Inspection on 27/11/05 for Kent House

This inspection was carried out on 27th November 2005.

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

Kent House 31/03/08

Kent House 19/06/07

Kent House 18/12/06

Kent House 11/05/06

Kent House 28/06/05

Kent House 10/04/05

Kent House 02/12/04

Kent House 22/06/04

Kent House 22/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Kent House George Street Okehampton Devon EX20 1HR Lead Inspector Unannounced Inspection 11:00 27 and 29th November 2005 th 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 Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kent House Address George Street Okehampton Devon EX20 1HR 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) 01837 52568 01837 55280 Stonehaven (Healthcare) Ltd Vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25), of places Physical disability over 65 years of age (25) Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8/11/05 Brief Description of the Service: Kent House is a large detached Victorian House located in the centre of Okehampton. The Home is registered for 25 older people who may have dementia, or a physical disability. There are 21 single bedrooms, nine with en suite facilities, and two double bedrooms. There is a shaft lift, although there are steps to 9 of the 21 bedrooms. These rooms are only suitable for service users who are able to negotiate steps. On the ground floor there are three lounges, a dining room, kitchen, two toilets, adapted bathroom, and 5 bedrooms. On the first floor there are 13 bedrooms and 2 bathrooms. On the second floor there are 5 bedrooms and 2 bathrooms. The Home has a front garden with seating and a small patio at the side of the home. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection took place on Sunday 27th and Tuesday 29th November 05. The inspection on Sundays started at 11.00am and concluded at 5pm, whilst on Tuesday the visit started at 2.00pm and concluded at 6pm. Fiona Cartlidge and Helen Tworkowski conducted the Inspections. These visits were made to Kent House because of concerns raised at previous inspections (19/5/05, 28/6/05& 29/6/05, 25/8/05 & 6/9/05, and 8/11/05) The Inspections included a partial tour of the building, examination of some records, and discussions with staff and Service Users. In addition feedback had been received from the District Nursing Service following the inspection on 8th November. This feedback included: • • • • The rudeness and lack of professionalism of senior care staff. The lack of competence amongst all staff to carry through basic care tasks such as washing Service User’s legs. The high level of minor injuries sustained by Service Users. The lack of awareness amongst staff of dementia, particularly in relation to ensuring that Service Users have sufficient to drink. What the service does well: What has improved since the last inspection? What they could do better: Service User’s needs are not met and their health and wellbeing is placed at risk. The daily routines at Kent House are for the convenience of staff not for Service Users. The food provided is at times cold, insufficient and not to the taste of Service Users. Service Users feel the need to supplement their diets with food brought in. Service Users were found to be cold, requiring that they wear gloves and coats, staff including managers did not have the initiative to respond to this situation. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 6 Standards of hygiene are low, and again service users health is placed at risk. Service Users have been left to eat their meals next to used commodes. Many of the staff do not have the ability to communicate with Service Users or Inspectors visiting the home. Senior Care staff have little understanding of some of the basic elements of care practice, for example in relation to continence or risk assessment. The management of the service is poor, repeated requirements are not met. One of the service users commented “It’s all done on the cheap here”. 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. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 &4 Assessments of Care Needs are inadequate. This places Service Users and staff at risk. EVIDENCE: Three Service Users have been admitted to the home since the end of September 05. Because of concerns regarding previous assessments and admissions to the home a Statutory Requirement notice was served on 5/8/05, to be met by 7/11/05. A visit took place on 8/11/05, and during this inspection it was found that Mrs Stone (Responsible Individual) had completed the assessment for one of these individuals. The assessment was inadequate and provided insufficient information to provide care. One of the other people, who had complex needs, had assessments on file that contained information about their needs. However this information had been provided after agreement that this person should move to the home. The process of assessment is critical to ensuring that a person’s needs can and will be met. Failing to complete a proper assessment places Service Users at risk. It is a legal requirement that Service Users receive confirmation in writing that the Registered Provider can Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 9 meet assessed care needs- this had not happened for the people who had recently moved to the home. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, and 10 Service User care needs are not met and their health and well-being is being placed at risk. EVIDENCE: On the visit on 8th November 05 it was found that Service User Plans had improved significantly, however they still lacked detail in some areas failing to specify the actions staff need to take. It was also found that Service User Plans had not been developed until the person had been living at Kent House for a week. It was also found on 8th November 05 that moving and handling issues were inadequately addressed. Whilst there was some references to these issues in the Service User Plan they were not properly addressed by a moving and handling plan. Equipment that was required could not be found. At the inspections on the 27th and 29th November 05 there had been no improvements in relation to the moving and handling plans. It was also of concern that the acting manager had not read all of the Service User Plans. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 11 It was noted that a district nurse had required that a Service User see a chiropodist urgently, there was no record of such a visit. An immediate requirement was made that this matter be urgently pursued. During the visit on the 27th November 05 it was noted that for one individual daily records included concerns regarding an individual Service User and that they were at additional risk of falling. No revised risk assessment could be found and the Senior Care Staff on duty did not know what a risk assessment was. From observation and discussions with the District Nursing Service it is clear that Service User needs are not being met. Some individuals were found to be unkempt and had not been bathed. It was noted on one file that one Service User was not to have a bath, though it was unclear why this was. However the Senior Care Staff when asked to give an account of how this lady was washed, including washing her feet, could not say. There was a comment in the Staff communication book that one person should not wear underwear at night, to make sure that the incontinence pad would be changed easily. However the effect of this action means that the skin is more likely to become sore. Some Service Users also complained that: • They were had to use a commode in their room rather than the staff assisting them to walk to the toilet. This apparently was because of a risk of falls, however there appeared to have been no attempt to involve other professionals to enable this individual to maintain her mobility and dignity with out undue risk. The commodes and perching stools were not available. • It was also noted that one Service User had been moved to an alternative bedroom. This new room was on corridor which was accessed by 4 steps. The individual concerned was unable to climb stairs, and was therefore trapped in this area of the home. There was no accessible bathroom in this area. Daily records show that staff were asking the individual to bathe on a daily basis, however it is difficult to see how this could be achieved, as there were no bathing facilities she could access. One Service User, has as part of her Service User Plan, an identified need that she should be encouraged to walk short distances. This Service User confirmed that the only time she saw staff was when they brought up her meals. Some of the Service Users at Kent House have dementia, and require a high level of care by staff. It was noted that two of these Service Users had very dirty fingernails. It was also noted that the cook and some of the staff referred Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 12 to Service Users who needed assistance to eat as “feeders”. Such terms are derogatory and must not be used. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15 Service Users, particularly those with dementia, are not given the opportunity to exercise choice over normal daily routines. Dietary needs and preferences are ignored. Service Users have chosen to make their own arrangement to have a balanced and at times sufficient diet. Some individuals are served meals sitting next to un-emptied commodes, this unhygienic, degrading and is exceptionally poor practice. EVIDENCE: On the evening of the 29/11/05 it was noted that two service users who had dementia were wearing their nightclothes at 5 pm, when they were taken for their tea. The Acting Manager said that three of the Service Users with dementia are normally put into their nightclothes before 5pm as this saves them having to be changed later. This is unacceptable practice. Service Users, particularly those with dementia can easily become confused as to time and place. Dressing someone in their nightclothes at 5 pm indicates it is time for bed- not time for tea, compounding confusion. From discussions with Senior Care Staff it is concluded that the homes practice is that night staff have to make sure that 6 of the homes Service users are up and dressed before 8am. The exception to this is if one of the 6 Service Users Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 14 are listed on the bath rota for that day. They are then able to remain in bed. Unfortunately another Service User who is not identified on the bath rota must to be their place in the Service User group identified to get up early. Whilst it is recognised that some Service User’s like getting up early not all do. Getting up early must occur because a Service User chooses to do so. Some of the Service Users have diabetes, in looking at these records it appeared that checking the blood sugar levels is part of the night staffs duty, and is therefore done before 8am. On one occasion it was done as early as 6.50am. There appears to be no reason for this, other than the convenience of staff. The lunch on the 27th November 05 was roast chicken with mashed potatoes, stuffing, roast potatoes and carrots and sprouts. There was tinned fruit salad and spray cream for desert. Five Service Users spoken with complained about the meal. Complaints included: that it was cold, that staff had forgotten the chicken, and that food preferences had been ignored. In some of the rooms where Service Users were sitting and eating their meals, there were commodes that had been used and not emptied. One Service User said that the night staff emptied the commodes before they went off duty and they were not emptied during the day. Commodes should be emptied and cleaned after each and every use. To leave an individual to eat their meal in the presence of a used commode is very poor practice. Service Users spoke with said that they had to buy their own fresh fruit. One individual complained of constipation and had also bought prunes to help with this problem. A further Service User said that relatives purchased food that was more to the person’s taste (ham, biscuits, crackers, faggots). Two people complained that there was insufficient food in the evenings. Tea is served at approximately 5.30 pm and breakfast is not until after 8am. The meals over the weekend were being cooked by the person normally employed as a cleaner, he sometimes stands in as a cook. All milk in the home for Service Users was reconstituted skimmed dried milk. Repeated requirements have been made for the Registered Provider to provide fresh milk, dried milk should be available as an alternative if Service Users choose it. if the Service User requests it then dried milk can be offered. Concerns have also been raised regarding the provision of skimmed milk. Whilst some Service Users may need to reduce their weight or control their fat intake, many don’t and are in fact severely underweight. There was no cake in the building on 27th November 05, though the cook was making a packet cheesecake for tea. Following a prompt by an Inspector staff offered biscuits to Service Users with their afternoon tea. One person who is on a soft diet was seen trying to suck a chocolate bourbon biscuit. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 15 In the pantry there were some oranges- however from the comments made by Service Users, they felt obliged to buy their own fruit. On the 29th November 05, it was noted that one individual was given a milky cup of tea. She confided that she did not drink milky tea, but much preferred coffee. This meant she went without a drink. It was noted in her Service User Plan that she likes coffee. Failing to provide sufficient drinks places elderly people at risk of dehydration, which can exacerbate urinary tract infections and other health problems. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 16 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 The views of Service User and from visiting professionals are not listened to and are not acted on, Service Users can not be assured that their rights will be protected. EVIDENCE: During the inspection on the 27th November 05 a number of Service Users expressed concerns about the service. During the inspection visit on 29th November 05 one of these individuals said that on the 28th November 05 the Responsible Individual had questioned her as to what she had told the inspectors. The individual felt upset by this questioning. As is noted later in the report some areas of Kent House were found to be very cold on the 27th November 05. The District Nurse, said that she had in the past raised concerns regarding how cold it was in the home. It is of concern that issues raised are not dealt with. As has already been noted in this report there are concerns that Service Users needs are not being met and these omissions in care can be considered as neglect. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, and 26 Service Users do not live in a safe, comfortable and hygienic environment. EVIDENCE: Kent House is well situated close to the centre of Okehampton. The home is generally well laid out, with 3 separate lounges on the ground floor and a large dining room. Nine of the bedrooms are on half landings that mean that these rooms are only accessible to someone who can climb stairs. Requirements have previously been made that no one who is unable to climb stairs should be admitted to these rooms. At the inspection on 8th November 05 it was noted that one individual who is not able to climb stairs had been moved to such a room. As there is no accessible bathroom on that level this individual is not able to bathe. It was noted on 27th November 05 that some of the rooms on the top floor of the house were cold as were the lounge and dining room. Service User complained about the cold, and Service Users in the lounge wore gloves. An additional electric fire was placed in the lounge. An immediate requirement was made to improve the of heating the home. At the visit on the 29/11/05 Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 18 Service Users on the top floor confirmed that their rooms were much warmer. However the lounge and dining room were still cold and Service Users felt the need to wear gloves or a coat. It was found that the supplementary heater had been removed. It was in the room where staff sleep. The Acting Manager was required to put it back in the lounge immediately and a further immediate requirement was made. One window in room 12 was found not to shut properly and in room 14 a window had been boarded up though it was not clear why. On Sunday 27th November 05 none of the bins had appeared to have been. A cleaner is not employed to work over the weekend. On the 29th November 05, the bins had been emptied however not all bins had disposable liners, although they were being used for clinical waste such as disposable gloves. Tablet soaps were being used and left in bathrooms and toilets. Ideally liquid soap should be used, however some individuals may wish to have tablet soap, and this is acceptable if it for their sole use. It is poor practice leave tablet soaps in areas used by more than one person. On the 27th November 05 it was also noted that there were a number of used damp flannels were left in a shared bathroom. Again this is poor practice. At the visit on the 8th November 05 it was noted that one of the Service User’s “nurse call bell” was not working, the Inspector was told that this was about to be repaired. On the 29th November 05 the bell had not been repaired, the Service User had to walk on a zimmer frame into the nearest bathroom to ring for assistance. An immediate requirement on 27th November 05 was made that this bell be repaired, and it was repaired by the 29th November 05. On the top floor of Kent House there is a “library”, this room is identified in the Statement of Purpose as part of the communal space of the home, for the use of Service Users. At the inspection on the 8/11/05 it was found that one of the staff was living in this room. The Registered Provider had made a similar arrangement in the past and a requirement made, that this should cease. It is therefore of serious concern that this should occur again. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 19 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 and 30 There is insufficient staff (ancillary and care) at Kent House to meet the needs of Service Users, placing Service Users and staff at risk. Many of the staff on duty do not have the communication skills to meet the needs of Service Users. EVIDENCE: On Sunday 27th November there were four staff on duty. Three of the staff were working twelve hour shifts, and the inspector was told that during this period each would take a one hour break where they could if they chose leave the building. This means that for three hours between 8am and 8pm there are only three staff on duty. This report has already identified a number of practices that are done for staff convenience including: - The night staff getting a minimum of 6 people up before 8am. - Three of the Service Users being prepared for bed at 5pm - Blood sugar levels being done at 6.50am - A Service User not wearing underwear at night for the convenience of staff, potentially causing soreness. Other indicators of a insufficient staffing are: - bins are un-emptied at weekends Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 20 - service users looking unkempt and with dirty nails - commodes are not emptied after use - staff only see some service users in their rooms when they serve food or drink. It is also noted that many of the staff on duty spoke English as a second language. Many of the Service Users said that they found these staff to be very kind and caring, however they could not understand what they said. On the first day of the inspection three out of the four care staff did not have English as their first language. Both inspectors found difficulties in communicating with these staff. One person also complained that staff spoke to each other in their first language, she did not know what they were talking about. All of the Service Users said that in general the staff were kind and did their best. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 21 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, 32, 33, 37 and 38 This Care Home is badly managed, placing Service Users and staff at risk. EVIDENCE: The last Registered Manager left Kent House in December 04, since then the home has been managed by a series of acting managers. The current management arrangements are unsatisfactory, this is evidenced throughout this report by the poor standards of care. The Responsible Individual visits Kent House each month and reports on the running of the home. In spite of all the concerns raised in previous inspections and again identified in this inspection, the Responsible Individual reported of Kent House that there were no concerns. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 22 There is no coherent set of policies and procedures. Two files of policies could be found, however it was not clear which of these were current, and which related to the previous owners. The Acting Manager said that she had not read these policies. Health and Safety concerns have been identified through out this report: including the lack of moving and handling assessments, poor hygiene practices and that a Senior Care Staff did not know what a risk assessment is. On the 27th November 05 no accident book could be found, though it was finally located on 29th November 05. The accident book must be readily available enabling staff to complete it when necessary. The Registered Provider visits the home monthly unannounced to monitor the conduct of staff and assess the quality of care they provide. Copies of reports of these visits made have been supplied to the Commission, however in spite of concerns being raised consistently at inspections, no concerns are ever identified through these reports. Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 23 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 1 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 X 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 X X X X X 1 1 STAFFING Standard No Score 27 1 28 1 29 X 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 X X X 1 1 Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 24 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 OP3 Regulation 14 Requirement Requirement made following Inspection on 8/11/05: No Service User is to be admitted to the home without a comprehensive assessment of their needs, unless as part of an emergency admission. Requirement made following Inspection on 8/11/05: No Service User is admitted to the home without a Service User Plan, as specified in the National Minimum Standards, unless as part of an emergency admission. This Requirement was made as part of Statutory Requirement Notice to be met by 19/5/05. Requirement made following Inspection on 8/11/05: No Service User may be admitted to the home without Stonehaven (Healthcare) Ltd confirming that their needs can be met on the basis of an assessment. This requirement was made as part of a Statutory Requirement Notice to be met by 7/11/05. DS0000032744.V269685.R01.S.doc Timescale for action 27/11/05 2 OP8 15 27/11/05 3 OP4 14 27/11/05 Kent House Version 5.0 Page 25 4 OP22 23,15,12 5 OP20 23 6 OP7 13 7 OP28 12 8 OP7 13 9 10 OP10 OP22 12,13 23 11 12 13 OP7 OP7 OP28 12 12, 18 18 Requirement made following Inspection on 8/11/05: Only ambulant service users, who are able to climb stairs, should be admitted to the 9 bedrooms accessed via steps. This requirement was also made at the Inspection on 22/2/04. Requirement made following Inspection on 8/11/05: Communal Space (including the second floor lounge) is not to be used for staff, including as a staff bedroom. This requirement was also made at the inspection on 22/2/04. All Service users must have a moving and handling assessment that must be fully implemented. This requirement was made at the inspection on 8/11/05, and has not been met. All care staff must be familiar with the Service User needs and how they are to be met, as expressed in the Service User Plan. Risk Assessments must be regularly reviewed and where there has been a change in risk it must be amended. Commodes must be emptied and cleaned after each and every use. Service Users must be provided with equipment such as commodes and perching stools as is appropriate to their needs. Service Users must not be referred to by derogatory terms such as “feeders”. Service User must be given support to maintain their personal hygiene. Staff must have sufficient communication skills to be understood and to make themselves understood to the DS0000032744.V269685.R01.S.doc 27/11/05 27/11/05 27/11/05 01/01/06 01/01/06 29/11/05 29/11/05 29/11/05 29/11/05 01/01/06 Kent House Version 5.0 Page 26 14 OP7 12, 18 15 OP14 12, 18 16 OP33 12, 18 17 OP15 16 18 OP15 16 19 OP15 16 20 OP15 16 Service Users and to visiting professionals. Service Users must be provided with appropriate support in relation to their continence to ensure that they do not become sore. Where there are concerns appropriate advice from the continence advisor must be sought. Service Users, including people with dementia, must not be got up and put to bed at times to suit the staffing of the home. Daily routines in the home must reflect the needs of Service Users primarily not the convenience of staff. The timing of meals must be reviewed, there should be no greater gap than 12 hours between supper and breakfast. A requirement was made on the 6/9/05 that the meals should be better spread through out the day by 1/11/05. This had not been met. Dietary needs must be identified in Service User Plans and must be met. This requirement was made at the inspection on 6/9/05 to be met by 1/10/05. This has not been met. Service Users must be provided with a range of fresh fruit as part of their overall diet. This requirement has been made repeatedly over the last two years. Service Users must be provided with fresh milk (full fat, semi skimmed or skimmed) to drink in their tea and coffee and on their cereals. Reconstituted dried milk may be offered as an alternative, if the Service User requests such milk. This requirement has been made repeatedly over the last DS0000032744.V269685.R01.S.doc 08/12/05 08/12/05 08/12/05 29/11/05 29/11/05 29/11/05 29/11/05 Kent House Version 5.0 Page 27 21 OP38 13 22 23 24 25 OP15 OP16 OP18 OP16 13, 23,12 12 13 22 26 OP25 13 27 OP25 13 28 OP22 13 30 31 32 33 OP19 OP19 OP26 OP26 16 16 13 13 two years. The registered person must ensure that there is a proper system for the monitoring of accidents including falls. This requirement was made at the inspection on the 28 and 29 June 05 to be met by 1/8/05, and has not been met. Service Users must not eat their meals adjacent to used commodes. Service Users must not be crossquestioned about their discussions with Inspectors. Service User must be protected from abuse: both acts of omission and commission. The Registered Provider must ensure that all concerns raised are investigated and appropriate action taken. Immediate Requirement made 27/11/05: Proper heating must be provided throughout the house. Immediate Requirement made 29/11/05: The lounge and dining room must be sufficiently warm for Service Users not to wear gloves and coats. Immediate Requirement made 27/11/05: The Call bell in room 13 must be accessible and working at all times The window in bedroom 12 must be able to close fully, rather than leaving a gap. The window in bedroom 14 must be repaired and the boarding removed. The premises must be kept clean and tidy seven days per week. This includes emptying bins. Bars of soap and wet flannels should be removed from shared bathrooms and toilets. DS0000032744.V269685.R01.S.doc 29/11/05 29/11/05 29/11/05 29/11/05 29/11/05 28/11/05 30/11/05 28/11/05 01/01/06 01/01/06 14/12/05 14/12/05 Kent House Version 5.0 Page 28 34 OP27 18 35 OP30 18 36 OP22 16 37 OP24 16 38 OP19 16 39 OP32 12,8 41 OP32 12, 8 There must be sufficient staff (including ancillary staff) to ensure the well being of service users. All care staff must have the ability to communicate effectively with the service users who live at Kent House, this includes people with dementia, visiting professionals and relatives. Any refurbishment of the home should take into account the needs for people with dementia. Adequate signs must be provided for people who may have dementia or who may be confused. This requirement was made at the inspection on the 6/9/05 to be met by 1/11/05, no refurbishment has been completed. All Service Users must be provided with adequate bedding. This requirement was made at the inspection on 6/9/05 to be met by 1/11/05, this requirement has not been inspected. The bathroom on the first floor must have adequate ventilation. This requirement was made at the inspection on 6/9/05 to be met by 1/11/05, this requirement has not been inspected. The Registered Provider must ensure that the Commission receives an application for Registered Manager. This requirement was made on 6/9/05 and has not been met by the timescale of 1/11/05. The Registered Provider must ensure that proper interim management arrangements are made to ensure the proper management of Kent House and DS0000032744.V269685.R01.S.doc 14/12/05 01/01/06 01/01/06 01/01/06 29/11/05 01/01/06 14/12/05 Kent House Version 5.0 Page 29 42 OP9 13 43 44 OP38 OP37 13 12, 13 the well being of Service Users. Where Service Users are able and wish to self-medicate, this must be done within a riskassessment framework. This requirement was made at the inspection on the 6/9/05, to be met by 1/10/05, and has not been inspected. The accident book should be available to be used at all times. The Registered Provider must ensure that there is a comprehensive set of Policies and Procedures that inform practice in the home. 27/11/05 14/12/05 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kent House DS0000032744.V269685.R01.S.doc Version 5.0 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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