CARE HOMES FOR OLDER PEOPLE
Kenmure Lodge Kenmure Lodge Kenmure Place Off Garstang Road Preston Lancashire PR1 6DD Lead Inspector
Mrs Felicity Lacey Unannounced Inspection 28 September 2007 9:30am 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 DS0000009833.V345052.R01.S.doc Version 5.2 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. DS0000009833.V345052.R01.S.doc Version 5.2 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 DS0000009833.V345052.R01.S.doc Version 5.2 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). 19th May 2006 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. DS0000009833.V345052.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to Kenmure Lodge. During the visit the inspector was able to speak to people who lived at Kenmure Lodge, staff, a relative and the manager. Case records and documentation kept at the home was looked at. A tour of the premises took place. As part of this inspection the manager provided written information about the running and administration of the home. People who live at the home, relatives/friends and health professionals completed comment cards. What the service does well:
The people who live at Kenmure Lodge consider it to be a friendly place. There is a low turnover of staff. People who live at the home are treated with respect and their individual ways are understood by the staff. Health needs are monitored and good relationships have been maintained with the local district nurses and GPs that serve the care home. People who live at the service were positive in their views. Their comments include: ‘The staff are lovely’ ‘Staff are always ready to help and listen to what I want.’ ‘I am a fussy eater, but nothings too much trouble, I have what I want.’ ‘I am thankful to be with people who listen.’ ‘The staff are always willing and helpful whatever we need.’ ‘Satisfied with everything.’ Relative’s comments include: ‘Mum needs assistance with all activities of daily living. This is provided by a caring staff.’ ‘Whenever a problem arises, they find a solution.’ ‘Arthur or one of his team telephone me if they have any concerns relating to my mother health. They are also available to talk to me when I visit. DS0000009833.V345052.R01.S.doc Version 5.2 Page 6 Staff receive regular training opportunities and are supported in their roles by the manager. Staff were observed supporting people in sensitive and caring ways. What has improved since the last inspection? 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. The summary of this inspection report can
DS0000009833.V345052.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. DS0000009833.V345052.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000009833.V345052.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. A full assessment of a persons support needs is completed before an admission to the home is agreed, this ensures that the staff are able to meet the person’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager ensures that any assessment completed by health or social services is obtained prior to accepting a person to live at the home. The case files seen contained copies of assessments. The manager also completes a checklist of activities of daily living and any assistance needed is recorded. A questionnaire of individual family details and preferences is also completed; this provides background information such as the person’s favourite type of film, music and pastimes. The people who were spoken with during the visit to the home confirmed that this information had been collected by the staff, and that personal preferences and choices were respected. DS0000009833.V345052.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. Health and personal care needs are understood and managed by the staff of the home in line with personal preferences, this promotes the welfare of people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people who live at Kenmure Lodge have a care plan which details the support needs identified, the plan is signed by the resident or their representative. There is a system of monthly review of all care needs, which ensures that any changes to a persons health or personal care needs are recorded, and all staff are aware of this. Care plans are supported by risk assessments which briefly describe the risk involved in an activity and the steps taken to minimise the risks involved. People spoken with during the visit to Kenmure Lodge thought that their health care needs were understood and responded to by the staff of the home. A number of people spoke about the caring attitude of the staff and how they had been cared for during times of illness. The GP who completed a survey described the home as ‘caring’ and confirmed that staff always sought advice regarding individual health care needs and acted upon this. Examination of the
DS0000009833.V345052.R01.S.doc Version 5.2 Page 11 daily records showed that a range of health professionals were involved in the care of people at the home, including District Nurses, Community Psychiatric Services and Specialists. Medication is administered by trained staff at the home. The records seen during the visit to the home were accurate. Medication is stored safely. People who live at the home are able to self medicate if they wish and if it is safe to do so. The staff of the home are respectful of the privacy of the people who live there. This was confirmed by people spoken with, who said that staff knock before entering rooms, use the preferred name and ensured that when treatment or examination was required this was carried out in privacy. At the time of the inspection a member of staff was doing residents hair, unfortunately the lack of available space meant that she had to do this in the dining room, she did use a screen to provide a more private area. She also explained that when a ground floor room was empty this is used for hairdressing, however at present all rooms are occupied. Where bedrooms are shared screening is provided, and an agreement to share is signed at the time of admission. DS0000009833.V345052.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. There has been an increase in activities on offer and this provides greater opportunity for people living at the home to enjoy social activities in line with their own interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents have been involved in planning and suggesting activities, both within and outside of the home. There has been an increase in trips out, and over the summer there were several opportunities to go to the park for a picnic. This was successful and a number of residents spoken with confirmed that they had enjoyed this. There has also been a trip to Blackpool Illuminations that some residents went on. Some residents remain independent and are able to go out regularly, for example some residents go to the local church hall for and exercise class. The home is located near local shops and several residents continue to go out on a daily basis. Families and friends are welcome and this was confirmed during the visit when a number of visitors called at the home. DS0000009833.V345052.R01.S.doc Version 5.2 Page 13 There is no set routine of activities held within the home, but each day some type of activity is offered depending on what residents wish to do, these include bingo, gentle exercise or music. At the time of admission a profile of the resident is compiled which included social, cultural and religious preferences. People spoken with during the visit confirmed that they could choose how to spend there time, some people liked to spend time alone, reading or knitting and others choose to take part in organised activities, and their choices were respected by the staff. Residents manage their own finances if they wish, alternatively an agent can be appointed. Small amounts of personal allowances are kept at the home, and if these are administered by staff a signed record is maintained. The manager and administrator check these records every two weeks to ensure they are accurate. Residents are encouraged to personalise their rooms and are able to bring their own furniture if they wish. Residents spoken with were pleased with the standard of food at the home. One lady described herself as a ‘fussy eater’ but said that the cook always made her something she liked. A mealtime was observed during the visit. Tables were set with condiments and sauces, there was a choice of hot and cold drinks on offer. Those people who required assistance were discretely supported. A staff member was observed assisting a lady, she took her time and spoke throughout describing the meal and encouraging the resident, who appeared to enjoy the meal. Special diets are available and there was evidence on files of advice being sought over nutrition and dietary needs. The cook knows all the residents and takes time to ask if they would like any new dishes and if the food is to their liking. DS0000009833.V345052.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. The home has complaint and adult safeguarding policies, which ensure that the welfare of residents is promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission for Social Care Inspection has received one complaint, which the manager of the home investigated under its own procedures, and there have been two complaints logged with the manager directly. All complaints have been dealt with satisfactorily and resolved. It is the policy of the home to try and resolve any complaint as soon a practicable. Residents spoken with said that they could raise any concern with the manager or staff and were confident it would be sorted out. Staff spoken with were able to explain how complaints would be dealt with. All surveys returned indicated that people knew how to make a complaint if the need arose. Staff have received training in Adult Protection as part of their National Vocational Qualification training. A policy is in place which provides guidance in cases of suspected abuse. Staff spoken to understood their responsibilities under safeguarding procedures. DS0000009833.V345052.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. The home is warm and clean, there is an ongoing programme of decoration and maintenance and this ensures the home is a safe and pleasant place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A number of rooms have been redecorated and recarpeted over the past year. There is an on going maintenance programme which ensures that rooms are regularly decorated and any repairs are carried out. The home has two communal rooms, one of which is also a dining room. There is a small outdoor area, which has seating. The bedrooms are of varying size and shape. Some rooms are very spacious and others are compact. People are encouraged to make the rooms their own. The home is clean and warm. There are dedicated domestic staff and the care staff also undertake some domestic duties. The residents spoken with were happy with the standard of cleanliness at Kenmure Lodge. There are infection control procedures in place; protective aprons and gloves were used by staff when providing personal care.
DS0000009833.V345052.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. The staff of the home are competent and qualified and are able to meet the needs of the people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents spoken with thought there were enough staff on duty. The staff have time to complete their daily tasks and can spend time with the residents. Staff turnover is low. The home has exceeded the recommended minimum ratio for numbers of staff with a National Vocational Qualification, currently 10 staff have achieved this. Staff spoken with feel they are encouraged to undertake training and are valued by the management team of the home. The manager is also keen to encourage all grades of staff to undertake regular training, and most training is available to care and ancillary staff. Staff files showed that application forms, references and Criminal Record Disclosure checks are obtained prior to a person being employed. All staff have a statement of terms and conditions. Staff confirmed that they had undergone a period of induction and documentation on staff files confirmed this. DS0000009833.V345052.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. The manager creates an open and inclusive atmosphere in which residents and staff feel valued and that their opinions matter. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has 15 years experience working in social care. He has completed a National Vocational Qualification at Level 4. Residents, relatives and staff members feel the manager is approachable and able to sort out any difficulties that arise. He has ensured that regular staff and residents meetings are held and encourages people to share their views and has a good working relationship with the owners of the home. DS0000009833.V345052.R01.S.doc Version 5.2 Page 18 Satisfaction levels at the home are gauged through regular contact with residents and staff, and through questionnaires that are completed by residents, representatives and professionals who visit the home. The owner provides monthly reports on the conduct of the home, and these include comments from residents and visitors. Records are maintained of financial transactions. When money is spent on behalf of a resident this is countersigned. Receipts are kept of all transactions. Safe working practices are promoted at the home by the provision of regular training, for example all staff have recently completed a Moving and Handling course. A matrix of training undertaken is maintained by the manager and this ensures that health and safety training is kept up to date. The pre inspection information completed by the manager indicates that routine maintenance checks on health and safety equipment and for a safe environment have been completed. An accident book is maintained. It is important that all accidents however minor are recorded, as unforeseen complications may arise following an accident. The manager is to adopt the recommended format for reporting of accidents for both staff and residents. This way of reporting ensures that important information is stored on an individual’s personal record, this meets the requirements of data protection and allows for monitoring of the frequency and cause of accidents at the home. DS0000009833.V345052.R01.S.doc Version 5.2 Page 19 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000009833.V345052.R01.S.doc Version 5.2 Page 20 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. Refer to Standard Good Practice Recommendations DS0000009833.V345052.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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