Inspection on 24/07/07 for Kirkley Manor

This inspection was carried out on 24th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Kirkley Manor 23/07/08

Kirkley Manor 18/05/06

Kirkley Manor 20/10/05

Kirkley Manor 29/04/05

Kirkley Manor 21/10/04

Kirkley Manor 20/05/04

Kirkley Manor 19/11/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Kensington House Nursing and Residential Home 3 Kirkley Park Road Lowestoft Suffolk NR33 0LQ Lead Inspector Mary Jeffries Unannounced Inspection 24th July 2007 12:00 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 House Nursing and Residential Home DS0000040035.V349009.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 House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kensington House Nursing and Residential Home Address 3 Kirkley Park Road Lowestoft Suffolk NR33 0LQ 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) 01502 573054 01502 513862 adrienne@kingsleycare.co Kingsley Care Homes Ltd vacant post Care Home 71 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (54), Physical disability (5) of places Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2006 Brief Description of the Service: The home is registered for 71 service users in 51 single rooms and 10 shared rooms. Of these, 45 rooms have en-suite facilities. The home has grown up around the original large Edwardian house, and is set in well-tended grounds, to the front and rear. The provision of accommodation is suitable for older people with mobility problems, with appropriate aids and adaptations fitted, although the shaft lift is not modern - being fitted with a heavy, hand-operated outer door, and an internal iron grill cage door. Consequently, some service users may find this difficult to manage on their own. Kingswood unit is a newly built, self-contained dementia care unit that has been added to the rear of the home, and provides modern, comfortable accommodation for 17 persons with dementia. In addition, the main building can now accommodate persons with dementia, who require nursing care. The home is also registered to care for five people with physical disabilities aged between 50 and 65 years. At least one nurse is on duty at all times. There is a competent team of care staff, assisted by a full complement of ancillary workers. The home is operated by Kingsley Care Homes Ltd, which owns a number of other care homes in East Anglia. The Company Directors are regularly on the premises, as is the Operations Manager. The company also has a director of Quality and Compliance who provides support to the home. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. An Annual Quality Assurance Assessment (AQAA) was provided by the home prior to the inspection. The inspection occurred on an afternoon and early evening in July 2007 and took six hours and a quarter hours. The process included a tour of the building, observations of staff and resident interaction, including a mealtime. A number of documents were examined including residents care plans, medication records, the staff rota, recruitment, training records and records relating to health and safety. The inspection was facilitated by the manager. Three residents were tracked, including one with dementia. One relative was spoken with. What the service does well: What has improved since the last inspection? The home has extended its provision for people with dementia. The environment continues to improve with a continuing programme of maintenance and refurbishment in place. The activities programme has been developed and the social needs of resident are now being assessed and reviewed. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 6 A training analysis has been drawn up and update training in core mandatory areas is being provided or all staff. 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 be made available in other formats on request. Kensington House Nursing and Residential Home DS0000040035.V349009.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 House Nursing and Residential Home DS0000040035.V349009.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4,6,Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to have access to the information they need to make an informed choice about the home, and to have the opportunity to visit the home before deciding whether to live there. The home does not offer intermediate care, and therefore NMS 6 is not applicable. EVIDENCE: Since the last inspection, the home had varied its registration so that there was no limit on the number of residents with dementia that could be cared for. Please note, the description of categories and numbers on page 4 represents there being no restriction on the number of residents with dementia. Previously, most of the residents with dementia were cared for on Kingswood unit, and small number only and who also had nursing needs, were cared for in Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 9 the main part of Kingswood. A carer advised that in their opinion none of the residents exhibited challenging behaviour. The home had also increased the number of residents it could care for by one. The home remains registered for five younger adults who have a physical disability; no one within this category of need was accommodated at the time of the inspection. The home’s Statement of Purpose was on display in the home. The Statement of Purpose was revised in May 2007 to support a change to the home’s registration which was approved in June 2007, such that there is no restriction on the number of residents with dementia that the home may accommodate. There is a separate Statement of Purpose and Service User Guide for Kingswood unit, which was purpose built to accommodate people with dementia. The Service User Guide for Kensington House states that weekly fees start from £335, and £575, dependent upon resident’s needs and the type of accommodation. The Service User Guide for Kingswood states that places on this unit start from £575 per week. Fees exclude magazines, toiletries, dry cleaning, hairdressing, chiropody and optician costs. Three residents files were inspected, including two who had been admitted since the last inspection. All three contained pre admission assessments, two of them incorporated a social care single assessment, and the third incorporated a hospital discharge record. The assessments covered all essential areas, including moving and handling issues, and risk. The AQAA stated that potential residents are offered a trial visit when they may attend lunch and participate in activities. One relative spoken with advised that they were aware people sometimes came to have a lunch and consider whether they wanted to come into the home. The manager advised that few take up this option. Kensington House Nursing and Residential Home DS0000040035.V349009.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): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be assured that they will have a care plan and that their health needs will be met. EVIDENCE: Information relating to care plans is located in paper files and on the home’s computer system. The manager advised that the computerised records system in use was about to be changed as it was not very easy to use. Residents each had a personal plan and a copy of this is kept in their top drawer in bedrooms. The care plan includes a section on their social needs that the activities coordinator updates on a monthly basis. Three personal plans and two electronic records were inspected. They were comprehensive, and the plans for the two residents who had been in the home for some time had been reviewed on a monthly basis. Relatives are not routinely invited to these reviews. The home is focusing on developing its relationship with relatives, and AQAA stated that it is planning to invite Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 11 relatives, with residents’ permission, to monthly reviews of the residents’ care plans. Daily notes seen for three residents contained good detail and were complete. Records contained details of visits from GP’s, chiropodists, opticians and district nurses. Two district nurses were attending the home on the day of the inspection. The turn charts and wound care charts for a resident who was on bed rest were also inspected. These records were complete; the turn chart detailed two hourly turns, showing which side the resident had been left on. One relative spoken with advised that as a regular visitor they there had seen deterioration over the last year on Kingswood, and that they had told the manager this. The staffing section of this report gives further information on staffing levels on this unit, and supports the relative’s advice. The relative advised that during a recent morning six people had been left to sit in wheelchairs between breakfast and dinnertime. The resident said that this was an exception, but that staff were sluggish at moving people in wheelchairs into easy chairs. They also advised that there were often only two carers on duty on this unit in the afternoons. The said that they had observed that sometimes people in wheelchairs on this unit could wait after lunch had finished which was approximately quarter to two until almost three to be moved by two staff into an easy chair. On this occasion this relative requested that the carers move their relative from a wheelchair into an easy chair at 2:15. They did so immediately. Not all residents requiring assistance with transfers had been seated in comfortable chairs by this time. Two carers were seen attempting to move a resident from there wheel chair to an easy chair using a hoist. Although the carers were speaking kindly to the resident they continued to try to cajole through the resident calling out two or three times, “I don’t want to go in there.” One carer sought advice from the manager who attended. The suggested that the carers to let the resident remain in their wheel chair for the time being, and try again later. On the whole, staff were observed to carry out their duties in a calm and relaxed manner, displaying a good level of sensitivity and attentiveness. An examination of the arrangements for the storage and administration of medicines found these to be generally in good order, with some minor shortfalls in recording. The teatime medication round was undertaken by nurses, each did the round for half of the home. A nurse was accompanied by the inspector, and the records for half of the home inspected. The nurse followed good procedures in administering the medication, which was in a monitored dosage system. Medication was correctly individually popped into small containers to take to residents. Each time the medication trolley was left it was locked. The nurse Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 12 checked if residents needed a glass of water, and waited with each resident until they had taken their medication. One of the residents took time to swallow their tablets. The nurse displayed considerable skill in encouraging and checking that the resident had swallowed them before leaving. They were gentle and kind and sensitive. Another resident told the inspector that this nurse was very good at their job. Medications were signed for as they were given, and the nurse advised that after they had completed the round they would go through and check the records. The records checked covered twenty two days of medications, and there were a small, but significant number of gaps where there should have been either a signature or a code to account for why the medication had not been administered. All records with the exception of a resident who had been admitted the day before had a photograph attached to their records. The homes 2007 quality assurance residents survey found nine out of twelve residents responding thought that they ware always treated with dignity by care staff, three thought that they usually were. The AQAA stated that there had been ten deaths on the hone over the last twelve months, and two in hospital. Regulation 37 reports received by the CSCI indicated that only three of the deaths in the home were unexpected. The home did not have a policy on palliative care, however the manager was aware of the Liverpool care pathway approach to palliative care and advised that they had spoken to the Primary Care trust the previous week about developing this. The home’s policy on death and dying did not include any reference to what should be done in relation to a resident’s room and possessions after a death. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 13 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. This judgement has been made using available evidence including a visit to this service. Residents are being offered a good choice of choice of activities. They are offered a choice of nutritional meals. They are supported to maintain family and other contacts. EVIDENCE: The home has a programme of organised summer outings that have been chosen by residents. A list of activities for the week of the inspection were displayed on the notice board. Something was on offer every weekday morning and afternoon, including gardening, foot spas and manicures, trips out, games, craft activities and sing along activities. A poster displayed in the home gave details of a monthly service provided in the home by a local church. A relative spoken with confirmed that the home did have a good range of activities and outings, including music and church. The home employs a full time activities coordinator who also has a role in reviewing the social aspect of individual residents’ care plans. The home has plenty of communal space and there are quiet areas where residents can choose to sit. One resident spoken to advised that they liked to Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 14 spend evenings in their own room, where they had a television, and that a member of staff would take them up just after 6pm. A relative advised that they could visit whenever they liked, and that the home gives them a meal. They advised that they also take their relative out. The homes quality assurance report shows that the vast majority of relatives feel very welcomed to come into the home. Two relatives were present in the dining room in Kingswood, one of these was assisting their relative with eating, and advised they did so every day. Lunch in the dining room on Kingswood was observed. A number of factors and events during the mealtime on Kingswood detracted from the main meal of the day. Tables were attractively laid, however four residents on one table were all wearing plastic aprons to protect their clothing. Staff advised that they were given the choice and did not have to wear them. The meal was served by carers from hot trolleys that were brought into the dining room. These carers were also responsible for assisting the residents, and a number of them required some help with feeding. Whist serving and assisting was being carried out, one woman who was able to feed herself a little, and very slowly, (but kept falling asleep), received assistance to eat from three different carers. A number of the residents did not eat all of their dinners, and it was noticed that one of these ate two puddings. It was noticed that not all employees respected the importance of the occasion of residents’ main meal of the day. An employee of the company concerned with buildings entered the room without relating to the residents to provide requested but not immediately urgent information to the inspector. A worker carrying a tied black bag entered a door in the dining room and left through another exit a little further along the same wall, having stopped briefly to speak with carers serving the meal only. Although this was on the periphery of the room, it was not acceptable and was commented on later in the day by a relative spoken with. They advised that sometimes someone would come in at dinnertime and sit working at a computer during the mealtime. That week’s menus were inspected. The main meal on the day of the inspection was minced beef cobbler with fresh vegetables followed by treacle sponge. Residents could have an omelette as an alternative. For supper residents had the option of cauliflower cheese or sandwiches, followed by Vienetta. Other main meals during the week included beef in red wine, fish and chips, stew and dumplings and roast chicken. Notes of a residents meeting held on 16th July, attended by eight residents, detailed a number of concerns about food and meal times. The manager advised that she supported these views put forward by residents, and had already given consideration to some further menu changes. Notes of a staff meeting held at the beginning of the month showed that the manager had identified meal times as needing to be overhauled, and that they would be looking into the whole meal time process. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. Residents can expect to have good access to formal and informal routes of raising complaints and for them to be listened to, taken seriously, and acted on. EVIDENCE: The home has an appropriate complaints procedure in place, and responds actively to any expression of concern. This has been demonstrated since the last inspection by the managements handling of two formal complaints made to the CSCI. In both cases, an investigation was undertaken by senior managers. The Commission was copied into correspondence, and provided with copies of reports, so that this process could be monitored. Records of these were available in the home and shown to the inspector. The AQAA stated that all residents had a copy of the Statement of Purpose and Service User Guide, and two residents spoken with confirmed that they had these documents which include the complaints policy. The home’s AQAA stated that no complaints had been received. This was discussed, and the response had been interpreted as formal complaints made to the home directly, using the complaints procedure. The home did not have a log which detailed all complaints, although it was evident that the home is open to hearing and responding to informal complaints and concerns, and that this is a useful channel for ongoing service improvement. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 16 The homes 2007 quality assurance residents survey found eight out of ten residents responding to the enquiry, “ how easy is it for you to speak to staff about anything or any concern?” felt that they could usually or always do so. Two others stated that they rarely did so. There are examples stated in this report of residents and a relative having discussed concerns informally with the manager. These are detailed under environment and under health and personal care. A relative spoken with was asked if they knew how to make a complaint, they advised that they had asked recently and the manager had attended to see them. They advised that they sat and talked with the manager but that the items had not been found. The manager subsequently advised that they had taken action in response to the report of items missing from the laundry, by making changes to the domestic staffing roster and duties. Protection of Vulnerable Adult training had been provided to twenty-seven of the staff in 2007. Two others had received in 2005, and the manager advised further training will be made available for those who have not had it. Management are aware of local Protection Of Vulnerable Adult Procedures. One carer spoken with was aware of different types of abuse, and the need to report any such concerns to management without delay. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives can be assured that the home provides a comfortable and well-maintained environment. EVIDENCE: The home is divided into two units. There are designated areas for relaxing. activities, eating and drinking and watching television. The front lounges were busy, with much activity, but also conveying a relaxed and good-humoured atmosphere. Staff were noted to be interacting in a positive manner with service users. The home has an ongoing programme of maintenance; the AQAA states that bedrooms are being upgraded as they become vacant. A number of communal areas had been redecorated since the previous inspection, including the front entrance lounges and dining room, and carpets had been replaced in these areas. Two residents advised they had raised their dissatisfaction with new Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 18 curtains provided with the manager, who subsequently advised the inspector that blinds would be put up in addition to these voiles. A refurbishment of bathrooms was due to start in September. The AQAA provided stated that the home had made changes in the last twelve months after the Fire Officer and Environmental Health Officer had visited. The manager was asked about this but did not know of any recent visits from these agencies. There were no signs or pictures in the individual room doors of those residents with dementia in the nursing unit; the environment on the nursing unit had not been significantly modified to cater for the needs of residents with dementia, other than by the provision of security measures. Additional keypads had been fitted to upstairs corridors at the top of each flight of stairs and on the remaining exit doors on the ground floor. These were linked to the fire alarm. It was not clear why all of these were considered essential. A member of staff advised that residents without dementia knew the numbers to keypads, and if they forgot, only had to ask to be let through. This means that residents’ access to some parts of the building is restricted, and the independence of those without dementia limited unnecessarily. These changes had been made when the home was granted a minor variation in May 2007 to the effect that there would be no limit on the number of residents with dementia that the home could place on this unit. The AQAA stated that CCTV is in operation in the home. This was seen to be the case, however, on this occasion, the extent of the system was not checked to ensure that it did not intrude upon residents daily lives, One cupboard door marked “fire door keep locked “was unlocked. The manager locked it when it was brought to her attention, however the signage may have been incorrect. The home was clean and homely throughout. In one residents room there was a very faint lingering odour. This was discussed with the manager who advised that it was deep cleaned on a weekly basis, and that the vinyl floor in the ensuite and carpet in the room was scheduled to be replaced. The home had not reviewed its infection control policy since May 2006; since then a person had been nursed in isolation. The home had, however, obtained guidance on best practice in respect of infectious diseases. Protective equipment for staff, including aprons and gloves were available in the home. During a tour of the home it was noted that bathrooms and WC’s were clean and well stocked with soap and paper towels. Alcohol hand cleanser Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 19 dispensers were sited on walls throughout the building, encouraging staff to cleanse their hands frequently. It was recommended at the last inspection that the adequacy of the provision of WC’s near the rear lounge should be reviewed. This was not followed up at this inspection. The manager advised that they were seeking to appoint a housekeeper who could monitor and manage the domestic team, cleaning functions and laundry facilities. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. The home can demonstrate safe recruitment procedures, which protect residents. Residents cannot be assured that there will always be enough staff on duty to meet their needs. EVIDENCE: The roster for Kensington showed that there is always at least one nurse on duty and sometimes two. The 24-hour period is divided into three 8-hour shifts. On the day of the inspection, there were two nurses and seven carers on the early shift and two nurses and five carers on the late shift on the main nursing unit. This was one carer down on each shift to the normal compliment, but one additional nurse on each shift was on duty to ensure that there were sufficient staff overall. One nurse and three carers were scheduled to cover the night shift. On the day of the inspection the home was fully staffed and call bells were heard to be responded to within a reasonable amount of time, the longest observed being approximately six minutes just before lunch; the call was from a toilet. The home employs a full time activities coordinator in addition to these care staff. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 21 Three carers are based on the daytime shifts on Kingswood, to care for seventeen residents with a dementia. Staff were observed to be constantly busy at this level of staffing, particularly at lunchtime when the staff were also responsible for serving meals. The manager confirmed that there were sometimes only two carers on duty on this unit, where a number of the residents are also wheelchair users. The roster for the previous week for this unit was examined. On the day prior to the inspection, there had only been two carers in duty in the morning and two in the afternoon. On the day before that, a Sunday, there had been just two on afternoon; this was also the case on the afternoon shift on the previous Friday Thursday, Tuesday and Monday. The manager advised that there had been some staff sickness recently. Evidence of the impact of this level of staffing is detailed under the health and personal care section of this report. The files of three recently recruited staff were randomly selected and inspected. All three had evidence of correct employment procedures in place. Files contained written references, received prior to the date of employment. All contained Criminal Record Bureau (CRB) checks. In two cases these were dated prior to employment commencing, in the third a PoVA first check had been undertaken prior to employment commencing. All contained proof of identity. The manager advised that Skills for Care common induction standards are the basis of induction training which is supervised by a named carer and a trained nurse. The staff files evidenced that thus had been undertaken. The AQAA states that 19 out of 36 carers employed have NVQ2 or above, and That a further 11 carers are working towards it. The AQAA stated that 40 of 41 staff were white British, 2 Indian and 1 black Caribbean. This was queried at the inspection, and it was ascertained that this was an error and that of the forty white staff 24 are British white, 16 are Eastern European. The AQAA also stated that all of the residents in the home the first language of al of the residents in English. In the homes Quality audit, a number of residents had commented that the Polish care staff did not always understand them. The manager and the quality manager were spoken with about the language skills of staff from Eastern Europe, as this had been noted as a barrier to improvement on the homes AQAA. The quality manager advised that they were aware that there were some language difficulties; they advised that these staff had been encouraged to undertake English lessons, and required to speak English in the home at all times. (One resident had noted in the audit that when two carers performing care duties spoke to each other in Polish it made them feel very uncomfortable). The manager advised that some of the eastern Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 22 European staff had left the home, and staff from Suffolk had been recruited to reflect the background of the residents. At the residents and relatives meeting held in June, communication and understanding with Polish staff remained a matter of concern for some. The home had a training and development plan and an analysis of training undertaken by staff. The manager advised that they had focused on analysis staff training and ensuring all mandatory training was up to date, as a priority. Mandatory training had been provided to the majority of staff now in post in 2007 in moving and handling, Protection of Vulnerable Adults, and fire safety. Some staff were detailed as having had moving and handling training and fire safety training in 2006. Twelve staff had had food hygiene training updates in 2007. The manager confirmed that a further course would be put on for staff who had not had this in the last two years. Further courses in the control of substances hazardous to health and in food hygiene due to take place in August were advertised on the staff notice board, with advice that these were mandatory. Basic dementia training had been provided for twenty staff, but some still had work to hand in to evidence that this had been satisfactorilly completed. Training had been completed by seven staff. The manager advised that training in this would be provided for all staff. A staff file inspected showed that they had applied for this. The manager advised that she was aware that a small number of staff had had more advanced training in dementia care, but had not yet analysed the details of this. A member of staff on the nursing unit was asked if they needed to respond differently to residents with dementia. They advised that they needed to respond differently to all residents, and that since all of their work was based on person centred care. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 23 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): 31,33,35,37,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect the home to be well managed, and for the management to be responsive to their needs and opinions. EVIDENCE: The CSCI was notified in March 2007 that the Registered Manager had left the home. A manager who had covered some of the registered managers period of absence had subsequently been appointed manager. The Statement of Purpose states that the Manager holds the NVQ Registered Manager Award. The CSCI has not yet received a completed application form for the manager to be registered; the manager advised that they were awaiting the Criminal Record Bureau check they required, and intended to submit their application once they had received this. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 24 A deputy manager was in post. Part of the remit of the deputy manager is to strengthen link between the home and relatives. A summary of a residents’ quality questionnaire undertaken in January 2007 was provided, and an annual quality report based partially on the results of this and partially on a relatives survey had been published and made available to residents and relatives in March 2007. This contained an analysis of thirteen residents surveys. The company undertakes regular and thorough regulation 26 monthly monitoring visits and forwards copies to the CSCI. The home had produced a quality report detailing what they have done and what they will do in respect of relatives and residents suggestions and comments elicited from questionnaires. Residents meetings held quarterly are one consequence of this. Minutes of a residents and relatives meeting held in June were seen. The manager advised that residents had asked for separate meetings to be held, to ensure that their views came forward. This had been actioned, and a residents only meeting had been held in July. The manager was asked what if any monies were held on behalf of residents. They advised that an administrative worker dealt with this. This member of staff advised that they held a few small sums of money in the safe. This amounted to minimal amounts for two residents, (one had entered the home with this in their pocket), but a larger sum was being looked after for one resident who had been given this sum by a relative. The sum received was written on the outside of the envelope, which was kept in a safe. Inside the envelope were four receipts. These were not signed or listed, however the money remaining in the envelope was checked and found to tally with the original sum less these receipts. The public liability insurance certificate was displayed. The most recently issued certificate of Registration was displayed. Fire extinguishers were seen to have been services in September 2006. The home’s fire risk assessment was dated September 2005; the manager advised that this was currently being reviewed. Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 25 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X 3 3 Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 26 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. Standard OP9 Regulation 13(4) Requirement Accurate and complete records of medicines administered must be maintained. This is a similar requirement to one made at the inspection of 18th May 2006. The security arrangements on the main unit must be reviewed, so that sufficient security is provided for residents with dementia to meet any assessed risks, and also that the independence of residents without dementia is not unnecessarily restricted. The carpeting and vinyl flooring in one residents room must be replaced so that the faint lingering odour that remains after deep cleaning is removed. The competency of staff in English language must be assessed to determine whether they can understand and respond appropriately to the needs of residents. Adequate staffing must be provided at all times to meet residents’ needs in a timely and DS0000040035.V349009.R01.S.doc Timescale for action 24/07/07 2. OP19 23(2)(a) 30/09/07 3. OP26 13(3) 30/09/07 4. OP27 18(1)(a) 30/09/07 5. OP27 18(1)(a) 30/09/07 Kensington House Nursing and Residential Home Version 5.2 Page 27 6. OP35 17(2) dignified way. Monies must only be held for residents in line with the home’s policy, and where these are held then monies received in and out must be recorded and any receipts for goods or services purchased on behalf of the resident signed and countersigned. 30/08/07 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 OP4 Good Practice Recommendations The term EMI is used by staff and in the homes documentation to describe the nursing unit for people with dementia. This term does not properly describe the needs of the people care for, and also, since language influences the way in which thing are perceived and responded to the term the terminology should be changed. The homes policy on death and dying should be developed to include actions to be taken after a death in respect of the resident’s room and belongings. Appropriate signage to assist those with dementia should be used through out the environment. It should be ascertained whether the signage requiring a cupboard door to be locked is correct. 2. 3. 4. OP11 OP22 OP38 Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 © 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 Kensington House Nursing and Residential Home DS0000040035.V349009.R01.S.doc Version 5.2 Page 29 - 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. 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