Inspection on 28/04/08 for Kent Lodge

This inspection was carried out on 28th April 2008.

CSCI found this care home to be providing an Adequate service.

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 Lodge 08/03/09

Kent Lodge 30/04/07

Kent Lodge 29/11/06

Similar services:

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Kent Lodge 1 Pitshanger Lane Ealing London W5 1RH Lead Inspector Ms Jane Collisson Key Unannounced Inspection 28th April 2008 09:50 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 Lodge DS0000068006.V361737.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. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kent Lodge Address 1 Pitshanger Lane Ealing London W5 1RH 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) 020 8998 2412 020 8991 2658 kent_lodge@shaw_homes.co.uk www.shaw.co.uk Shaw Healthcare (Group) Limited ****Post Vacant**** Care Home 38 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (18) of places Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP (Maximum number of places: 18) Dementia - Code DE (Maximum number of places: 20) The maximum number of service users who can be accommodated is: 38 30th April 2007 2. Date of last inspection Brief Description of the Service: Kent Lodge is a purpose built care home registered for thirty eight older people. It includes a first floor dementia unit for twenty people, which was opened in 2007. Both permanent and respite care are provided. The home is owned and managed by Shaw Healthcare (Homes) Ltd. This is a private organisation that manages residential homes nationwide. The home is located close to transport links and main roads. It is situated on a corner of two busy roads, with local shops and facilities nearby, including a small library, cafes and churches. The facilities of Ealing Broadway can be reached by bus. Although there is limited parking at the home, there is nearby street parking. All areas of the home are accessible, with a passenger lift between the ground and first floors. There are thirty eight single bedrooms. Twenty people are accommodated on the first floor and eighteen on the ground floor. None of the rooms are en suite but each has a wash hand basin. Both floors have communal lounges, dining rooms, bathroom and toilet facilities. There are lounges for people who smoke on each floor. A courtyard garden is available and there are balconies on the first floor, with seating. The staff team consists of a Registered Manager, Deputy Manager, Team Leaders, and a team of day and night support workers. There is an administrative officer, catering, laundry, domestic and maintenance staff. The current weekly fees are from £490 to £572 for the dementia unit. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We carried out this unannounced inspection on the 28th April from 9.50am to 5.30pm. A further visit was made in the afternoon of the 7th May to complete the inspection and the inspection process took a total of ten hours. The Acting Manager was present on both occasions. She has been in post since February 2007 but has only recently applied for registration to the Commission for Social Care Inspection. The home has one vacancy and, the time of the inspection, one person was on respite and one had been admitted as an emergency placement. The home was toured with the Manager and most of the people living in the home were met during the course of the visits. A number of people prefer to remain in their bedrooms, watching their televisions, and the remainder spend their time in the various lounges. There were no formal activities on either visit and the post of Activities Organiser is still vacant. One staff member was providing some activities in the dementia unit. Three people were seen to have visitors, one of whom was met, and there are private areas where they are able to meet. The Manager had recently completed the Commission for Social Care Inspection’s Annual Quality Assurance Assessment which provides statistical information about the home, information about how it is managed and its plans for future improvement. We examined a range of documentation, including care plans, medication, maintenance, finance records, staff and training records. All of the key National Minimum Standards were examined on this inspection. We found that there have been noticeable improvements to the home in the last year and efforts have been made to make it more homely and comfortable. It was noted, however, that there are items of furniture in need of replacement. Agreement to have some items replaced was made during the inspection and new floor covering and a carpet were laid in two of the small lounges. Improvements have been made to the home’s environment by the painting and brightening of bedrooms and bathrooms and this is an ongoing project. One of the meals was sampled and both of the dining rooms observed during lunch. No specific cultural needs are met on a regular basis although the home has a number of people from the West Indian and Asian communities. People living in the home and a visitor were positive about the staff team, one commenting that “all the staff are very good”. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 6 The home had nineteen requirements at the inspection in April 2007 and two were found to be outstanding. An additional eleven have been made, details of which are also under “What they could do better”. What the service does well: What has improved since the last inspection? What they could do better: We found that the Statement of Purpose does not demonstrate how the needs of people with dementia, and other specialist needs, are to be met. In particular, information on the ways in which people can be supported to retain their independence and the activities in place for people with dementia, need to be detailed. The home needs to ensure that people living in the home, and their representatives, are fully aware of the terms and conditions and have details of fees, room number and any additional expenditure that is required. We found that the care plans are very long and would not be accessible to the people they concern. Care plans should be more person centred and be userfriendly to the people living in the home and their representatives. They need to reflect the needs of the person receiving the service and be shown to have their agreement, wherever possible. Where there are restrictions, these need to be seen to be agreed. Where people may be at risk, the assessments need to be completed based on the information that is known. These need to be checked for accuracy so that they are in accordance with the person’s care plan, and then monitored and reviewed on a regular basis. We found errors on the medication procedures. Previous errors had been found on the Shaw Healthcare’s recent internal audit. The Manager must ensure that sufficiently robust monitoring takes place of the medication administration. Systems need to be in place to find any discrepancies as soon as possible after medication is administered. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 7 In view of the medication errors, the Manager must ensure that the competency of the staff who are responsible for medication administration is assessed regularly and appropriate action taken when errors are found. The lack of an Activities Organiser has not supported the home in providing a better range of activities and interests for the people living in the home to pursue. The Manager must ensure that there is an activities programme which takes into account the wishes and needs of the people in the home. Sufficient opportunity must be given for people to enjoy outings, entertainments or individual activities. This is partially restated and needs to be addressed. We found that, while most people are happy with the food provided, anyone wishing to have a special diet has limited choice. The Manager must ensure that anyone receiving a special diet is offered a choice of varied and nutritious meals, on a daily basis. A number of items of furniture were noted to require replacement. A sufficient budget needs to be available to replace furniture and fittings as they are required. An audit should be carried out and an Action Plan be provided to show which items will be replaced and a timescale for this. Where cleaning cannot remove the unpleasant odours from carpets, the carpets need to be replaced. We found that, while the recruitment processes appeared satisfactory, the record keeping was very poor and needed to be improved. The Manager must ensure that the records required for inspection are up-to-date and maintained in good order, with regular monitoring being carried out. To support this process, the Registered Providers need to ensure that the policies and procedures which provide guidance for the record keeping are up-to-date. A number of the issues which have been the subject of requirements, including the medication administration, have been the responsibility of senior staff. Appropriate training for senior staff is needed to enable them to fully understand and carry out their responsibilities. 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. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 (6 does not apply) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The documentation provided by the home, to help people to make a decision, does not demonstrate how the needs of the people with dementia or other disabilities and illnesses are met. People are provided with terms and conditions but these do not reflect the fees to be paid, or the facilities provided. The home receives information before admission and carries out an admission procedure. The regular changing of staff between units may not have the best outcomes for the people living in the home. EVIDENCE: We found that the Statement of Purpose had been updated since the last inspection but does not contain the information about the ways in which the needs of people with dementia are being met. This was required when the dementia unit was set up and the home needs to demonstrate how the staffing levels, activities, facilities and services meet the differing needs of the people living there. It also needs to be shown that the younger people with dementia Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 10 who have been admitted can have their needs met by a more age appropriate lifestyle and activities. There are also other people in the home with special needs, such as mental health issues, and the Statement of Purpose also needs to demonstrate how these are met. A number of people from ethnic minorities are accommodated but there is no specific information on the type of needs that the home can meet in relation to any special diets, cultural and religious needs. The staffing levels shown in the Statement of Purpose were not those currently agreed and these need to be amended. It was a requirement at the last inspection that the terms and conditions were issued to each person. In the files we examined, copies have been included but did not contain the details of the room, or the fees and they were not always signed by the person or their representatives. As rooms have been changed, it needed to be demonstrated that there was agreement to this and a new contract should be available showing the new room number. When the units were changed, one person wished to retain their bedroom, and has been able to do so We examined a sample of files which contained assessments from the Local Authorities or the hospitals. The Manager informed us that she carries out all of the assessments and uses a pre-admission assessment process, copies of which were seen. A request was made for an emergency respite stay during the first visit and the Manager requested an assessment to be supplied by fax to help her to make a decision. Because the dementia unit was only opened in 2007, not all of the staff had chosen to work in this area of care. All of the staff have had basic dementia training and twelve staff were undertaking Level 2 certificate in dementia care. However, we found that not all staff are happy with the current practice of staff being rotated around the home, working on both the dementia and nondementia units. We discussed this with the Manager, who was planning to look at this practice once she recruits more staff. It is recommended that the Manager looks at providing dedicated teams for each unit, to enable staff to develop their skills in an area where they feel they can provide the best possible support. The home does not provide Intermediate Care, therefore this standard could not be assessed. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each person has a detailed care plan, but they are not person centred. The style and length of the care plan would not support people, or their relatives, to be fully involved in the process. Care plans are not focussed on outcomes, particularly for those people with dementia. Health needs are met by the involvement of the community professionals but guidance is not always in place where specific medical needs are identified. EVIDENCE: We examined six care plans from both of the units. While improvements have been made to the general record keeping, the length of the assessments and care plans does not allow for ease of use. Most areas of support have been assessed but the information does not provide for a person-centred care plan with clear outcomes for the person concerned. The information in some of the plans did not appear accurate or thoroughly reviewed. There has been a recent audit carried out the Shaw’s own quality assurance department which also identified a number of shortcomings in the care Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 12 planning files. This included the need to review the care plans regularly and update information. However, the length of the information does not allow for easy auditing and, while the assessment processes are of use in identifying areas of the need, there are no clear care plans showing the way in which the person would like their support provided or to show the staff how to deliver it. An example was the lack of information about a person’s personal care needs, their preferences for a bath or a shower, whether this has been risk assessed, and which bathing equipment available would better suit their needs. Some of the information was not accurate. For instance, a risk assessment to minimise the risk of falls was contradicted by the information in the person’s file. The provision of cross gender care for one person appeared not to be appropriate and the care plans needed to be checked for accuracy and suitability after they are compiled by the Team Leaders. There were no risk assessments in place for a person recently admitted. Care plans should be available to the people using the service, or their representatives where this may be more appropriate, and be seen to be agreed. Any restrictions placed on a person also need to be agreed by all those concerned and, where this may result in a loss of freedom, needs to be fully documented. This was not evident where decisions have been taken on behalf of someone with dementia. The dementia unit has key pads, which restricts the movement of the people to the ground floor. While this is mainly for safety, because of the stairs, it needs to be demonstrated that people have some freedom to move around the garden and other parts of the home where this is of benefit to them. The health needs of the people in the home are met by community services. Information was seen in the care planning files of visits from general practitioners and other health professionals. However, information in one file examined was not detailed sufficiently, in regard to the severity of the illness or how staff would deal with any symptoms that might arise. The Manager undertook, on the first visit, to correct this and put in place the information required. The home uses a 28-day blister pack system for its medication administration. A medication audit has also been undertaken by the Shaw Quality Assurance team. There were a large number of shortfalls noted in the report, including gaps in signatures, a lack of stock checks and updating of information. At the second visit to the home, a sample of medication was checked. We showed the Manager evidence that medication from the non-blistered packets, for the same medication, had not been given on either one or two days for five of the residents. There were also errors in the recording of stock for “as and when” medications, such as paracetomol. She undertook to carry out an enquiry as to the reasons for this. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 13 The Team Leaders are responsible for the administration of medication and the Manager was planning a meeting to speak to them about the audit. Better systems of monitoring are required by the management staff to ensure that errors do not continue to occur. We discussed with the Manager that a daily count of all non-blister pack medication is made to ensure that medication is dispensed correctly. Many of the people in the home were unable to discuss fully their experiences of living in the home because of dementia or other communication difficulties. Those who were able to discuss the support they receive said that they had no concerns about the way in which they are treated by the staff and one person said “I cannot fault them”. A small number of people prefer to spend their time in their rooms, and this is respected. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence including a visit to this service. People do not always have the opportunity to enjoy a regular programme of activities but the home is making efforts to remedy this situation. There is insufficient evidence to show that people are being enabled to retain their independent living skills, particularly in the dementia unit. The food is generally well received but people who have special diets do not have variety and choice. EVIDENCE: We found that the home was without a regular programme of organised activities and was in the process of advertising for an Activities Organiser. A person recently employed had withdrawn before commencing work but, between the inspection visits, the Manager had started the employment process for another person. We talked to three people who said that they did not really know about any activities taking place and one person said that they would enjoy a game of bingo if it was available. One member of staff was providing some individual activities in the dementia unit, but further work is needed to providing a stimulating atmosphere in the unit and help people to retain their skills. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 15 Although the Manager said that activities, such as games, are available, they were not in evidence and there would be little opportunity for spontaneous involvement from the people living in the unit. There are a number of younger people in the dementia unit, whose needs may be different from the older, less active people. It needs to be demonstrated that the home has identified activities which may suit their needs and that these are available. We discussed with the Manager ways in which the staff could engage the people in activities. She is aware of the many ways in which life can be enhanced, and has encouraged the staff to try them, but needs to ensure that the ideas are put into practice. A small number of people are able to go out independently, one to a day centre, and their quality of life is improved by this. At the time of the inspection, there were no outings arranged. However, a minibus was delivered during one of the visits, which is to be shared by Shaw homes. This should provide the home with the opportunity to arrange outings. A small number of people had visitors during the inspection and three were met. The Manager said that there were no people currently who visited a place of worship. Evidence was seen, in one of the files examined, that the person’s cultural and religious needs had been discussed but they did not wish to pursue any special diet or participation in their religion. The Manager reported that the home had been unsuccessful in recruiting another cook when the last one had left, but the assistant cook has now taken over and is undertaking a National Vocational Qualifications Level 2 in Basic Cooking. The meal on the first day of the inspection was minced beef and dumplings, mashed potatoes, diced swede, and broccoli. An alternative of mixed grill was available. The dessert was bakewell tart and custard, which staff said had been prepared so it was also suitable for the diabetic people in the home. Although there is a vegetarian alternative available it is not specific as to what it is. It was noted at the inspection in June 2007 that the choice should be specific and not just advertised as “Vegetarian Option”. The people choosing this option said that it was usually jacket potato or an omelette. The Manager said that the people from ethnic minorities in the home are generally happy to have what is on the usual menu, although one did like rice and this was provided occasionally. The Statement of Purpose says that a “full range of special diets” can be provided, although it does not detail how much variety is provided. A balanced and varied diet, with choices, should be available to anyone requiring a special diet and the home should look positively at providing these. While most people spoken to were happy with the food provided, one person said that it “could be worse, could be better”. Two people complained to the Manager during the inspection that an item advertised on the menu was not available at the weekend. The Manager undertook to investigate why. A Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 16 person in the dementia unit, who required help with their meal, was seen to be supported appropriately. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 17 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. The service has a complaints procedure which meets the National Minimum Standards and the Care Home Regulations 2001. While major complaints are taken seriously, people’s concerns are not always recorded or used to improve practices. Safeguarding adults training is undertaken and issues now reported appropriately. Staff may need to be more confident about “whistle blowing” to ensure poor practice is reported. EVIDENCE: We found that there were two complaints recorded since the last inspection. However, there were a number of small concerns raised during the inspection, including the non-availability of a meal that was on the menu and repairs to a toilet seat. We discussed with the Manager that these concerns should be recorded so that any recurring items can be investigated and to show people that these are taken seriously. While people said that they would raise a serious complaint, some were reluctant to raise their smaller concerns. We recommended that a “grumble” book or similar system is introduced for people who do not wish to take their smaller concerns through the formal complaints procedure. Since the last inspection, there have two safeguarding adults issues which have been investigated through the London Borough of Ealing’s procedures. One of these was ongoing at the time of the inspection but was agreed to be taken through the disciplinary procedures of the home. We noted that all of Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 18 the staff, except one on long term sick leave, have had safeguarding adults training. However, the recent safeguarding adults issue had highlighted a possible problem with staff “whistle blowing” and should be discussed with them through supervision and in meetings. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 19 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, 20, 21, 23, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements are being made to the home’s communal and private areas with a redecoration programme but furniture is not always replaced promptly when required. Most bedrooms are limited in size but people are able to personalise them. EVIDENCE: We found that efforts have been made to improve the home’s environment and to make it more comfortable and homely. However, there were areas were upgrading is still required and items of furniture need to be replaced. Some work was carried out during the inspection visits and seating was ordered during the inspection for a lounge and to replace some of the older items. The floor covering in the ground floor smoking room was replaced between visits and a new carpet laid in the adjoining small sitting room. A regular programme of replacement is needed, with a sufficient budget to ensure that items can be replaced as required. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 20 There is limited space in the main lounge of the dementia unit for everyone to sit, with space for only thirteen chairs. There is a small lounge/meeting room on the same floor and a dining room. These rooms could be utilised better to provide activities and this should be considered. There is a smoking room in both units. All of the bedrooms have been redecorated to people’s tastes and those seen reflected this. Twenty five of the rooms are under 10 sq metres, including all those in the dementia unit, and do have limited space. However, those seen have been personalised as much as possible. In the dementia unit, “memory boxes” have been placed out the bedrooms to support people to recognise their room by placing their personal items in the box. Bathrooms have been painted, although one was still awaiting new tiling. There were four in use at the time of the inspection, including one shower room. The Manager has improved most of the areas, with the addition of plants and pictures, in an effort to make the home more homely. All of the bathrooms had equipment to support people with their bathing. There is a small enclosed garden in the middle of the home, with seating. The Annual Quality Assurance Assessment records that it is planned that attractive areas will be created for both units. The dementia unit, which is on the first floor, has access only to two balconies. Some efforts have been made to brighten these areas with flowers. Additional comfortable seating is needed to ensure that there is access for everyone to use in good weather. One person from the dementia unit was seen to be enjoying time in the garden and the opportunity for access needs to be part of the daily programme. The home was seen to be clean but some odour remains on part of the first floor. Where the carpets cannot be cleaned sufficiently, they need to be replaced. The laundry is in need of redecorating and, preferably, refurbishing. This work has been outstanding for some time and needs to be completed. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are generally satisfied with the care they receive. Staff levels appear adequate but need to be seen to be maintained throughout the day. While the recruitment procedure is satisfactory, the record keeping is in need of improvement. Basic training is undertaken regularly. Senior staff do not always demonstrate that they are fully aware of their roles and responsibilities. EVIDENCE: We were informed that the home had five care staff vacancies at the time of the inspection, and there were also domestic posts to be filled. There had recently been agreement for six staff to be on duty, four in the dementia unit and two in older person’s unit, with a Team Leader on each shift. While this is an improvement, there are times when the staffing levels are below this level as a number of staff work double shifts and have an hour’s break during the day. The Manager said that the management staff try to cover when these when breaks take place. The company has a system of six hour shifts, so that full time staff are required to work six days a week or combine their shifts into a thirteen hour long day. From the rota, most staff work for the longs day although they are not allowed to work on three consecutive days. While the system is not unpopular with staff, the implications for health and safety need to be kept under review. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 22 As discussed elsewhere in this report, we found that the practice of rotating staff between the different units is not enjoyed by some staff and does not appear to enhance the support for the people living in the home, particularly in the dementia unit. We discussed this with the Manager, who had a number of vacancies to fill and was not in a position to make changes at the present time. However, she is aware of the situation and will look at this when full recruitment takes place. We found that action is needed to be taken to address the roles and responsibilities of the Team Leaders. This was due to areas in which they have particular responsibility, including the medication administration and care planning documentation. There were deficiencies in both of these areas and this may point to a lack of specific training to fulfil this role. We discussed this with the Manager, who was due to speak to the Team Leaders about these shortfalls. Team Leaders fulfil a management role when the Managers are not on duty, and this must be seen to be supported by appropriate training and supervision. The home’s staff carry out their own staff recruitment. When the staff files were checked, it was found that they are in urgent need of reorganising. We found that the Manager was aware of this but, in view of the other areas of work that needed to be undertaken, had not made this a priority. The home’s administrative assistant is part-time and deal mainly with the finances in the home. Consideration needs to be given to providing the administrative assistance that is required to ensure the record keeping and recruitment processes do not necessarily fall to the management staff to complete. We found that the home has a good record of National Vocational Qualifications training and eleven of the twenty one staff have Level 2 or 3 National Vocational Qualifications. Six staff are undertaking the qualification. Twelve of the staff working towards gaining a certificate in dementia care. Each staff member undertakes an annual update of the basic training courses, including manual handling. A matrix, showing the training undertaken by each staff member, was provided. New staff undertake a three day induction course. Kent Lodge DS0000068006.V361737.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, 32, 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. The Manager has the experience to run the home and has made progress on the required improvements. The Registered Providers have systems in place for thorough quality monitoring. People’s finances are safeguarded. Fire precautions may not always be enforced sufficiently. EVIDENCE: The Acting Manager had been in post for just over a year and has previous experience of home management. She has only just applied for registration with the Commission for Social Care Inspection, which has meant the home has been without a Registered Manager since November 2006. The Registered Providers need to ensure that applications are made speedily when the management vacancy occurs. The Manager has a nursing qualification. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 24 We found that the management team had worked hard to make improvements to the home from a position where the home had been without consistent management for some time. However, there is a need for further environmental upgrading and more work in the dementia unit to ensure that current care practices in dementia care are being implemented. In particular, better use made of the space available on the first floor to accommodate the varied needs of the people living there. The staff team were generally positive about the home, but there are concerns about working in the dementia unit which need to be addressed by the management. The need to have staff in the unit, who have expressed a positive decision to work with people with dementia, would help to provide a better standard of care and help to support the development of the unit. Shaw Healthcare has its own internal auditing systems and thorough audits had been carried out shortly before this inspection on the care planning and medication. These are referred to elsewhere in this report. The Manager completed the Commission for Social Care Inspection’s Annual Quality Assurance Assessment in April 2008. This gave us details of the management of the home, which includes information on the way in which it meets the National Minimum Standards and Care Home Regulations 2001 and its plans for the future. Statistical information is also provided about the people living in the home and its staff. Meetings are held with the people living in the home from time to time to gain views. At the second visit to the home, a check was made with the administrative assistant in regard to residents’ finances. There are difficulties in getting banks and building societies to open accounts for people and three people have their finances dealt with through Shaw. These are held in a non-interest bearing account and this has been investigated in the past to see if this can be changed. In some cases Local Authorities hold accounts and personal allowances are paid into Shaw’s account and withdrawn as required. The remainder of the people either manage their own finances, or have them dealt with by families or solicitors. The majority of the expenditure we saw in the accounts is for newspapers, hairdressing, chiropody and toiletries. The Administrator confirmed that audits are carried out on the accounts by Shaw Healthcare and the Managers also check the accounts regularly. Although there have been improvements in the record keeping, there were areas, such as recruitment records, care plans and medication, where better organisation is required. We noted in the Annual Quality Assurance Assessment that some of the policies and procedures of Shaw Healthcare had not been reviewed for some time. These included policies for referral and assessment, last reviewed in 2003, racial harassment in 2003, staff grievance and disciplinary in 2004, COSHH in 2004, and sexuality and relationships in 2004. Some of these may be affected by legislative changes and should be reviewed regularly. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 25 At the first visit to the home we found that several bedroom doors were still being propped open as people were choosing not to have their doors closed when they were in the room. We discussed this with the Manager, and by the second visit, battery operated devices had been fitted to ensure that the doors will close when the fire alarm is activated. As part of the compliance with the fire risk assessment, the Manager needs to ensure that all of the fire precautions needed are in place. It was recorded that health and safety checks and services have been made for the following: Lifts in December 2007, portable electrical equipment in December 2007, hoists in February 2008, fire detection and equipment in January 2008. The gas appliances and heating system were checked in January 2008. There had been concerns with the heating system at the 2007 inspection but the system was working satisfactorily on the day of the inspection. The Manager reported, after the inspection, that the long outstanding requirement from the Environmental Health Officer had been actioned. This was to provide for proper ventilation in the staff toilets. Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 26 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 2 2 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 3 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 2 3 Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 27 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. Standard 1 OP1 Regulation 4(1)a, 12 (1) (a)(b) Requirement The Manager must ensure that the Statement of Purpose evidences how the home provides for the needs of all of the people in the home, including those with dementia. The Registered Providers must ensure that people are provided with a contract or terms and conditions, which must be completed with the information required, such as fees payable. (The previous timescale of 30/06/07 not met) The Manager must ensure that the care plans fully reflect the needs of the person receiving the service. The involvement of the people using the service must be demonstrated and any restrictions seen to be agreed. The Manager must ensure that all risk assessments are in place and that these are checked for accuracy, and are in accordance with the person’s care plan. The Manager must ensure that sufficiently robust monitoring takes place of the medication DS0000068006.V361737.R01.S.doc Timescale for action 31/07/08 2 OP2 5 (1) b 31/07/08 3 OP7 12 (1) a 15 (1), (2) a 31/07/08 4 OP7 13 (4) 31/07/08 5 OP9 13 (2) 30/06/08 Kent Lodge Version 5.2 Page 28 6 OP9 7 OP12 8 OP15 9 OP19 10 OP26 11 OP29 12 OP30 administration and a system is in place to ensure discrepancies can be found as soon as possible after medication is administered. 13 (2) The Manager must ensure that the competency of the staff who are responsible for medication administration is assessed regularly and appropriate action taken when errors are found. 18 (1) a The Manager must ensure that 16 (2) m, n there is an activities programme which takes into account the wishes and needs of the people in the home. Sufficient opportunity must be given for people to enjoy outings, entertainments or individual activities. (Previous timescale of 31/07/07 not fully met). 12 (2)(3)16 The Manager must ensure that (2) (i) anyone receiving a special diet is offered a choice of varied and nutritious meals, on a daily basis. 23 (2)(c) The Registered Providers must ensure that there is a sufficient budget available to replace furniture and fittings as they are required. An Action Plan must be provided to show which items will be replaced and the timescales involved. 16 (2) k The Registered Providers must ensure that, where carpets cannot be cleaned to eradicate odour, the carpets must be replaced. 19 (1) The Manager must ensure that Sch.2 the recruitment records are maintained in good order to evidence that all of the required information has been obtained and is in place for inspection. 18 (1) (c)(i) The Registered Providers must ensure that there is appropriate training for senior staff to enable them to fully understand and DS0000068006.V361737.R01.S.doc 30/06/08 31/07/08 31/07/08 31/07/08 30/06/08 31/07/08 31/08/08 Kent Lodge Version 5.2 Page 29 13 OP37 17 (3) carry out their responsibilities. Monitoring systems must be in place. The Manager must ensure that 31/07/08 the records required for inspection are up-to-date and maintained in good order, with regular monitoring being carried out. To support this process, the Registered Providers need to ensure that the policies and procedures which provide guidance for the record keeping are up-to-date. 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 That the Manager looks at providing dedicated teams for each of the two units, to enable staff to develop their skills in an area where they feel they can provide the best possible support. That an evaluation of the care planning and assessment documentation is undertaken, to assess its effectiveness and whether it could be streamlined to provide ease of access to the people using the service. That a “grumble” book or similar system is introduced for people who do not wish to take their smaller concerns through the formal complaints procedure. That an evaluation of the administration procedures in the home is carried out to ensure that there is sufficient time available to carry out procedures, such as recruitment, and maintain records in good order. 2 OP7 3 4 OP16 OP29 Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Kent Lodge DS0000068006.V361737.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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