Inspection on 10/06/09 for Kenmore Home - Leonard Cheshire Disability

This inspection was carried out on 10th June 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kenmore Home - Leonard Cheshire... 18/06/07

Kenmore Home - Leonard Cheshire... 18/01/07

Kenmore Home - Leonard Cheshire... 05/01/06

Kenmore Home - Leonard Cheshire... 23/09/05

Kenmore Home - Leonard Cheshire... 17/03/05

Kenmore Home - Leonard Cheshire... 07/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Kenmore Home - Leonard Cheshire Disability 100 Whitcliffe Road Cleckheaton West Yorkshire BD19 3DR Lead Inspector Paula McCloy Key Unannounced Inspection 10th June 2009 09:00 Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kenmore Home - Leonard Cheshire Disability Address 100 Whitcliffe Road Cleckheaton West Yorkshire BD19 3DR 01274 872904 01274 851996 john.hrynczyszyn@LCDisability.org www.LCDisability.org Leonard Cheshire Disability 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) Care Home 29 Category(ies) of Physical disability (29) registration, with number of places Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Day care - 5 Date of last inspection 18th June 2007 Brief Description of the Service: Kenmore offers nursing care for up to twenty nine people, aged 18 to 65 years, with physical disabilities. The home is a detached Victorian house set in its own grounds and has been extended to provide single room accommodation on the ground and first floor. The first floor is accessed by a passenger lift. It is situated in a residential area of Cleckheaton close to local amenities and easy access to the motorways. Kenmore is one of nineteen services run by Leonard Cheshire Services, a charity that provides services for people with a disability. Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is no stars – poor service. This means the people who use this service experience poor quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. We inspected the home in June 2007 and at that time it was assessed as being a good service. This inspection was carried out to assess the quality of care provided to people living at the home. The inspection process included looking at the information we have received about the home since the last key inspection as well as a visit to the home, which lasted approximately 7½ hours. During the visit we spoke to 4 people living in the home, 5 members of staff, the manager and 4 relatives. We also observed staff delivering care, looked at various records and looked around the home. Comment cards were sent to 10 people living in the home, 10 staff and 5 health care professionals; these cards provide an opportunity for people to share their views of the service with us. Information received in this way is shared with the home without identifying who has provided it. Four people using the service or their relatives on their behalf five members of staff and two health care professionals wrote to us with their comments. Their comments have been used in this report. What the service does well: Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 6 People living in the home have a good relationship with some of the staff, who understand their needs. There are some activities on offer to keep people stimulated. Relatives are made to feel welcome when they visit. People are offered a choice of meals. The home is clean and tidy. The care staff are well trained and 72 of them have a qualification in care. This means that they are qualified and competent to do their job. Staff enjoy working in the home In the surveys we asked people what the home does well. These are some of their comments: ‘The home has very good care assistants and nurses and the care is very good.’ ‘Pleasant, helpful staff.’ ‘The food is good.’ ‘We are made to feel welcome.’ ‘The staff work very hard, they are always happy and nothing is too much trouble.’ What has improved since the last inspection? The service has deteriorated since the last inspection in June 2007. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 7 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can get written information about the service so they can see what the service has to offer and if they think it is suitable for them. Staff do assess people before they move in, however, there is no guarantee that the home will be able to meet their needs. EVIDENCE: There is a service user guide and brochure available. This means that people can get written information about the home and the service it offers if they are thinking of moving in. We looked at the records for two people that had moved into the home recently. We could see that staff had assessed them before they moved into the home. Both people require a lot of care and support from staff and arte very dependent upon staff for all of their personal needs. Whilst we think that staff have the ability and equipment they need to care for these two people appropriately, we do not think that staff have taken into consideration how meeting their needs would impact on people already living Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 10 in the home and if everyone’s needs can continue to be met within the current staffing levels. (see section on staffing) Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are not planning people’s care properly. This means that they are not receiving the care and support they need. EVIDENCE: We looked at two care plans because we wanted to see what individual needs had been identified and what action staff have to take to meet these needs. We found one care plan was in the process of being completed. This person had moved into the home 6 days before this inspection visit and their care plan was still in the process of being written. We asked the manager about this. He told us that the hospital were keen to make the discharge and that he felt pressurised into taking this person quickly. He assured us that the equipment that this man needed was obtained prior to the admission being made but that the care plan was still in the process of being written. It is important that Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 12 when staff have completed their assessment that a care plan is put in place as far as possible before a person moves into the home. This will make sure that staff are aware of people’s needs and what support they will need to offer. We felt that staff had not addressed the following areas of care and support sufficiently: There were specific risk assessments that were not in place. It was unclear from the care plan if this person was paraplegic or quadriplegic. This person was being nursed in their bed room. It was not clear from the care plan how this had been agreed with the person or when this arrangement would be reviewed. The nutritional risk assessment identified that this person was at high risk of malnutrition. Having made this assessment staff had identified that the nutritional risk assessment should be reviewed in 3 months. There was an entry in the daily records that staff were having difficulty with some of the remarks that were being made by this person. There was nothing written down to tell staff what they should do or how they should respond in future. Five days after this person was admitted a member of staff recorded in the daily records that they had tried out different eating utensils to see which ones the person could manage best with. All of these areas should have been part of the planning prior to admission. Without proper assessment and planning there is no assurance that staff will be able to meet people’s needs. The other care plan we looked at took 90 minutes to read. It was difficult to find information quickly about this persons needs. (see section on personal and healthcare support) We talked to some staff who were working extra hours to try and bring care plans up to date. They agreed that for any new members of staff or agency staff it would take them a long time to find out from the care plan exactly what care and support was required. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16 & 17 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are activities available to keep people stimulated and some people are active in the community, however, there are some people who do not have any planned social support. Meals are good, but mealtimes are not a social occasion. EVIDENCE: There are some people living at the home that enjoy a range of activities and are involved in going out on trips, to day centres and church. The home also organise trips out shopping and visits to places of interest. For other people their opportunities for personal development seem to be very limited. For example we looked at the care plan for one person who has lived at the home for approximately 11 months. There was an entry on his care plan in Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 14 December 2008 that stated ‘awaiting a volunteer to take home out.’ We talked to staff about this. They told us that he didn’t have a volunteer. They did tell us that for a period of time this man had one to one support because he was leaving the building. Staff said that they used this time to provide a range of activities for example playing on the play station with him and watching DVD’s. This person’s mobility has now deteriorated and he no longer receives one to one support. We looked at the daily records for the last 10 days and could find no evidence of him taking park in any activities or outings. On the day of our visit he spent most of the day sitting in the dining room. There is an activities co-ordinator who works 5 days per week between 10am and 4pm. There is an activities room in the basement and the manager is in the process of creating another room on the ground floor so that it is more accessible for people. The list of activities on offer is displayed in the hallway. We spent most of the morning in the lounge. The television was on and one person was sat there all morning. Two other people joined her later on in the morning. None of them were watching the television. The only interaction they had with staff was when staff brought someone into the room or when the housekeepers came into clean. One person had been to the hairdresser but apart from this there was nothing in the way of stimulation or activity being provided. We talked to staff about this they agreed that they felt more should be on offer for people, but they do not have the time to spend with people. All of the relatives we spoke to said that staff make them feel welcome. We could see that relatives were visiting in the communal areas or in bedrooms if they wanted privacy. We made the following observations about meals and meal times: During the morning no one sitting in the lounge was offered a drink. Some people were making drinks themselves in the dining room and relatives were also making drinks. We saw one person having her breakfast in the dining room at 11:20am staff said this was because she had been to the hairdressers. A knife, fork and spoon were set out on every table. People who required special cutlery were given this when their meal arrived. We asked the manager why the place settings weren’t automatically set with people’s cutlery. He told us this was because people could sit wherever they wanted, but did concede that people tend to sit in the same places. At 12:15 there were 10 people in the dining room. Two members of staff were assisting two people with their meal. There were a further 5 people who had been given food. One person was struggling to eat a jacket potato with just a fork. No one went to assist him. One person was well supported by a member of staff with her meal. The carer had everything ready and they had a really good chat over lunch, which made it a very social occasion for the person concerned. At 12:25 there were still 5 people without any food. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 15 At 12:53 the last person was served with their meal. He had been sitting at the table waiting since 12:00. The only people who had a cold drink with their meal were people whose relatives were there to assist them. The meal time was disorganised and some people had to wait a long time for their food. People we spoke to said that the food was good and that they get a choice of meal. There are at least two choices for each meal and other options are available if people want them. The menu is not on display. We asked the manager about this. He told us that it is not the organisations policy to use a menu board the menu. We think it would be helpful for the menu to be displayed prominently so that people can see what all the options are. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s healthcare and personal support needs are not being met. EVIDENCE: We found moving and handling plans that set out what equipment staff needed to use to transfer people safely. One of the plans we looked at stated that this person was now not mobile and had been assessed by wheelchair services. We saw that this person was in his wheelchair during our visit. When we spoke to staff they told us that this man gets up at night and goes to the smoking room for a cigarette. We could see that this person had fallen on a number of occasions and that their mobility was deteriorating, however, the care plan does not accurately reflect the current situation or agreements about when and for how long the wheelchair should be used. It is important that people are able to be as independent for as long as possible and that appropriate support is offered to keep people mobile. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 17 We talked to people living in the home and relatives about the flexibility of routines in the home. They told us that if they ask to get up by a certain time because they are going out that this happens, however, they also felt that the home is short of staff and that they have to wait longer than they would like at times for staff to support them. People gave examples of having to wait to get out of bed, breakfast being served an hour before lunch is due and people being left on the toilet for longer than they would like. Some relatives also thought that staff did not pay enough attention to detail. They mentioned people having dirty spectacles. We also noted the following areas that would support this observation: Wheelchair straps were dirty and covered with food, one persons hair looked as if it hadn’t been combed it was very flat at the back, one persons personal hygiene needs had not been met and another person’s wheelchair table was dirty. We could see from the care plans that people received health care support from a range of health care professions for example GP’s, tissue viability nurses and speech and language therapists. Details of visits are recorded together with the advice given. One of the care plans we looked at showed that staff had not followed the instructions from the GP. The GP had been contacted as this man was loosing weight. He asked for him to be weighed weekly, the records show that although he has been weighed staff have not done this on a weekly basis. We also saw in the records that the same person was seen by a dentist in September 2008 and the care plan states that he should have regular check ups. In the care plan staff have written in April 2009 ‘teeth have some plaque/offensive.’ No action has been taken to arrange another dental check up. Staff must make sure that they follow advice from GP’s carefully and that care plans are explicit about when follow up appointments need to be made. For example dental check ups need to take place every 6 months. In the surveys staff told us that communication could be better. They made the following comments: ‘We don’t always get the right information.’ ‘We need better communication between teams and individuals.’ It is important that staff are kept informed about people’s needs and their care otherwise they don’t know what support to offer. In the other care plan we looked at the tissue viability nurse had provided staff with a treatment plan for one person who has numerous pressure sores. We could only find a record of two of the pressure sores being dressed. We also noted that this person had been assessed as being at high risk of malnutrition, but staff had only asked for this risk assessment to be reviewed in 3 months. Staff must make sure that they record all of the dressings they apply so it is Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 18 clear they are following the advice from the tissue viability nurse. Staff also need to be clear that anyone assessed as being at ‘high risk of malnutrition’ needs to be monitored closely to make sure that this risk is reduced. We observed part of a medication round. The nurse we observed was from an agency. Most of the medication records are prefaced with a photograph although there were no photo’s of the two people whose care plans we examined closely. The nurse was asking relatives and staff who people were. She brought one person her liquid medication in a large pot with a spoon. The person wouldn’t accept the medication. One of the care staff explained to the nurse that this person liked her medication in a small pot so that she can take it independently. It would be helpful if details were included with the medication administration records of how people like to have their medication administered. There should also be a photograph of everyone to help new or agency staff to identify people. In January 2009 the home notified us about a shortfall in medication. We looked at the medication records for the two people whose care plans we had looked at. We found the following: One person is supposed to have bladder washouts everyday. The medication administration records had not been signed for three days. This means that he did not receive this treatment. One person is prescribed regular medication to help them go to the toilet otherwise there is a risk of constipation. We saw from the care plan that they had been to hospital in April because of this. The care plan also states that constipation causes this individual to suffer from nausea, occasional vomiting and increases the risk of agitation. We looked at the records and saw that for ten days staff had made no record of if this person had had their bowels open. On the medication administration records staff had frequently recorded that medication had been refused. No further explanation had been given. It is very important to this persons’ wellbeing that they do not become constipated. It is not enough for staff just to record “refused” in relation to this medication. They must indicate why this is the case. For example, “refused” or “not required” or that they have discussed with the person why they should take the medication. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are not being dealt with properly and people living in the home are not being kept safe. EVIDENCE: The complaints procedure is on display and is in the service user guide. People we spoke to told us that they knew how to complain. Prior to this inspection a social worker contacted us about a complaint that had been made about her clients personal appearance. There were no details of this complaint in the homes complaints log. We spoke to a relative about a complaint that she had made via a case review. She told us that she had not received a response to her complaint. We looked at the home’s records that said the outcome of the complaint had been discussed with her. It is important that all complaints are recorded and if people do not have a written response that they get minutes of any verbal feedback. This will make sure that complaints are dealt with properly and complainants are advised in full about the outcome of their complaint. When we looked at the accident records we found incidents that should have been dealt with using the adult protection procedures. We found two incidents of physical abuse and one of verbal abuse between people living in the home. We were not notified about these incidents and there was no record in the home of how these incidents were dealt with or if they were reported to the Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 20 safeguarding team. It is important that staff deal with these issues properly to make sure people living in the home are kept safe. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26 & 30 People using the 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 is clean and comfortable but is in need of refurbishment and redecoration to bring the accommodation up to date. EVIDENCE: The home is set in its own gardens and grounds. There is car parking available and a garden area that is easily accessible for people to use in fine weather. The manager told us that the communal areas have been redecorated since the last inspection in June 2007. We looked at some bedrooms; all of them were very personal. All of the bedrooms we saw had fitted furniture and vanity unit. The furnishings look very dated. One person told us that the wardrobe is small and that there is Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 22 not enough room for all of her clothing. In the annual quality assurance assessment (AQAA) the manager has told us that there is a redecoration programme in place. This needs to be extended to include refurbishment of the bedrooms and general modernisation. We found that there was a prevalent odour of stale urine in the entrance hall when we arrived. We asked relatives about this. They told us this is not usually the case and that they find the home to be generally clean and tidy. People told us that the laundry system is generally good. Some relatives said that they always make sure clothing they buy is machine washable to lessen the chances of anything being shrunk or spoiled through washing. We spoke to the laundry assistant who gave a good account of the infection control procedures in the home and how soiled laundry is dealt with. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, &35 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The organisation, deployment and supervision of staff is poor and people’s needs are not being met. Staff are well trained and competent to do their job. New staff are not being properly checked to make sure they are suitable and safe to work with older people. EVIDENCE: When we visited there were 27 people living in the home. In the morning there were two agency nurses and eight care staff on duty together with the manager and care supervisor. Staff told us that 24 people all require two staff to attend to their personal needs. This level of dependence was confirmed on the information the manager gave us on the annual quality assurance assessment (AQAA). In total there were 11 caring staff on duty this means that each member of staff less than 3 people each to care for. The staffing levels in this respect would appear to be adequate, yet people’s needs are not being met. For example, people did not get a mid morning drink, people weren’t getting their breakfast until 11:20am, staff had no time to spend with Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 24 people unless they were providing some direct care. In the surveys people made the following comments about staffing: ‘More staff would help.’ ‘More staff on standby for when people ring in sick because we can’t always get cover at the last minute.’ We discussed the staffing levels with the manager, who said that he was over the establishment figures for staffing. The way staff are organised, deployed and supervised needs to be looked at to make sure staff are working in an organised and efficient way. Staffing levels must be kept under review and must be adjusted to make sure the needs of any new admissions and people’s changing needs are met in a consistent way. Recruitment practices at the home are poor. Staff have started working at the home before their full criminal records bureau (CRB) check has been received. Although staff are, in exceptional circumstances, allowed to work with just a protection of vulnerable adults check this is on the condition that they are supervised at all times. We found that one of the nurses has been working at the home for 3 months without a full CRB check. The manager told us that although there is another nurse on duty this person is not always supervised. We also found that one member of staff only had one reference and that one of the references for another carer only confirmed their dates of employment. Recruitment practices must be improved to make sure staff are suitable and safe to work with older people. We talked to staff about training. They told us that they get annual updates on moving and handling, first aid, fire safety, health and safety, infection control and food hygiene. They all said that they had good opportunities to undertake further courses that are on offer. The nurse we spoke to also said that she has the opportunity to attend training to make sure she remains up to date and continues her professional development. There are 72 of the care staff that have completed their National Vocational Qualification (NVQ) in Care. This means that they are qualified and competent to do their job. All of the staff we spoke to enjoy working at the home. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not being managed properly and is not being run in the best interests of people living there. EVIDENCE: The registered manager has many years experience of caring for people with physical disabilities. He has also completed his registered managers award, which means he is qualified as a manager. The home carries out an internal quality audit every year, surveys are sent to people using the service and their relatives to find out their views about what is being provided. They do not currently seek the views of any outside Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 26 agencies that may be involved with the home. The last quality assurance survey was completed in June 2008. Residents meeting are held every month and this gives people the opportunity to comment on the service they receive. Monthly monitoring visits are also undertaken by various people. These visits take place to check that the home is being managed properly and is being run in the best interests of the people living there. We are concerned that the home is not being managed properly and the monthly visits are not picking up some of the major issues that have been highlighted in this report as follows: Care plans are not up to date. People’s health and personal care needs are not being met. The medication system is not being managed properly. People are not receiving medication and treatment that they require. Complaints and adult protection issues are not being dealt with properly. Staff are not being deployed and supervised properly and people’s needs are not being met Staff are not being thoroughly checked before they start working in the home. There were no apparent health and safety issues observed during this visit. In the annual quality assurance assessment (AQAA) the manager told us that all of the safety checks on equipment and services were up to date. Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 1 34 1 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000001087.V375843.R01.S.doc 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 x 3 X 1 X X X 3 Version 5.2 Page 28 Kenmore Home - Leonard Cheshire Disability No 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 YA6 Regulation 15(1) Requirement Care plans must be in place that clearly contain the following information: The current needs of the service users together with an accurate plan that tells staff what care and support they have to provide. How people’s ongoing health care needs are going to be met. This will make sure that people’s needs are met. 2. YA12 16 (2) Care plans must be put in place that clearly show how people’s social care needs are and how these will be met. This will make sure people are stimulated and kept active. Arrangements must be put in place to make sure that mealtimes are properly organised and that staff are available to support and assist people with their food intake. This will make sure that people get their meal in a timely fashion DS0000001087.V375843.R01.S.doc Timescale for action 31/08/09 31/08/09 3. YA17 12 14/07/09 Kenmore Home - Leonard Cheshire Disability Version 5.2 Page 29 and that they receive a nutritious diet that is appropriate to their individual needs. 4. YA18 12(4) Arrangements must be in place to make sure that people have all of their hygiene, cleanliness and personal grooming needs attended to on a daily basis and after meals. This will make sure peoples personal appearance is maintained as they would wish and their dignity is respected. Arrangements must be put in place to ensure that care plans include detailed information and instructions for staff in respect of the administration and management of medicines, including the reasons to give medicines on an as and when basis, and what constitutes as required for the named person. This will make sure that people receive their medication in a consistent and appropriate way. 14/07/09 5. YA20 13(2) 31/07/09 6. YA22 22 7. YA23 13(6) 8. YA33 18 (1) All complaints must be 14/07/09 documented and responded to in line with the home’s complaints procedure. This will make sure complaints are dealt with properly and people are informed of the outcome. Staff must make sure that adult 14/07/09 protection issues are properly reported and any necessary action is taken. This will make sure people in their care are kept safe. The staffing levels in the home 14/07/09 must be kept under review. There must be enough suitably qualified staff on duty, including ancillary staff, to make sure that DS0000001087.V375843.R01.S.doc Version 5.2 Page 30 Kenmore Home - Leonard Cheshire Disability 9. YA34 19 10. YA39 26 people’s needs are met consistently. This will make sure people get the care that they need. Staff must be fully checked 14/07/09 before they are allowed to work without supervision. This will make sure that staff do not deliver care until it has been confirmed that they are suitable and safe to do so. Ensure that the providers 31/07/09 monthly visit reports demonstrate their full assessment of the standards of care and conduct of the home. This will make sure any shortfalls are picked up and dealt with at an early stage. 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 YA6 Good Practice Recommendations Care plans need to be set out in a way that makes it easy for staff to find specific information about people’s needs quickly. This will make sure staff can refer to a care plan to see exactly what support anyone living in the home needs. Mealtimes need to be improved. This will make sure they are a social occasion for people. The refurbishment of bedrooms should be included in the homes redecoration and refurbishment plan. This will make sure that the accommodation is updated. 2. 3. YA17 YA26 Kenmore Home - Leonard Cheshire Disability DS0000001087.V375843.R01.S.doc Version 5.2 Page 31 Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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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