CARE HOMES FOR OLDER PEOPLE
Kenmure Lodge Kenmure Lodge off Garstang Road Preston PR1 6DD Lead Inspector
Lesley Plant Unannounced 28 April 2005 11:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kenmure Lodge v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Kenmure Lodge Address Kenmure Place, Off Garstang Road, Preston, Lancashire, PR1 6DD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01772 250513 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 v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 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). Date of last inspection 6.1.05 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. Service user 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 service users are able to take advantage of the many amenities available in the local area. Kenmure Lodge v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced, started at 11.30 am and took place over six hours. The inspector spoke to eight of the 22 people living at the home, the manager, two members of staff and two visitors. A tour of the premises took place. Medication, money held for safekeeping and care records were inspected and some of the written policies were viewed. What the service does well: What has improved since the last inspection? What they could do better:
The reviews of care plans must be thorough and use information from the daily records, which give a good overview of how each person is. A system of regular checks of peoples’ money and accounts should be introduced, which includes regular banking of excess money. Medication procedures although improved, need to be followed by all staff. The staff rotas show that there has
Kenmure Lodge v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 6 not always been enough care staff, there must always be at least three staff on duty during the day and evening, in order that everyone’s needs can be met. People living at the home could have more choice at meal times, even though staff are aware of preferences. Three individuals said that although the meals are very good, they don’t know what it is until it is served. There must be a photograph kept at the home of all individuals living there. Health records are good but the record of weights would be better kept individually, rather than in one book. 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 v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Kenmure Lodge v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 Prior to moving into the home, a full assessment takes place, which ensures that needs can be met. EVIDENCE: Documentation was examined for three people living at the home. Assessments take place and include a moving and handling assessment and individual risk assessments for any special area of need. This information provides staff with a good picture of needs, interests, abilities and support required. Information from these assessments is used to create the care plan for each person. Staff confirmed that they had access to this information and showed a good understanding of the needs of people living at the home. One member of staff explained that when a new person is admitted to the home staff read the assessment information and that senior staff then guide them when working with new people. People are not admitted to Kenmure Lodge solely for intermediate care. Kenmure Lodge v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 Care plans do not always fully reflect changing needs and although health care needs are met, medication procedures are not consistent and could pose risks for individuals. EVIDENCE: Care plans, risk assessments and moving and handling assessments are reviewed every month. However the review for one individual did not take into account recent changes in her mental health. The review states “no problems to report regarding dementia” yet significant changes in behaviour had been recorded in the daily notes written by staff and the door to the home was being kept locked. The manager agreed to review this care plan and put systems in place, which do not involve locking the door to the home. Staff keep good daily records and health monitoring and contact with health professionals is good. One person is cared for in bed and staff work hard to ensure her needs are met. Since the last inspection although medication procedures have improved, there were some discrepancies in medication administration. Two medications left in the blister pack indicated that medication had not been given. More staff have received medication training and the manager is keen to further improve the medication system. Photographs are not held for all individuals living at the home.
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The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Social activities and contact with family and friends are actively encouraged. The meals are good and are enjoyed by people living at the home. EVIDENCE: Photographs on display show group activities such as a movement group using floats and a rope. Some individuals attend local events arranged by the nearby church. One person stated that she was looking forward to playing bingo, which is soon to be reintroduced at the home. Two individuals enjoy knitting and have been encouraged to continue with this hobby. The manager is hoping to improve the level of activities provided and this is particularly important for those people unable to go out alone. Visitors commented that they are always made welcome, can visit at any time and that staff provide information about the well being of their friend/relative. At present the home is without a cook and other staff have been doing the cooking. People living at the home indicated that they enjoy the meals and that staff are aware of their personal likes and dislikes. Menus show that choices are available but three individuals said that although they enjoy the meals they don’t know what the meal is until it is served. A cook is soon to start work. Kenmure Lodge v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Arrangements for handling complaints are in place. People living at the home and their relatives and friends are confident that any concern would be responded to. EVIDENCE: The home has a complaints procedure, which is made available to all service users and a copy is also displayed in the hall. Information about advocacy services is also available. The people living at the home, spoken to by the inspector, all responded that they are able to voice their views and know who to speak to if they are unhappy about any aspect of their care. The two visitors spoken to also stated that they know how to raise concerns and feel confident that any complaint would be responded to. There have been no complaints since that last inspection. Kenmure Lodge v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The home is warm, clean, homely and comfortable, meeting the needs of those who live there. EVIDENCE: The location and layout of the home is suitable for the people living there. People living at the home like the easy access to the city centre, and nearby shops, churches etc. Although routine maintenance continues, this should be closely monitored, as the building is old. People living at the home said they are happy with the accommodation and are able to personalise their bedrooms. The manager has attended to recommendations made during a recent visit by the environmental health department. The home is clean, with dedicated domestic staff on duty each day. The laundry area is sited in the basement and can be accessed without going through the kitchen. Policies and procedures guide staff in ways to work, which maintain hygiene and promote the control of infection.
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The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 Appropriate staffing levels are not always maintained, which could lead to difficulties in meeting the needs of everyone living at the home. Staff training is improving, which increases competence in their work. EVIDENCE: People living at the home felt that their needs were being met and stated that staff come quickly in response to the call bell including at night. However rotas show that there have not always been three care staff on duty, as on occasions staff have been deployed to cooking duties. A cook is soon to start work, which will resolve this problem. Good progress is being made with staff training, with six staff starting NVQ level 2, two staff having already completed this award. Staff have attended other short courses and plans for further training are in place. A member of staff on duty confirmed attending a number of health and safety related courses during her induction. The manager is developing a programme of staff training, which will meet national training standards. Kenmure Lodge v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 14 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 35 The home is well run by a competent manager who is keen to make any improvements, which will enhance the service. Records of money held for some people living at the home are not accurate. EVIDENCE: People living at the home, visitors and staff all made positive comments about the manager being approachable. The manager is keen to make any improvements to the service and responds positively to advice given during inspections. The manager is working towards the NVQ level 4 award. Individual records are kept for any money held on behalf of people living at the home. These records show income and expenditure, are signed for appropriately and show when excess money is banked in the individual’s account. Following previous advice these records are kept separate from the cash held. Although money is stored safely, the money held for two individuals did not correspond with the written records and excess money for some individuals needed to be banked.
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This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x x x 2 x x x Kenmure Lodge v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 16 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 27 Regulation 18 (1) (a) Requirement The manager must ensure that there are always sufficient care staff on duty. Timescale for action Immediate and ongoing 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. 5. 6. Refer to Standard 7 9 28 30 31 35 Good Practice Recommendations Care plan reviews should be thorough to take account of changing needs. Medication practices should be reviewed and to ensure consistency. 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. Money and corresponding records of money held in safe keeping should be regularly checkec. Kenmure Lodge v216199 f57 f09 s9833 kenmure lodge v216199 030505 stage 4.doc Version 1.30 Page 17 Commission for Social Care Inspection Unit 1, Tustin Court Portway Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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