CARE HOMES FOR OLDER PEOPLE
Kenmure Lodge Kenmure Lodge Kenmure Place Off Garstang Road Preston Lancashire PR1 6DD Lead Inspector
Lesley Plant Unannounced Inspection 15th November 2005 14:30 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 Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 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. Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Kenmure Lodge Address Kenmure Lodge Kenmure Place Off Garstang Road Preston Lancashire PR1 6DD 01772 250513 01772 563861 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) Rowedast Developments Limited Mr Arthur Naylor Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 24 service users to include up to 24 service users in the category of OP (older people over 65 years of age). 28th April 2005 Date of last inspection Brief Description of the Service: Kenmure Lodge provides residential care for up to 24 older people. The home is situated in a residential area, near to the city centre and is close to a range of local amenities. Accommodation is arranged over two floors with a lift providing access to the first floor. Communal areas are domestic and homely in character. The grounds are small, with limited provision for sitting outside but a ramp is provided for easy access. Strong links have been forged with the local community; relatives and visitors call into the home at all times and people living at the home are able to take advantage of the many amenities available in the local area. Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced, started at 2.30 pm and took place over four and a half hours. The inspector spoke to six of the 23 people living at the home, the manager, two members of staff and one relative. At the time of the inspection a physiotherapist and a chiropodist were visiting the home and both completed comment cards giving their views of the service provided. Feedback comment cards were also received from three GP’s. Medication, money held for safekeeping and care records were inspected and some of the written policies were viewed. Information was also gained from the pre inspection questionnaire completed by the manager. Key standards not assessed at this inspection will have been addressed at the previous inspection on the 28th April 2005. An additional visit took place on the 28th June 2005, with a separate report being available via the CSCI office. What the service does well: What has improved since the last inspection?
Information from the daily notes now forms an important part of the review process, meaning that changes are responded to. Better systems are in place regarding one individual who likes to go out, but is unaware of her vulnerability if out alone. Records of weight are now kept on individual sheets instead of in one book, which means that separate records are built up for each person. Improvements were noted in the medication administration procedures, with records being accurately completed.
Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 6 The last inspection raised concerns regarding staffing levels. An additional visit and looking at rotas during this inspection, confirmed that this has been addressed and that reasonable staffing levels are maintained. Staff training at Kenmure Lodge has greatly improved during the past year and now includes training regarding abuse and vulnerable adults. The manager is also working hard to provide a thorough induction for new staff. Residents meetings are now being held, providing opportunity for people to express their views. The money held for some people at the home is now regularly checked, which means that any errors can be quickly addressed and that records are confirmed to be accurate. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were assessed at this inspection. EVIDENCE: Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 The care planning system is easy to understand, meaning that staff have clear information regarding how needs are to be met. Medication procedures are consistently followed. People living at the home feel that they are treated with respect. EVIDENCE: The four care plans viewed all showed that regular reviews take place and improvements have been made in ensuring that information in the daily notes informs this review process. Better systems are in place regarding one individual who likes to go out, but is unaware of her vulnerability if out alone. Each element of the care plan is reviewed separately. Care plans show that needs identified within the assessment are addressed and are signed by the individual or a relative. Bed guards are used for three people at the home and risk assessments regarding this have been carried out. However, the manager should gain professional advice regarding appropriate bed guard covers, the use of which needs to be included on the risk assessment. This is important, to protect people from potential injury. Staff keep good daily records, which show any contact with health professionals and significant events, as well as an overview of how things are for each person. Records of weight are now kept on individual sheets instead of in one book. The five health care professionals who completed comment cards all responded that staff demonstrate a good
Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 10 understanding of peoples’ care needs and if any specialist advice is given, that this is included in the care plan. Responses included, “Clients always appear to be happy with their care at Kenmure Lodge.” A monitored pre packed dosage medication system is used. Improvements were noted in the administration procedures. The medication administration records viewed were accurately completed and reflected the medication dosages as prescribed. Each sheet contains a photograph of the relevant person. Staff who administer medication have undergone training in this area, as confirmed by discussions with staff. The manager explained that refresher training is due to commence, using a training pack from the pharmacist. The people spoken to all confirmed that staff treat them well, with one lady saying, “the staff are very kind and always helpful.” At the time of the inspection a chiropodist was visiting the home. A screen in a section of the lounge provided privacy during chiropody treatment. The people spoken to were happy with this arrangement. The manager stated that if a bedroom were vacant, then the empty room would be used. Screening is provided in rooms that are shared and file records show that relatives as well as the individuals involved sign an agreement when rooms are shared. The five health professionals who completed comment cards all indicated that they could see their patient in private. During the inspection staff spoke respectfully to the people living at the home and responded patiently and with sensitivity, for example when explaining something to a lady who has become forgetful. Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 People are helped to exercise control over their day-to-day lives and choices are respected. EVIDENCE: People are encouraged to manage their own financial affairs for as long as they wish, with relatives being involved where this is not possible. Advocacy information is available. People are able to bring personal possessions into the home. The manager arranges residents meetings where people are encouraged to air their views. Minutes of these meetings show that requests are responded to, such as a recent request to provide more practical prizes for bingo games. Staff show a good understanding of respecting peoples choices and decisions such as when choosing not to join in an activity. People can have access to their records, although those spoken to did not express any wish to do so. Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff training, good practice and set procedures provide protection from abuse. EVIDENCE: The manager has a good understanding of issues relating to vulnerability, protection and abuse. The “NO Secrets” policy and guidance is displayed on the notice board in the hallway, available for everyone to read. Staff have completed training regarding abuse and vulnerable adults, and one member of staff discussed the importance of this training and the issues raised. The recruitment process includes checks and safeguards, with good systems and regular checks ensuring the safety of any money held on behalf of an individual. Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were assessed at this inspection. EVIDENCE: Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Reasonable staffing levels are maintained. Recruitment procedures help to protect those living at the home. Staff training, although improving, still requires some work to meet agreed national standards and targets. EVIDENCE: The last inspection raised concerns regarding staffing levels. An additional visit confirmed that this has been addressed and that reasonable staffing levels are maintained. The people spoken to all felt that their needs were being met and stated that staff always come quickly in response to the call bell. One healthcare professional commented; “Staff are always helpful.” Since the last inspection a cook has been appointed, which means that care staff do not have to be deployed to carry out cooking duties. Although the cook was not working on the day of the inspection, rotas show that there are always three care staff on duty and that if cover is needed for kitchen duties, then this is an additional shift and does not deplete the levels of care support. The administrator also helps in the kitchen if needed. Progress is being made with NVQ training. One staff member has gained the level 2 award and one the level 3. Five members of the team are currently undergoing the level 2 training, with another registered to start soon. The manager should continue to monitor the progress of NVQ training. The recruitment records for a recently appointed staff member showed that correct procedures are being followed. These records include; references, identification documents and Criminal Records Bureau clearance. The forms
Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 15 used to request references could be improved to clearly show who it is being sent to and their position in the company/organisation. The manager is working hard to provide a thorough induction for new staff. Each staff file has an induction checklist, which records when important information about working at Kenmure Lodge has been discussed with a senior member of staff. New staff now also attend a one-day induction programme run by an external training provider. Staff undertake a programme of training, which includes moving and handling, first aid, vulnerable adults, food hygiene, health and safety and working and operating safely, medication and dementia. A clear training matrix shows what courses have been completed by each staff member. There are still some gaps in meeting national training organisation induction standards, namely the lack of infection control training and the gaps on the training matrix for some staff regarding food hygiene. The manager is working hard to rectify this and so provide a strong induction for new staff. As a short term measure the manager is advised to hold short in house training sessions for those staff that have not attended formal training. This would be particularly useful for night staff. Staff training at Kenmure Lodge has greatly improved during the past year. One healthcare professional commented; “Staff are always helpful.” Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The home is well run, with the views of those who live there being important. People’s money is safely stored. Staff training, policies and good practice promote the health and safety of those living and working at Kenmure Lodge. EVIDENCE: The manager is undertaking the Registered Managers Award and hopes to complete this within the next six months. In addition, the manager attends regular training to update his knowledge. Discussions with staff confirmed that they feel well supported by the manager, with one person commenting; “ The manager is approachable and will always try his best to sort out any problems.” The manager is keen to make any improvements to the service and responds positively to advice given during inspections. Comment cards, for people living at the home and their relatives, are available in the reception area. In addition the manager has devised a questionnaire for other visitors such as health professionals and church ministers. These contain many positive comments, particularly regarding the friendly and welcoming
Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 17 staff. The manager works closely with the staff team, which gives natural dayto-day opportunities to get feedback from staff and the people living at Kenmure Lodge. More recently residents meetings have been held, again providing opportunity for people to express their views. Minutes of these meetings show that requests are responded to, such as a recent request to provide more practical prizes for bingo games and a request to have information about the menu each day. Kenmure Lodge has achieved and still maintains the Investors in People award. Policies and procedures are regularly reviewed, with the key policies being laminated and displayed in the hallway. The registered provider has an office base next door to the home and is in regular contact with people living at the home, staff and relatives. Wherever possible people manage their own money or relatives may take this responsibility. Where relatives are given monies for safe keeping/banking, then signatures are obtained. Small amounts of spending money are held for some people at the home, with details of income and expenditure recorded and signed for appropriately. Since the last inspection a system of regular monitoring has been introduced, with the manager and administrator carrying out checks approximately every two weeks. This means that any errors can be quickly addressed and that the records are confirmed to be accurate. The two records viewed both corresponded with the money held. Money is stored securely. Regular fire drills take place and staff read and sign the fire procedure. Risk assessments are in place and cover many working practices. Water temperatures are regularly checked and records maintained. Certificates confirm other testing such as the testing of electrical equipment. Staff training covers many aspects, such as medication, working safely and first aid. The manager is keen to address the lack of infection control training and ensure that all staff complete a food hygiene course. Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x x x x x x x x STAFFING Standard No Score 27 3 28 1 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 19 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. Standard Regulation Requirement Timescale for action 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. 4. Refer to Standard OP7 OP28 OP30 OP31 Good Practice Recommendations The manager should gain professional advice regarding appropriate bed guard covers 50 of care staff should achieve NVQ level 2 The manager should ensure that induction and foundation training is in line with National Training Organisation specification. The manager should achieve NVQ level 4. Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kenmure Lodge DS0000009833.V252654.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
