CARE HOMES FOR OLDER PEOPLE
Kendal Bank Quarr Gillingham Dorset SP8 5PB Lead Inspector
Trevor Julian Unannounced Inspection 4th & 19th January 2006 01:30 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 Kendal Bank DS0000026828.V276571.R02.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. Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kendal Bank Address Quarr Gillingham Dorset SP8 5PB 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) 01747 825666 01747 825002 care@kbc.gb.com Mrs Pamela Mary Halstead Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 0ne place for a named service user - category MDE(Mental Disorder [Elderly]) 26th August 2005 Date of last inspection Brief Description of the Service: Kendal Bank is located in an attractive rural area of North Dorset, five minutes away from the A303 trunk road and ten minutes away from Gillingham town, which is on the main Waterloo train line. The home is registered to provide care and accommodation to three older people with low care needs. The home overlooks a pretty garden, paddocks and fields. The service user accommodation is comprised of three single bedrooms, bathroom, lounge and a dining area in the kitchen all located at ground floor level. Kendal Bank is also the home of the proprietors and their family and a very homely, comfortable environment is provided Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection was started on the 4th January and concluded 19th January 2006. The visit was the second of the two statutory visits carried out during the year. The purpose of the visit was to monitor the key standards not assessed during the previous inspection and to investigate allegations made in an anonymous complaint. Before the visit, comment cards had been received for residents, visitors and healthcare professionals giving their views of the home; none expressed any concerns. During the visit, information was gathered through discussion with the residents, a member of staff, the owners, a tour of the premises and inspection of records. Further information was gained through discussion with healthcare professionals. The time taken on site was 6 hours, the time, including preparation, travelling time, inspection and report writing, totalled 18 hours. For the purpose of this report, the terms resident and service users are interchangeable. The residents were all independently mobile and were able to express their preferences. The inspection took a proportionate approach based on the low level of dependency and needs of the residents. What the service does well:
The home had care plans to inform the staff how the needs of individuals were to be met. The medication records were clear and up to date. Residents said they had annual checks from their GP when their medication was reviewed. The comment cards from healthcare professionals showed the owners maintain good contacts with the surgery and make appropriate referrals. The residents were very positive about life at the home. The residents enjoyed watching the birds visiting the bird table outside the patio door. One person was busy crocheting and had a number of completed pieces of her handwork were seen in her room. The residents enjoyed the large screen TV in the lounge. Two of the residents had regular trips out to visit their families and during the warmer weather, the owners took them to local events where they sometimes met old friends. The bedrooms seen had some items of furniture, photographs pictures from the residents’ former homes. The owners kept an inventory of the items brought into the home; the resident had signed the one seen.
Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 6 During both visits, the residents said the food was of a very good standard and they had plenty to eat and drink. One person had special dietary needs and this was accommodated within the menu. Information was provided for the residents and visitors about how they could raise complaints and included CSCI details. There was a separate utility area where the washing machines and dryers were located. The floor was tiled for easy cleaning helping infection control. Considering the care needs and the size of the home the staffing levels were appropriate. Residents described the owners and staff as kind and helpful they felt they were at home and appreciated the welcome given to their visitors being offered refreshments. The staff were also approachable, one resident had told a carer of an issue she had and the problem was resolved without any fuss. One member of staff had just returned to work in the home after a short break she said she had worked in many homes but said Kendal Bank was a “lovely place to work”, “it was homely” and “would be fit for her own mother”. Mrs Halstead had owned the home for several years and was very experienced; she had completed the required professional qualifications. There had been recent manual handling training. What has improved since the last inspection? What they could do better:
Accident reports were in place. However not all accident reports could be cross-referenced to the daily reports so the outcomes were not clear. The evening meal was served at 16:30 and the next meal was breakfast at 08:15. Mrs Halstead advised that food was available on request and that water was provided in their bedrooms. The maximum recommended gap between meals is 12 hours. There were no call alarm facilities in the bathroom or lounge. The infection control policy should be revised to inform staff how to manage different levels of soiled laundry.
Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 7 There were occasions when the residents were left in the home for short periods. This could have serious implications for the safety of the residents. The first aid qualifications were not up to date. Mrs Halstead was arranging suitable training to be given. 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. Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 8 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 Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 9 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): Not assessed during this visit. Please refer to the previous inspection report. EVIDENCE: Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 10 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 Care plans were in place to identify how needs were to be met. The home had good communications with local healthcare services to ensure the residents’ health was monitored. Medication was well managed and reviewed to ensure the residents’ treatments remained appropriate. Residents were treated with dignity to respect their basic rights. EVIDENCE: The records seen were up to date and showed generally good levels of recording. There was evidence that although accident reports were completed when there were falls these were not always cross referenced to the care diary. One person had restricted mobility, some aids had been provided to aid her independence, Social Services were arranging a review by an occupational therapist. The residents were all registered with one surgery, the residents
Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 11 said they had annual health checks, one resident had seen her GP on the day of the visit; he had arranged a referral to try to improve her mobility. The GP’s and a specialist nurse’s comment cards showed they felt the home managed the residents’ medical need very well and sought appropriate advice. The home had a visiting chiropodist who called at regular intervals but also attended on request. Medication was securely stored and the records were up to date. The medication administration records were produced in the home and checked by a second person. One person did have painkillers prescribed as needed. The resident said they were provided when she needed them, she said her medication was reviewed by her GP. All the residents said that Mrs Halstead took them to the surgery if they needed to see the GP. They all saw a visiting chiropodist. The residents said they were well treated and they were respected. They felt part of the family. Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 12 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): 12, 13, 15. The residents were encouraged to take part in their own hobbies and pastimes. Families and friends of the residents were involved to help them to remain in contact. The food provided encouraged the residents to maintain a balanced diet. EVIDENCE: The residents each described their weekly routines two people said they regularly spent days out with their families. One person said she was very content with her lifestyle and took great pleasure from watching the birds and other wildlife from the lounge, she added that the owners encouraged the birds by providing large amounts of bird food. Another resident had a birthday visit from the residents of her former home. One resident was busy crocheting squares for a blanket, the room had other items she had previously made. The room was well lit, as with the other residents she was satisfied with her lifestyle. Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 13 All the residents said they were able to receive visitors either in the lounge or in their rooms. They said their visitors were made welcome and always offered refreshments. One resident said she particularly enjoyed watching the horses, she added that during the warmer weather they would go out with the owners to horse events where she often saw friends and acquaintances. Resident’s bedrooms contained personal effects of the occupants. There were records of items brought into the home by the residents. One of the records was seen and it contained a signature of the resident. One person had some items stored in loft for safekeeping and to avoid risks associated with too much clutter. During both visits, the residents were very positive about the variety of the meals provided. They all said they liked traditional meals and their preferences were respected. They were seen having drinks during the day and they all had water in their rooms. The residents all said they had their own preferences for drinks one enjoyed cranberry juice; another enjoyed cappuccino coffee and the other milky coffee. The evening meal was served at 16:30. On the second visit, they were having cheese and crackers and cake served with a cup of tea. This does mean there is a gap of 15 hours between teatime and breakfast. National minimum standards recommend that there should be no more than 12 hours between meals. Residents said they do have fresh fruit, one person said she does buy herself fruit as a supplement. Environmental Health Officers inspected the home in April 2004. At that time, no requirements or recommendations were made. The home did not record fridge temperatures but there were thermometers in both fridges to monitor that the fridges were operating correctly. There were some items of food uncovered in the fridge but Mrs Halstead said that the food had been served for the residents at lunch and the remainder was for the family’s supper. Some items in the fridge appeared to be out of date; Mrs Halstead explained that this was because they had been recently taken from the freezer therefore the dates were not relevant. Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 14 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): 16 There was a procedure to inform residents and visitors of the home’s complaint process. EVIDENCE: The home’s procedure for making complaints was included in the service user guide. It had contact details for the Commission. Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 15 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): 22, 26. The home had some specialist equipment to assist the residents. The home was clean and warm providing the residents with a comfortable environment. EVIDENCE: There were mobility aids, a hoist and a lifting bath seat provided to aid independence. A referral had been made for an OT assessment to review the equipment provided for one of the residents. Each of the residents had a wireless call alarm in their rooms to use if they needed assistance. The bathroom and lounge had no call point. Conventional radiators heated the home; these were not guarded so they could pose a risk of burns to the residents. Information was given about topics to be included in the risk assessment; the assessments were not examined on this occasion.
Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 16 The house was clean; the utility room housed two washing machines and was home to the owner’s dogs. Part of the complaint identified concern about the owners’ dogs and associated hygiene issues. During the visit, the utility room was checked the tiled floor was dry and clean. One of the washing machines was only used for washing the dogs bedding. Mrs Halstead said she instructed the staff to follow the washing instructions for the individual items. One person had problems with incontinence and there were instructions for dealing with the soiled items, however, these instructions should be revised. The utility room could be accessed without entering the kitchen. The residents were fond of the dogs and added that the dogs rarely came into the home. Residents said the last time was resulted from the gate being left open. Mrs Halstead said she arranged for a person who looks after the dogs when she is away from the home. Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 17 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 The residents’ safety could be compromised if the home is left unattended. EVIDENCE: Mrs Halstead provided the majority of the care. The home employs two carers who cover daytime and weekends. Considering the mobility and care needs this level of staffing was appropriate. Mrs Halstead confirmed there had been two occasions when staff had left the residents alone. The residents said the staff were kind and helpful. One person said she was comfortable with the carers and that they did respond appropriately when she had raised a concern. The member of staff had recently returned to the home after a break for personal reasons. She had been delighted that there had been a vacancy as it was a “lovely place to work”. Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 18 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, 38 The home was well managed. The home’s procedures protected the residents from financial abuse while in the home. Generally the home’s health and safety systems protected the residents and staff from harm. EVIDENCE: Mrs Halstead had completed the required training to manage the home. The family had considerable experience of operating a small home. Mrs Halstead did not normally become involved with the resident’s finances although one person has needed increasing help from the owners. The matter
Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 19 had already been addressed and a friend of the resident was being nominated as the resident’s power of attorney. The owners and staff had recently attended manual handling training. The first aid training was out of date and Mrs Halstead was in the process of arranging for the training to be updated. Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X 2 STAFFING Standard No Score 27 1 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP7 OP15 Regulation 17(1) 16 (2) 1 Requirement The care records must indicate the action taken and outcome of any accident reports. The meals must be provided at regular intervals throughout the day. The interval between refreshments should not exceed 12 hours. The home must be suitably staffed at all times. Timescale for action 28/02/06 28/02/06 3 OP27 18 (1) a 28/02/06 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 2 3 Refer to Standard OP22 OP26 OP38 Good Practice Recommendations The owners should supply an accessible call system in the lounge and bathroom. The home’s infection control policy should be revised to inform staff of the procedure for minimising the risk of cross infection. The owner and staff should receive appropriate first aid training and regular updates. Kendal Bank DS0000026828.V276571.R02.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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