Inspection on 12/07/06 for Kensington

This inspection was carried out on 12th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kensington 12/07/07

Kensington 19/07/05

Kensington 26/04/05

Kensington 05/11/04

Kensington 05/05/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kensington Ayton Street Byker Newcastle Upon Tyne Tyne & Wear NE6 2DB Lead Inspector Aileen Beatty Key Unannounced Inspection 12th July 2006 09:30 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 Kensington DS0000000409.V295246.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. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kensington Address Ayton Street Byker Newcastle Upon Tyne Tyne & Wear NE6 2DB 0191 265 2888 0191 276 2888 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) Mr Baldev Singh Ladhar Mrs Lilian Lancaster Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (47), Physical disability (2) of places Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The five basement rooms are only to be used for service users requiring personal care 19th July 2005 Date of last inspection Brief Description of the Service: Kensington is a home providing nursing and residential care. It is situated in a residential area of Byker, on the outskirts of Newcastle upon Tyne. The home is purpose built and was first registered in August 2000. Accommodation is provided over three floors. The lower ground floor has five beds registered for personal care only. A passenger lift is available, if required. The bedrooms are all ensuite and of a good size. Double bedrooms are available if required. There are lounges available on each floor and a designated smoking area. There are two homes on this site and they share kitchen and laundry facilities. They are otherwise independently staffed and function separately. The fees range from £355 to £365. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day and was carried out by two inspectors. It involved a tour of the premises, discussions with staff residents and visitors, and reading records. The inspectors ate lunch with residents. The inspection found that the overall standard of care is good. What the service does well: What has improved since the last inspection? A variety of drinks are now offered to all residents. Over 50 of staff are now trained to NVQ level two or above. Additional storage has been provided in the kitchen. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 6 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. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 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 Kensington DS0000000409.V295246.R01.S.doc Version 5.2 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): 3. Intermediate care is not provided. Judgement - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory pre-admission assessments are undertaken and this is reflected in the care plan. The home is not registered for and therefore does not provide intermediate care. EVIDENCE: The staff undertake detailed pre admission assessment and liaise with the residents and family prior to admission. Care plans have good information to ensure that the home can meet the needs of the prospective resident. The Manager is involved in the decisions and in the majority of instances visits the residents herself prior to their admission. Pre admission assessments are obtained from other professionals such as social workers, psychiatrists and health. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 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): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service user needs are set out in an individual plan of care. Service user health needs are fully met. Medicines are managed effectively and residents receive their medication safely as prescribed and in line with safe practice guidance. Service users feel they are treated with respect by most staff. EVIDENCE: The home has in place detailed care plans, which show a process of assessment, planning and action taken. Evaluations are in place to allow staff to address any changes. In some of the care plans weight loss was noted, this was identified in the planning with action taken as necessary. In some care plans there is still a tendency to record evaluations using the month only, and not the day in the month that this took place. The date must be included as it Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 10 could be done at the beginning of one month and the end of the other and still be recorded as though the evaluations took place one month apart. This is particularly important when evaluating assessments for wound care for example. Food, fluid balance and turn charts are kept up to date. Moving and handling assessments are in place but correct procedures are not always followed. (See standard 38) Residents must be asked whether they prefer help with personal care by a male of female staff member. This should be recorded in care plans. There is evidence that advice is sought from relevant professionals such as Tissue Viability nurses who specialise in the care of skin, and wound care. Residents receive good support from staff to meet their personal care needs including the wearing of clean spectacles and the use of hearing aids. Clothing is clean and smart. There are policies and procedures available for safe receipt, recording, storage, handling, disposal and administration of medicines. These are being followed. The treatment room and medicine store cupboards were tidy, and organised. Controlled Drugs are recorded effectively. Medications receipt administration and disposal are recorded effectively with the home having sight of the prescription prior to it being sent to the Pharmacy for dispensing. Medicines for disposal are being removed using a nominated waste management supplier. Residents said that most staff are very nice and treat them with respect. One resident felt that some staff do not always knock when entering their room. There are some indications that there could be some improvement to ensure that privacy and dignity are always maintained. The general attitude of a small minority of staff also needs to improve. Information from residents and a recent complaint found that some staff use bad language at work. One resident referred to staff chatting about their personal lives. Staff are not always discreet and were heard discussing loudly who may need the toilet. Staff must also ensure that when they are transporting people in wheelchairs, that they do not stop to chat and should also keep the person informed of what they are doing. The recent complaint also found that an episode of incontinence was not dealt with immediately and inspectors heard from a number of sources that residents are sometimes kept waiting when they ask for the toilet. There is a concern among some residents that they do not want to disturb staff who they say always tell them they are busy. The manager is aware of the above concerns and is already dealing with them through staff supervision and staff meetings. Disciplinary action will be taken if Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 11 necessary. Some staff were very shocked by the recent complaint (see standard 16) but have learned that they must be conscious of their own conduct at all times and be aware of how others may perceive them. Most staff demonstrate genuine affection and warmth towards residents. Kensington DS0000000409.V295246.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users do not always feel that the lifestyle experienced in the home satisfies their social, cultural, religious and recreational interests and needs. A good range of activities is available. Service users maintain contact with family and friends and local community if they wish. Service users are generally helped to exercise choice and control over their lives. Service users do not always feel that they receive an appealing diet. Meals are served in a pleasant setting with good support from staff. EVIDENCE: A good range of activities is available. These include skittles, beetle, and other group activities, but also 1:1 activities such as taking one person out to a coffee morning, or shopping. Some residents recently attended the Mayors garden party, which they enjoyed. Good records of activities are maintained. Some “Life Story” work has been carried out and the life story of residents, as Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 13 described by them, have been typed up. Some of these are displayed with the resident’s permission, in the reception area. Some residents said that they are sometimes bored and do not have enough to do. Residents may receive visitors at any reasonable time and may see them in private. Residents are encouraged to exercise choice and control over their lives most of the time. Choices in meals and drinks are offered and additional menus are available so that if neither choice is appealing, they may choose an alternative. Residents themselves chose what they would like to have on the extra menu. Residents meetings are held and are used to address issues such as complaints about the standard of meals. Staff must ensure that they make the effort to provide choices at all times. For example, one resident asked if there was any alternative snack instead of biscuits. He was immediately told “no” but was then offered a plain biscuit. There were stocks of fruit in the kitchen, which could have been offered, or he could have been asked what he would prefer. It was reported that the standard of meals has improved but there are still times when meals do not meet the required standard. Inspectors ate lunch with residents. The standard of help offered was good, maximum independence is afforded, for example, one resident boiled the kettle and made a cup of tea (with discreet supervision from staff) and others requiring maximum assistance, were given this, also very discreetly and attentively. Although residents are asked to choose what they would like to eat the previous day, they are also able to change their minds. They were frequently offered second helpings. The meal was a mixed grill with chips. The chips were hard inside but this was due to the cook trying home made chips for a change as residents had requested this instead of frozen. He acknowledged that he had had some difficulty in gauging the correct temperature of the fryer on that occasion. The manager is continuing to work closely with the cook to achieve a consistent improvement in standards. Good supplies of food are available, and the kitchen appeared clean and tidy. Kitchen records are maintained, including cleaning schedules and food temperatures. Full fat yoghurts are now provided in addition to low fat. Kensington DS0000000409.V295246.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users and their relatives are usually confident that their complaints will be listened to and acted upon. Service users are protected from abuse. EVIDENCE: The home has a complaints policy and staff are clear about the procedure to deal with complaints, which is available in a number of places in the home. A visitor said that they knew who to talk to if they were unhappy and were confident that these would be dealt with. There have been five complaints made direct to the home since the last inspection. These have been fully recorded and dealt with appropriately by the manager. They have been mainly from residents and a common theme is the standard of meals provided. There is evidence that the home manager is trying to address these concerns and is taking them seriously. Residents meetings are held which provide a forum for views to be expressed. The Commission for Social Care Inspection has received 3 complaints since the last in section. The most recent is currently being investigated, one was Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 15 withdrawn, and the other was dealt with under adult protection procedures and was unsubstantiated. Discussions with residents revealed a common theme that some staff are sometimes rude and use bad language. This has already been brought to the attention of the home, as these issues were also raised as part of the most recent complaint. Steps are being taken to ensure that all staff are considerate and respectful at all times. Residents were keen to point out that their concerns related to “one or two staff” only. The home must resolve this issue and it is recommended that some training in customer care may be an advantage. One resident took the time to specifically ask the inspector to thank the staff for their hard work and care during the inspection. The staff spoken to were aware of the whistle blowing policy and informing the Manager of any incidents or issues of which there are concern. It was unclear from the training records which staff had completed Protection of Vulnerable Adults training. Satisfactory adult protection procedures are in place. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 16 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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a safe well-maintained environment. The home is generally clean, pleasant and hygienic. EVIDENCE: Some areas of the home are in need of redecoration and refurbishment. The home is otherwise generally clean and well maintained. There is a problem with some double- glazing, as it has condensation between the panes. A company has already been approached to carry out these repairs. Residents spoken to said they are happy with their rooms areas. Two bedrooms were found to be untidy. One had a blood) on the duvet cover, and faeces and dried food was another room. These were cleaned by staff. Care must be Kensington DS0000000409.V295246.R01.S.doc and communal stain (possibly found on a chair in taken to ensure all Version 5.2 Page 17 areas of the home are kept clean to prevent infection and odours. Most bathrooms have adequate supplies of hand towels and liquid soap. The laundry is used for Kensington and the adjoining home. It is clean and tidy and well organised. There are good control of infection practices, residents clothing looks well laundered and tidy. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. 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 protected by the home’s recruitment policies and practices. Most staff are trained and competent to do their jobs. EVIDENCE: There are sufficient staff on duty to meet the needs of residents. There were a number of comments about the fact that staff will claim that they are “short staffed” when they are working with a full complement of staff on duty. This appears to be a habit that some staff have got into, as the manager said that she is also aware of this tendency. This is being monitored and it is recommended that the manager investigate the reason that people feel they are short staffed to see whether any reorganisation of workload may help. Training in Dementia, Food hygiene, Moving and assisting, Safe handling of medicines, Fire, POVA (Protection of Vulnerable Adults) and First Aid has been carried out in the past 12 months. Some courses are long distance and take around 12 weeks to complete. Training in person centred care planning and Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 19 Diabetes is also planned. Refresher mandatory training is provided on an ongoing basis. The manager is completing the Registered Managers Award. The training matrix on the wall was not up to date with dates for moving and handling and fire training. It must be confirmed that these have been arranged. Staff files were not inspected, as the manager was not on the premises so inspectors did not have access to them. It was confirmed that recruitment procedures have not changed since the last inspection. A new staff member has received induction and criminal records checks are obtained before staff are employed. Due to recent concerns, training will be provided to staff to ensure that the dignity of residents is maintained, and that they are cared for respectfully and courteously at all times. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is being managed effectively but the manager has not yet completed the CSCI fit person process. The home is generally run in the best interests of service users. Service users financial interests are safeguarded. The health, safety and welfare of service users are not always fully protected. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 21 EVIDENCE: A new manager is in post and appears to be managing the home effectively. Recent complaints have been responded to appropriately and promptly. Staff meeting minutes demonstrate that some of the concerns identified during the inspection have already been picked up by the manager. The manager has not yet been through the fit person process and is currently completing the registered managers award qualification. New systems are being developed to improve accountability in the home. Nurses in charge of each shift have been reminded of their responsibility for ensuring that the home is run effectively. Financial systems have been updated following a theft from the home. A random inspection of resident’s money found that the correct amounts were available. Routine maintenance such as water temperature checks and fire checks are carried out regularly. Suitable arrangements are in place from contractors to check large equipment and passenger lift. Small electrical appliances are checked regularly. Moving and assisting training has been provided to staff. A recent complaint found that staff do not always follow the correct procedures. A resident also confirmed that staff do not always use the hoist when they should and manually lift people instead. The front door of the home was wedged open with a chair when inspectors arrived, compromising security. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 22 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP7 OP8 Regulation 15,17 12 (1) (a) Requirement Dates and times must be added to all entries on care records. Requests for assistance must be answered promptly and the manager informed of any problems. Staff must be discreet and preserve the dignity of residents at all times. Alternative choice of snacks must be available to residents. A consistently high standard of meals must be provided. A redecoration programme must be provided to the Commission with timescales. All areas of the home must be kept satisfactorily clean. Staff must refrain from telling residents that they are short staffed. All staff must be trained to deliver care in a professional and courteous manner. Moving and handling procedures must be followed. The front door must not be wedged open. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 24 Timescale for action 12/08/06 12/08/06 3. 4. 5. 6. 7. 8. 9. 10. OP10 OP14 OP15 OP19 OP26 OP27 OP30 OP38 12 (4) (a) 16 (2) (i) 16 (2) (i) 23 (2) (b) 23 (2) (d) 18 12 (5) (b) 13 (4) (c) 12/08/06 12/08/06 12/08/06 12/08/06 12/08/06 12/08/06 12/08/06 12/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP33 Good Practice Recommendations It is recommended that training in customer care be provided. Kensington DS0000000409.V295246.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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. 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