural and religious needs of residents in the home and are sensitive to these. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care records of residents have improved and are now more comprehensive than before but could have been clearer when describing the action to take to meet the needs of residents. The healthcare needs of residents are met to a good standard. End of life care needs of residents are not always aidentified and recorded to make sure that appropriate plans could be put in place to manage the identified needs. The management of medicines was on the whole appropriate with few issues identified. Evidence: We looked at the care records of five residents. We noted that the home has introduced the care plan format that is used by MHA. Prior to that the home was using a computerised format of care plans. The MHA care plan format is comprehensive and is completed from a person centred perspective. It links the assessment of needs with the plans of care in a Care Homes for Older People Page 13 of 32 Evidence: comprehensive manner. We noted that plans of care were on the whole completed appropriately but there were areas, particularly with regards to plans of care that were not clear. Out of the five care plans seen, one was noted to be clear about the action to take to meet the needs of residents. We found that the other four care plans had plans of care for each identified needs of residents and that these contained information that was not always relevant to the particular need of the resident. It was therefore difficult at times, to identify the action to take to meet the needs of the resident. For example a care plan on mobility contained action to prevent pressure ulcers, when there was already a plan of care for tissue viability. The care plan for nutrition of a resident was written on a whole page, but apart from mentioning that the resident needed to be fed, it was not clear what type of meals was suitable for the residents, whether the resident was able to make choices for his meals and the support that the resident needed when being fed. The care plan of a resident for managing incontinence was also completed on a whole page but was not clear about the incontinence aid to use and the toileting regime. We also found that the information in manual handling risk assessments did not always match the information that is contained in the care plan. These did not always clearly identify the equipment to use for moving residents and sometimes contained different information about the equipment to use. Care plans were agreed with the relatives of residents and there was evidence of internal care plan reviews when relatives were involved. We were however able to talk to two residents, whose care plans were inspected, and they said that they were not involved in the care planning process. Inspection of their their care plans confirmed that. Care plans were reviewed at least monthly and there were daily entries in the progress notes. We were informed that senior care staff were being encouraged to take a more active role in care planning rather than leaving only the nursing staff to write in care plans. The home has introduced a format addressing the resuscitation status of residents and information about end of life care. There was also a care plan entitled spiritual support that should also address end of life care. We found that whilst the resuscitation status of residents were on the whole clear, we noted that care plans contained little information about the hopes, expectations and fears of residents for the future and their wishes and instructions about end of life care. The manager informed us that MHA was arranging staff training in this area to increase the Care Homes for Older People Page 14 of 32 Evidence: confidence of members of staff in addressing this area of care and to engage with residents and/or their relatives about this subject. Residents presented with a good standard of personal care. They all, including residents who were confined to their beds looked clean and appropriately dressed. All residents appeared appropriately groomed and male residents looked well shaven. We however noted, from the personal hygiene charts that either, residents were not receiving regular baths/showers or that the records were not well maintained. There were two residents in the home with pressure ulcers. Records were kept as required and we noted from the records that the pressure ulcers were healing. There were care plans, wound progress notes and photos of the ulcers to monitor their progress. The pressure relief equipment to use was also identified in the care records. The manager said that all residents were registered with a GP and the healthcare professionals records showed that residents were seen by the dentist, optician and chiropodist. Nursing staff said that residents were referred to other relevant healthcare professionals through the GP when this was indicated. We checked the management of medicines in the home. We found that medicines were on the whole managed to a good standard. Medicines were signed when received in the home and when administered. Codes were used when medicines were not administered. We found that there were audits of the management of medicines by the home and by Boots, the supplier of medicines to the home. It was noted that the instructions for the administration of some medicines were not always clear and at times says as directed. The manager stated that this issue has been raised with the GP and that the home has been supported by the chemist who has also noted this issue. The records were generally clear about the amount of medicines that is administered when a variable dose of medicine is prescribed. We checked the management of controlled drugs in the home and noted that good records were kept. We identified that a liquid medicine was missing the date when it was first opened to monitor the expiry date. The instructions for the administration of creams and external medication were also not clear about the location to administer these. A new member of staff might not know where to apply these if the locations are not identified. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst care and nursing staff make an effort to meet the social and recreational needs of residents, it is not always possible for the home to meet the individual interests and hobbies of resident as well as when an activities coordinator is employed. The provision of meals in the home is flexible and the meals are varied and wholesome to meet the nutritional needs of residents. Evidence: The care plans now contains a format to record the personal profile of residents and their life history. These were on the whole appropriately completed and contained information about the social and recreational needs of residents. The home does not have an activities coordinator but we were informed that there are plans to recruit a part-time activities coordinator for the home. We were informed that MHA is committed to ensuring that residents lead fulfilling lifestyles that suit their individual needs. There was however a plan for activities for the week that has been prepared by the deputy manager. On the first day of the inspection there was an exercise session in the morning and one to one sessions in the afternoon. One resident who talked to us Care Homes for Older People Page 16 of 32 Evidence: said that they are able to find something to do to occupy their time in the home. Another resident said that they thought that they would be bored out of their head but was surprised to find that there were things that they could do to occupy their time together with other residents. The communal activities that are provided in the home include art classes, exercise and tai-chi sessions. Posters also showed that outside entertainers have been booked to come into the home at least once every month. However these are communal activities and may not address the individual needs, hobbies and interests of the residents. One resident mentioned that they like old films and that they ask their relatives to bring them old films. Another said that they do not like the group activities too much but take part because there is nothing else to do. The findings of the homes satisfaction survey confirmed that the provision of leisure and social activities, including outings, is the area that scored less as compared to other areas of the service that the home provides. The individual needs, hobbies and interests of residents will definitely be best served when more resources are allocated to the provision of leisure and social activities such as when the activities coordinator takes up their post. This is also reflected in the provision of outings. The home used to have a mini bus that was used for outings, but this is no longer available. The manager is now trying to identify opportunities and resources to arrange outings for residents. For example the home has plans to arrange for transport for people to see the christmas lights. However there must be more opportunities for residents to go for outings and to be involved in the local community. The activities coordinator when in post should be able to address this issue. We noted many areas over the home that have been accommodated to provide seating facilities where residents could sit if they wanted a change of environment. There was a fish tank and a cat that also got the attention of residents. The home has extensive gardens and we were informed that residents like to sit outside when the weather is nice. The manager said that this was happening as recently as a week prior to the inspection when the weather was quite warm. The home has regular visits from representatives from the local church. The dates have been clearly identified and put on notice boards for residents to be aware of. The chaplain from MHA also visits the home once weekly to talk to residents, offering the opportunity for one to one interactions or in group, and to offer spiritual support where needed. We were informed that the chaplain is also able to support staff where Care Homes for Older People Page 17 of 32 Evidence: required. This is a welcomed initiative that can only improve the lives of people who live in the home. We observed lunch being served on the first day of the inspection. There was fried fish and chips, poached fish and mashed potatoes. For desert there was bread and butter pudding. We noted that other meals were prepared for residents such as salads and currys. Residents were asked about their choices and the completed sheet was available in the kitchen when the meals were being dished out. Residents were encouraged to come to the dining areas and the tables were appropriately prepared with table cloths, serviettes and condiments to make the environment congenial. A few residents had their meals in the communal areas or in their bedrooms. We observed that residents were assisted with their meals in a sensitive manner where required. All residents that we spoke to said that they have the opportunity to make choices about their meals and that they were satisfied with the meals that they were served. Resident from ethnic minorities said that they receive culturally appropriate food. The chef also confirmed that he does make culturally appropriate food for residents according to their wishes. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes complaints seriously and deals with these appropriately. Allegations and suspicions of abuse are also taken seriously and staff are aware of the procedure to follow if they hear about or suspect abuse. However a significant number of staff have not had training in this area. Evidence: The home has had four complaints since the last inspection. One of these was through the Commission. One of the main areas of concerns of people who complained, was the staffing levels. There was a perception that these were reduced following the take over of the home by MHA. All complaints were appropriately investigated and addressed within the timescales as per the homes complaints procedure. We were not very clear whether the complaints procedure or whether the policy was given to residents. The procedure contains the actual step by step guide about making a complaint while the policy contains the broad statements of the organisation about dealing with complaints. Care homes regulations require that the complaints procedure be offered to all residents or to a person acting on behalf of a resident if that person so requests. The copy of a service users guide that was provided to us contains some information about how to complain but does not contain the full complaints procedure and does not have the contact details for CSCI. The manager confirmed, when we asked for clarification, that the complaints procedure is available in the reception area Care Homes for Older People Page 19 of 32 Evidence: of the home and in the bedrooms of residents with the contact details of CSCI. The manager and the deputy manager have worked for many years in the home and were familiar with the safeguarding adult procedure of the local borough. There has been one allegation of abuse since the last inspection. That incident was reported to safeguarding adult team of the local authority according to the relevant procedures. There was evidence that all staff in the home are offered training on safeguarding adults. The format for the induction of new staff shows that an introduction to safeguarding adult and whistleblowing is also covered in the induction of new staff. We however noted, according to the training matrix, that 14 care and nursing staff have not had training in safeguarding adult. The home own figures suggest that the home was 31 compliant with training in this area. We spoke to three residents about what they would do if they were worried about the treatment that they receive in the home or if they witness other residents being ill treated. They said that they would let the manager know or the person in charge. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is kept clean and provides a homely environment for residents needs to be met. Evidence: The home has extensive grounds in the front, on the sides and at the back. We noted during the inspection that these areas were on the whole maintained to a good standard. The lawns were kept trimmed, the bushes and shrubs were trimmed and there were many flower beds that were still blooming. All residents that we spoke to said that they enjoy sitting outside when the weather is nice. There was a skip in the grounds in front of the home, where rubbish from bedrooms that have been redecorated, have been disposed of. The communal areas were appropriately decorated and furnished. We found that some items of furniture have been replaced. We noted that some of the chairs in the dining area were not impermeable and that staff were using continence sheets on these. These were removed when we discussed their use with the deputy manager, who said that the home inherited these chairs. We were informed that the home has plans to further replace furniture to ensure that these are suitable to the needs of the residents. We noted that the home has Care Homes for Older People Page 21 of 32 Evidence: embarked on a programme of redecoration. Nine bedrooms have been totally refurbished, including replacing the carpet. We found that these have been decorated tastefully. The corridor in that section of the home has also been redecorated. Although the bedrooms are not en-suite, there is a small washing area in the room that consists of a wash basin. Residents or their relatives bring personal items of possessions to personalise the bedrooms and to make these homely. A few residents had keys to their bedrooms that they lock when they go out. The home was clean and there were no odours. The laundry area was also visited and was noted to be on the whole tidy. The manager informed us that only residents clothes are washed in the home. We therefore concluded that the equipment that is available in the home is suitable to manage the amount of laundry that is produced in the home. All laundering equipment was working appropriately and we noted that these items of equipment were appropriately maintained. The standard of laundering was generally good but we found that the woollen clothes of a resident had not been washed appropriately and has caused it to shrink. The resident said that very often her clothes disappear and other peoples clothes come to her room. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides staffing in adequate numbers to meet the needs of residents. A significant number of staff were not up to date with mandatory training. The recruitment procedures were not robustly applied to make sure that residents were fully protected. Evidence: At the time of the inspection there were two trained nurses and seven carers on duty for a morning shift and two trained nurses and four carers for the afternoon shift. At night there were two trained nurses and three carers. As there were forty-two residents in the home at the time of the inspection, this level of staffing seemed to be satisfactory. The manager is always supernumerary and the deputy manager has some supernumerary hours. Ancillary staff are provided in adequate numbers to address catering, laundry services and cleaning. The home did not yet have an activities coordinator at the time of the inspection but we were informed that it plans to recruit one from next year (2009). We are looking forward to the time when one will be appointed as we think that this will add to the quality of life of residents. Care Homes for Older People Page 23 of 32 Evidence: We looked at the personnel files of five members of staff. We noted that all members of staff had an application form, job description and contract of employment. We found that one applicant completed an application form after they had been employed and that there was at least one reference addressed to whom it may concern. The work history of applicants was not always completed as close to the month as possible leaving the possibility of gaps in the employment history. New employees are offered induction according to the homes policies and procedures. We were able to see induction packs in the files of members of staff. The induction package was comprehensive and was tailored to the job that the person has been employed to do. It reflects the common induction standards of Skills for Care. The manager kindly provided us with a copy of the training and development plan. We were able to see that the home provides a range of training for staff, including training in clinical areas. According to the plan we noted that 23 members of staff out of 48 were not up to date with manaual handling training, 17 were not up to date with fire training, and 14 out of 39 care and nursing staff have not had training in safeguarding adult/prevention of abuse training and 9 were not up to date with this training. The home own figures suggest that the home was 58 compliant with manual handling traning, 63 compliant with fire training and only 31 compliant with safeguarding/protection of vulnerable adult training. The manager said in the AQAA that the home has all its carers (100 ) trained to NVQ level 2 or above. However the training matrix shows that there are 14 out of 26 care staff trained to at least NVQ level 2, that means that the home has more than 50 of its care staff trained to that level. The home has a computerised training system that can be used by all staff. The manager said in the AQAA We have developed our e-learning programme to enable staff to have direct and prompt training in many areas of their work in bitesize learning at times convenient to them. We saw a demonstration of this training and staff were able to to confirm that they can access this training (EL-box) on the laptops that are avalaible in the home. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager runs the home in an open and inclusive manner. The home has an effective quality management system to monitor the quality of the service that it provides. Residents money is managed safely. Health and safety issues in the home are addressed appropriately to ensure the safety of all people who use the service. Evidence: The manager has been in post for many years and has been registered since the inception of the Commission. She is closely supported by the deputy manager. She stated that she is also closely supported by her line managers from MHA. The manager is a nurse and has a qualification in management. She is fully aware of and is familiar with the needs of the residents that are accommodated in he home. Residents meetings are arranged every month and the programme for the meetings is Care Homes for Older People Page 25 of 32 Evidence: arranged for the whole year in advance. Relatives meetings are held every three months. Minutes of staff meetings were seen, suggesting that these are held on a monthly interval. We were able to see from the minutes of staff meetings that the manager discussed many pertinent aspects of the service with staff.These included issues that are mentioned in complaints and areas for improvement. Staff and residents said that the manager is approachable and confirmed that they regularly meet with the manager in meetings and that they have the opportunity to express their views. We also saw that a few residents were waiting outside the managers office to go and see her. All the residents that we spoke to said that they would approach management if they had any concerns. The home uses the quality management system of MHA. The manager stated that there has been a customer survey in August. The results were kindly provided by the manager for inspection. There are many audits that are carried internally, such as care plan audits, health and safety audits and medicines audits. The manager said that MHA carries out a main annual audit in all their services, and that this is due imminently in Kenbrook. Monthly visits as per regulation 26 are on the whole carried out regularly, but we were not able to see the September and July reports. The homes administrator is mostly reponsible for the management of residents money. There is a bank account that is managed by head office where residents personal money is deposited. The home also keeps a small sum of money for each resident, who has money with the home, for day to day expenses. The money for each resident in the home is topped up when this is running low by the manager/administrator requesting for more money from head office, if head office has money for the resident, or the relative/person who manages the residents personal finances. We wanted to see how much money each resident has in the bank, but the up to date figures for this was not available as head office has this information. We recommend that an update of residents money ( a statement) that is kept in the residents account be provided to the home by head office at regular intervals to provide information about the amount of money that each individual resident has in the bank. We checked the accounts of three residents and noted that the balance of money that was in the home was accurate and that receipts and appropriate entries were made when expenditures were made for residents. The home now has an experienced handyman. Prior to that the home used to share a Care Homes for Older People Page 26 of 32 Evidence: handyman with the other homes within the organisation. Records showed that items of equipment were maintained as indicated and that all safety certificates were up to date. There were LOLER certificates for hoists and lifts, gas certificates for gas appliances, portable appliances test certificate, an electric wiring certificate and a certificate to show that the water system in the home was being maintained to make sure that it was safe to use from a Ligionella contamination aspect. The home had a maintained fire detection system and there was evidence that this was regularly checked. A fire risk assessment and fire emergency plan were available for inspection. Records showed that there were weekly in house fire detector tests and monthly fire emergency lights tests. Fire drills were arranged at about three monthly intervals, including at night time. The deputy manager said that there are plans to check all the wheelchairs in the home, as we were unable to see records that this was happening. Water temperature was monitored at water oulets to which residents had access to, to make sure the temperature was not above 44 degrees centigrade. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 5 All residents must be offered 09/02/2009 a contract as soon as possible All people who live in the home or their representatives must be aware of their rights and obligations when using the service. 2 7 15 Care plans must clearly describe the action to take to meet the identified needs of residents This is necessary to make sure that residents needs will be met 09/02/2009 3 7 13 The care plan and manual handling risk assessment must be clear about the manual handling equipment and the manoeuvres to use to move residents. This is required to make sure that residents are moved as safely as possible. 10/02/2009 Care Homes for Older People Page 29 of 32 4 9 13 The instructions for the administration of medicines must be clear, including the administration of topical medicines. The date of opening of liquid medicines must be clearly recorded. To make sure that the management of medicines is carried out safely. 09/01/2009 5 11 15 The care plans of residents 09/02/2009 must clearly address the end of life care of residents. To make sure that the end of life care of residents will be met when the time comes 6 12 16 The home must provide a 09/02/2009 range of activities to suit the individual needs of the residents For residents to live fulfilling lifestyles 7 18 13 The home must ensure that staff receive training in safeguarding adults To make sure that all staff fully understand their role in safeguarding older people 09/02/2009 8 29 19 The home must ensure that 09/02/2009 the correct recruitment procedure is followed at all times. Each applicant must complete an application form in a timely manner and there must be a full employment history. References must as far as possible be from the last Care Homes for Older People Page 30 of 32 employer and must not be testimonies. To make sure that residents are fully protected by the employment practices of the home. 9 30 18 The home must ensure that staff are up to date with mandatory training such as manual handling, fire training and safeguarding adult training. To make sure that staff are competent to care for residents. 09/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 8 That residents are involved in drawing up and reviewing their care plans whenever it is possible for them to do that. That appropriate records are kept about the showers/baths of residents. Empty spaces may mean that residents have not received their baths/showers. The home must ensure that residents clothes are laundered to a high standard. We recommend that an update of the amount of residents money (statement) that is kept in the residents account be provided to the home by head office at regular intervals to provide information about the amount of money that residents have in the bank. 3 4 26 35 Care Homes for Older People Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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