Inspection on 29/11/06 for Kent Lodge

This inspection was carried out on 29th November 2006.

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

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

Other inspections for this house

Kent Lodge 08/03/09

Kent Lodge 28/04/08

Kent Lodge 30/04/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kent Lodge 1 Pitshanger Lane Ealing London W5 1RH Lead Inspector Ms Jane Collisson Key Unannounced Inspection 2.30pm 29th November 2006 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.V317937.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.V317937.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 8998 2658 www.shaw.co.uk Shaw Healthcare (Group) Limited Ms Susan Jane Selfe Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user with Mental Health needs can be accommodated, as agreed by the Commission for Social Care Inspection on 16th November 2005. The home must advise the CSCI when the service user no longer resides at the home. One named service user with Dementia can be accommodated, as agreed by the Commission for Social Care Inspection on 16th November 2005. The home must advise the CSCI when the service user no longer resides at the home. As agreed on 28th April 2006, one named service user with Mental Illness and who is under the age of 65 years old, can be accommodated within the home. This is approved for as long as there is no deterioration of the service user that affects the well-being of any other person living at the home. The home must advise CSCI when the service user no longer resides at the home. 2. 3. Date of last inspection Brief Description of the Service: Kent Lodge is a purpose built care home registered for thirty nine older people. Both permanent and respite care are provided. The home is owned and managed by Shaw Healthcare (Homes) Ltd. This is a large 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 nine single bedrooms. None are en suite but each has a wash hand basin. Both floors have communal lounges, dining areas, bathroom and toilet facilities. There is one lounge, on the ground floor, for service users who smoke. A well maintained courtyard garden is available. The staff team consists of the 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 £445. Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection commenced on the 29th November 2006 from 2.30pm to 6.05pm. The Deputy Manager was present. The Registered Manager had been working, since the 6th November, at another Servite home. At this visit, the majority of the service users were seen. There were thirty four service users residing in the home, but two were in hospital. A further visit was made on the 5th December from 10.35am to discuss further the outstanding requirements and to look at records. The Deputy Manager and the Regional Manager were met on this occasion. In order to progress the inspection, it was necessary to meet with the Registered Manager and a third and final visit was made on the 14th December 2006 to do so. The inspection process took a total of ten hours. During the inspection, the majority of the service users were met, either in the lounges or dining rooms. Three were seen in the privacy of their bedrooms. One visitor, who was taking a service user for an outing, was met briefly during this inspection. No organised activities were taking place, but a number of Christmas activities, including a party and visits from local schoolchildren, and a church, were planned. On the second visit to the home, the London Borough of Ealing’s Environmental Health Officer was carrying out an inspection and made a number of requirements. A new chiropodist was also being shown around the home. Records examined included care plans, staff and training records, fire and maintenance schedules. For an assessment of all of the key standards, this inspection report should be read in conjunction with the unannounced inspection report of the May 2006. There were twenty three requirements made at that inspection of which three have been repeated. A further twenty requirements have been made. What the service does well: What has improved since the last inspection? In some areas of the home, new furniture has been provided and redecoration had taken place. Improvements have been made to the larger dining room. Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 6 What they could do better: The Statement of Purpose needs to reflect the services that the home provides, within its current category of registration, which is old age only. When the admission of service users is agreed, the Registered Persons should confirm to them that the home is able to meet their needs. The terms and conditions need to be completed before being provided to the service users. Improvements are needed in the way in which care plans are compiled and maintained. They need to accurately reflect the health and welfare needs of the service users, and be complete and up-to-date. Service users and the representatives need to be fully involved in the process to ensure that the care plans and other information gathered is accurate and meets the needs and the wishes of the service users. The recording of the way in which health needs are met, showing the involvement of the health care professionals, needs to be improved. It must be shown that staff have the training to meet service users’ health needs. There was found to be a lack of information on how any identified risks would be reduced. Staff need the appropriate training to be able to assess accurately. Regular monitoring of the medication administration is required to ensure that the information is accurate, that any errors by staff are recorded and action taken to prevent reoccurrence. The non-dosetted medication must be stock checked regularly. The lack of an organiser has impacted on the opportunities available to service users to enjoy activities. There must be sufficient staff on duty to provide suitable activities for the service users, which can be shown to suit their needs. It must be demonstrated that staff have the knowledge and training to understand the procedures for safeguarding adults and of reporting any issues that arise. Following a visit from the Environmental Health Officer, in the December 2006 visit, requirements were made which need to be actioned. Some of these were outstanding from the previous inspection. Although work was being carried out on the heating system, an Action Plan must be provided to ensure that the level of heating will be appropriate at all times. The lack of control over the bedroom heating needs to be addressed, if this is possible with the current heating system. The toilets and bathrooms should be brought up to a good standard, to provide a more comfortable environment for the service users. The management of malodours in the home needs to be better managed, and where the odours cannot be eradicated, the flooring must be replaced. A review of the staffing levels is needed to ensure that the health, welfare and social needs of the current service users are being met. This needs to take Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 7 into account the lack of an activities organiser and the impact of long shifts on the hours available for the service users. It must be shown that staff have sufficient training, including first aid, to support them to meet the needs of the service users. An evaluation of the current “statutory” training should be undertaken to show that it is sufficient. The basic information on staff records must be available for inspection if access to the computer, or the staff records, is not available. There must be sufficient management cover in the home, at all times, to ensure that there is support for the staff and monitoring and supervision can be undertaken to maintain good management. Staff need to be made fully aware of their responsibilities, particularly in relation to the maintenance of records and reporting health, safety and welfare issues. Record keeping is another area that would benefit from regular monitoring to ensure that records are accurate, up-to-date and complete. The review of the quality of care is outstanding and should be carried out regularly to demonstrate that the service users are consulted and the home is making improvements and developing its care. While a fire risk assessment was in place, it needs to be demonstrated that all of the potential risks to service users and staff are identified and show how they will be minimised. Action must be taken, and recorded, to address any identified shortfalls. 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.V317937.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.V317937.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 is not assessed as there is no Intermediate Care unit) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been limited progress with the requirements from the last inspection to improve the admission and assessment procedures. The criteria for admittance to the home needs to be clarified to ensure that service users’ physical and emotional needs are within the home’s capacity to meet. Staff training, and the means of referring to, and accessing professional support, must be in place if specialist health needs are identified. EVIDENCE: Copies of the Service Users Guide and Statement of Purpose were supplied. The Statement of Purpose does not fully reflect the needs of the service users that the home is able to support. As the home is registered to admit service users only under its category of old age, the references to meeting the needs of people with physical disabilities and sensory impairment need clarification. There are three variations for service users with mental health problems and dementia but, from the records examined, it is clear that other service users Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 10 may be within these categories. Some may have deteriorated since being admitted to the home but others appear to have more long-standing problems. There has been some discussion within the organisation about the provision of a dementia unit within the home. The categories of admission need to be addressed by the Registered Providers to ensure that the home is able to meet the needs of the service users it admits, and has the appropriate staffing levels and training to do so. The Service Users Guide was not dated and this should be rectified so that it can be seen which version is current and when it will be due to be updated. It can be provided in various formats to suit the needs of the service users. Copies of the terms and conditions were seen in the three of the files examined. Not all were fully completed with the fees, room number or signatures. Information as to whether the home informs service users it can meet their needs was not seen. Both of these are outstanding requirements and have been repeated. Assessments of the service users’ needs were seen to have been undertaken by the home’s staff. The service users spoken to were not able to discuss fully their admission to the home and some had been moved from another Shaw home that had closed earlier in 2006. From the assessments seen, it was not always shown how the specialist needs of service users were to be met. Where it has been agreed to admit service users with specific medical requirements, such as diabetes, Parkinson’s disease or similar illnesses, staff must have the relevant training, guidance and professional assistance to support them. The home has no Intermediate Care unit, so this National Minimum Standard was not assessed. Kent Lodge DS0000068006.V317937.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. All areas of care planning, health recording and medication administration are in need of improvement. There has been insufficient responsibility taken by senior staff to report deficiencies and errors as well as a lack of understanding of the procedures. The Registered Providers need to ensure, by training, observation and monitoring, that senior staff are carrying out their delegated duties. EVIDENCE: Four of the service users’ care plans were examined in detail. There were several areas where improvements in the recording could be made. Some contradictory information was seen, such as whether or not a service user had diabetes. The information on care plans was not always completed. The specialised assessments, such as Waterlow and Bartel, had been completed without any additional information as to how identified risks were to be minimised. Information on diabetic care was incomplete and staff were not aware of how this was being managed. The latest information in two of the Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 12 files, on weight loss and MRSA, could not be easily verified. One of the newer service users had in place only a night care plan. The monitoring of care plans has been poor. Senior and management staff must take responsibility to ensure that the information held about service users is complete, up-to-date and accurate. It has been a previous requirement that the service users, or their representatives, are consulted about the production of the care plans and it should be documented that this has been carried out. Proper consultation may have eliminated some of the queries which have been noted during this inspection. The new care planning system was due to be introduced by February 2007. A copy of the system was provided and was found to be very long, though comprehensive. It is recommended that, when the new system is introduced, a distinction is made between the assessment materials and the day-to-day care plans. Staff would then be working with the outcomes of the assessments, which may reduce the paperwork used on a daily basis. Sufficient should be provided to make the needs and the wishes of the service users known, together with the information on the management of their care and how any risks are managed and reduced. Because of the lack of accurate recording on the care plans, it was difficult to assess how the health needs of the service users were being met. Senior staff did not display sufficient knowledge of diabetes management in the home, and were inconsistent in their explanations as to how the care was managed. No training was in place to support staff with this care. This was brought to the attention of the senior management staff of the organisation. It was not clear that the relevant health professionals had been sufficiently involved in this process to formulate care plans to address each individual service users’ needs. It had been a previous requirement that the risk assessments were carried out by staff trained and experienced to do so. It was not evidenced that there had been any change and the requirement is repeated. The various assessments of health and wellbeing, such as the Waterlow, Bartel and food nutrition, as well as manual handling, are being included in the new care planning procedures. Staff must have the knowledge to complete these accurately and to use the information to provide the risk assessments and care plans which address the identified problems. The medication administration on each of the units was examined. A seven day dosette system, which is filled and sealed by the pharmacist, is in place. The list of medications, incorporated into the dosette boxes, was seen to have been changed by crossing out or covering with correction fluid. The staff said that these changes are carried out by the pharmacist and they do not make any alterations. A list of current medication, which matches the Medication Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 13 Administration Record sheet, needs to be provided to ensure that medication can be accurately checked. Staff said that there were plans to move to a 28day monitored blister pack system, provided by a different pharmacist, and the Registered Manager undertook to change this at the earliest possible time. There were errors in the medication administration. Some were of non-signing and, in one instance, two different staff had signed to say they had administered medication which could not have been available, as it is only given once a week. The PRN (“as and when”) medication could not be stock checked and was not necessarily included on the service user’s Medication Administration Record sheet. It was seen that staff had signed to say medication was administered, later putting an “R” for refused over the signature. Staff administering medication must take responsibility for ensuring that the correct procedures are followed. Where staff are found to have made errors, such as found on this inspection, then their competency must be assessed and further training provided if found to be necessary. Sufficient monitoring must take place, by management staff, to ensure that they are satisfactory. Kent Lodge DS0000068006.V317937.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 good. This judgement has been made using available evidence including a visit to this service. The provision of sufficient activities to interest and stimulate the service users must be available, with the opportunity for one-to-one outings and activities being available. Service users were generally complimentary about the meals and they have been given the opportunity to know the choices available. EVIDENCE: There had been no requirements made at the previous inspection regarding daily life and social activities in the home. At the last inspection, there had been an activities organiser in post. Unfortunately, she had left and had not been replaced by the time of this inspection. Service users said that they had not played bingo recently, which they enjoyed. Staff confirmed this had not been held. At the last visit, the Registered Manager said that she hoped to appoint a new organiser shortly. As Christmas was approaching, various activities had been organised and local schoolchildren, scouts and church members were coming to the home to help the service users to celebrate. A Christmas party was to be held and a Fair, to raise funds, had taken place. Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 15 Only one visitor was met during this inspection who was in the home briefly to take a service user out. Service users confirmed that their visitors were able to visit whenever they wish and the Service Users Guide indicates that visitors are welcome between 8am and 9pm. There are sufficient communal spaces where visitors and service users can meet. Service users who were spoken with on this inspection confirmed that they are able to stay in their own rooms, or in the communal areas. Some service users prefer to stay in their rooms, and watch television, and there are no restrictions on this. Those service users who are mobile, or able to use their wheelchairs independently, are free to use the various areas of the home and this includes the lounge available for service users who smoke. An improvement since the last inspection has been the production of the menus placed on the dining tables. A poem has been printed on the back of the menu, which are displayed in a see-through holder. As these are changed daily, it provides added interest for the service users. Both menu and poem are in print that can be easily read. One service user discussed, with pleasure, the “poem of the day” during one of the visits. The kitchen staff confirmed that no cultural needs are met by the provision of special meals for the service users from ethnic monitories, as they generally preferred the meals that are on menu. However, the cook said that “rice and peas” are sometimes provided for the West Indian service users. The meal on the first visit to the home was roast beef, Yorkshire pudding and vegetables with rhubarb crumble and ice cream. Staff said that there was not usually an alternative advertised when roasts were provided, twice a week, although they are available. The evening meal was thick vegetable soup, sandwiches, yoghurts and fresh fruit. Service users were generally appreciative of the meals provided. Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Only one complaint, sent anonymously, had been made since the last inspection. Although senior staff have had training in the safeguarding of adults, the procedures were not followed when issues arose. It needs to be evidenced that staff have sufficient and appropriate training to ensure that they fully understand the procedures for reporting any potential abuse issues. EVIDENCE: There had been no recorded complaints made in the home since April 2006. One anonymous complaint was received by the London Borough of Ealing and the Commission for Social Care Inspection. The Registered Manager investigated this and no evidence was found to substantiate the complaints. One issue, raised by the London Ambulance Service, has been investigated by the London Borough of Ealing’s Safeguarding Adults department in December 2006. The original incident, involving an injury to a service user, had not been brought to the attention of the senior managers of Shaw Healthcare, the Commission for Social Care Inspection or the Social Services department. The Registered Manager was not in the home at the time of the incident and was not informed. The investigation was still ongoing at the time of the inspection but it was agreed that there were issues to be addressed regarding appropriate reporting and that staff need to be trained or retrained in the procedures for reporting Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 17 potential abuse. One staff member has been suspended while the investigation continues. The training matrix supplied does not include safeguarding adults training and this should be rectified. The Registered Manager said that senior staff had been trained, as had many of the support staff. All of the staff who are not trained should receive training as soon as possible to ensure that they are aware of the reporting procedures. Staff who are responsible for reporting to the appropriate organisations, which include Team Leaders and acting Team Leaders, need to receive further guidance. It is recommended that the Registered Manager considers including the subject of safeguarding adults as a standing item on the staff meeting agenda, or in supervision sessions. This would reinforce to staff the importance of understanding fully the procedures for reporting, as well as recognising potential abuse. Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 18 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, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While improvements have been made to the environment, with some redecoration and new furniture, the bathrooms and toilets need to be improved. The problems with the heating still need to be rectified to ensure that appropriate heating levels are provided all the year round. The requirements of the Environmental Health Officer need to be met to promote a good standard of hygiene and compliance with the food regulations. A better awareness of reporting, and adhering to health and safety procedures, needs to be demonstrated by staff. Increased monitoring by senior staff is required to reinforce the importance of safeguarding the service users’ health and wellbeing. EVIDENCE: The central heating system has been the subject of a requirement at the inspection, which took place in May and June 2006. The heating could not be Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 19 turned off, without affecting the hot water system, and it remained on during the hot weather. At the first visit of this inspection, work was being carried out to clean the tanks, and the heating was left in working order. The heating system does not have individual controls in the bedrooms and one service user said that their bedroom, which is small, gets too warm. The Area Manager gave an assurance that the heating system would be able to be rectified by the summer to ensure that the heating could be controlled. The Registered Providers should also look at providing individual heating controls if this is possible with the current system. The Environmental Health Officer of the London Borough of Ealing visited during the inspection and made a number of requirements for improvement, some of which were repeated from their previous inspection. These included the provision of ventilation in the staff toilet and the proper disposal of cooking oils. The kitchen was found to be in need of deep cleaning. The cook required updated food hygiene training. Dates of meat delivery were also required to be recorded. During the first visit to the home, the sink unit in the first floor kitchenette was found to be in need of urgent attention. Staff has not reported this, although the smell of ”drains” was very strong and unpleasant. The sink unit was duly replaced. A lock was placed on the cupboard as COSHH materials had been found to be stored in the previous sink unit cupboard, which had no lock. COSHH materials were also found in the bathroom. Staff were asked to remove the items to secure storage. In the unused kitchenette on the first floor, the refrigerator had been left switched off and was full of black mould. This also appeared not to have been reported. Staff must be aware of their responsibility to report health and safety issues that arise in the home. The management staff must have sufficiently robust monitoring systems to ensure that regular checks are made. The radiators in the bathrooms and toilets were in the process of being covered at this inspection. Painting of the corridors and other areas have taken place this year but the bathrooms and toilets are in need of refurbishment to provide more pleasant facilities for the service users to use. A number of chairs and settees had needed replacing at the last inspection, as they were unsuitable for the service users, being too low or in poor condition. These have been replaced and one lounge had been refurbished and redecorated. Additional furniture has been provided in the lounge used by service users who smoke to make it more homely. The ground floor dining room has been improved and looked fresh and bright. It is a pleasant area which looks into the well-maintained garden. The home, at the previous inspection, was found to be in need of more thorough cleaning and there were areas where the odour of urine persisted. This has been an ongoing problem at the last two inspections. The areas of Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 20 the home seen on this inspection home were found to be cleaner but an odour of urine remains on the first floor. If cleaning cannot eradicate this, then the carpets or floor covering must be replaced. Suitable continence management needs to be demonstrated. Kent Lodge DS0000068006.V317937.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 adequate. This judgement has been made using available evidence including a visit to this service. The way in which staffing hours are arranged, with handover time and breaks taken from the staffing hours provided, are required to be reviewed to demonstrate that all the needs of the service users are being met. EVIDENCE: The staffing levels remain the same, which is four support staff and a Team Leader on each shift. The Registered Manager said that there are five or six staff on duty at weekends, as there is no management cover. However, the rotas seen had these additional staff only on the morning shifts. As care staff work six hour shifts, a number prefer to work “double shifts” of 8am to 8pm on three days a week, rather than over five or six days. Therefore staff undertaking these long shifts require breaks, which leaves less staff on duty at certain times of the day. This is not shown on the rota and must be taken into account when the staffing levels are reviewed. While several staff confirm that they prefer to do “long days”, the effect on the level of staff available to the service users needs to be kept under review. An 8am to 10am shift is used on weekdays to cover the early morning “peak period”. During the time that this inspection took place, the home was either without the Registered Manager or the Deputy Manager. Therefore additional administrative duties are placed on the Team Leaders. All of this needs to be taken into account when the staffing levels are reviewed. With the lack of an Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 22 Activities Organiser, the staff hours available to spend time with service users on a one-to-one basis, or to take out of the home, are very limited. A review of the staffing levels is required to demonstrate that there are sufficient to meet the personal care, health and social needs of the service users. This will need to be further reviewed if the vacancies in the home, which stood at four at the last visit to the home, are filled. The staff vacancies, and cover for sickness and leave, are covered by permanent staff. Agency staff are seldom used and their use requires the consent of the Area Manager. There are now vacancies for a Deputy Manager, Activities Organiser and support staff. These posts are required to be filled. Information on the recruitment procedures is maintained on the computer. No new staff had been recruited since the last inspection. Basic information on the staff employment records needs to be available in the home for inspection should access to the records not be available. In order for staff to have updated training, a “statutory” training day is held annually for all staff. This includes fire safety, manual handling theory and practice, risk assessment, COSHH, food hygiene, health and safety, and infection control. All but two of the staff were seen to have had this training in 2006. In view of the areas of concern raised on this inspection, particular around health monitoring, and health and safety issues, a review of the effectiveness of this training should be undertaken by the Registered Providers. Staff agreed that the amount of training, in one day, can be difficult to absorb. First Aid is not included on the training matrix and the Deputy Manager, who said that she had responsibility for training, was unsure of how many of the staff were trained in first aid. All staff must have basic first aid training and there needs to be sufficient staff with advanced training to meet workplace regulations. Kent Lodge DS0000068006.V317937.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, 34, 35, 36, 37, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are a number of areas where inadequate recording was noted. The staff do not show that they have a sufficient understanding of their responsibilities with regards to recording and reporting. Further and more thorough training is required, particularly for Team Leaders, to support them to understand their roles. Where responsibilities are delegated, there needs to be regular monitoring, by management staff, to ensure that the tasks are completed satisfactorily. The fire risk assessment does not address the concerns raised by the assessment of the service users’ needs. In particular, the staffing levels need to be shown to be sufficient to deal with the high level of confusion and immobility recorded. Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Registered Manager is a trained mental health nurse and has completed the Registered Managers Award. At the commencement of this inspection, she has been temporarily seconded to another Shaw home and was away from the home for five weeks. The Deputy Manager was in charge of the home during part of this period, but resigned before the last inspection visit was made. The final inspection visit of the 20th December was to meet with the Registered Manager to discuss the outstanding requirements and the issues raised during her absence. Not all of the requirements from the previous inspection have been met and a number of new ones have been made. The issues raised regarding health and safety, and an absence of appropriate reporting by staff, need to be addressed as a matter of urgency. All of the staff team need to be reminded about taking responsibility. It must be ensured that the Team Leaders are aware of the responsibilities of their posts, particularly in relation to medication administration, service users’ health needs, and the general running of the home. The identification of shortfalls in the recording and reporting processes needs to be addressed by further training and the monitoring of competency. The quality assurance processes in the home had not yet resulted in a report of the review of the quality of care. The Registered Manager said that this was in hand and it was hoped to complete this by the end of December. When the report is finalised, a copy must be made available to the service users and to the Commission for Social Care Inspection. At the previous inspection in May 2006, the service users’ monies were checked and found to be maintained in good order. Monies are usually kept only for hairdressing, chiropody, newspapers, cigarettes and toiletries. Because the Administrative Officer was not available on any of the there visits to the home, the accounts were not checked on this occasion. The record keeping in the home, as recorded throughout this report, requires the input to make certain that it is accurate and completed. Regular and thorough monitoring is required to ensure that all the required records are maintained and are up-to-date. The fire records were examined. It was found that weekly checks had been carried out until 27th November 2006 when four of the fire points had been checked. It was not apparent if all of the necessary fire tests, such as those for emergency lighting and fire doors, were checked. However, the eight battery operated door closing systems, which had been installed since the last inspection, are checked on a weekly basis. Servicing of the fire alarms had taken place in January, April, July and October. Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 25 The training matrix supplied showed that the majority of the staff had received fire training on the “statutory” training day. However, eleven of the staff were not recorded as having attended a fire drill and this needs to be rectified. The fire risk assessment had been revised in August 2006. This noted that “most staff will have attended a fire drill in the last 12 months” but that several night staff had “not attended training in using fire fighting equipment”. Where shortfalls are identified, it needs to be shown that these have been addressed. The risk assessment also needs to include the level of training and attendance at drills that are planned for the staff, in view of level of risk assessed, and whether this has been met. An assessment of the service users who were in residence in August 2006, together with their special day and night needs, was with the risk assessment. Sixteen were assessed as being confused and just under half would need assistance with wheelchairs, or have limited mobility. The fire risk assessment needs to address if the current staffing levels are sufficient to address the high needs identified. As there have been changes to the list of service users identified in the risk assessment, the list needs to be updated on a regular basis. Kent Lodge DS0000068006.V317937.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 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 3 2 X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X X 2 2 Kent Lodge DS0000068006.V317937.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. 1 Standard OP1 Regulation 4 (1) a Requirement The Statement of Purpose must reflect the services that the home provides, within its current category of registration, which is old age only. (Previous timescale of 31/08/06 not met). The service users must be provided with contract/terms and conditions which must be completed with the information required, such as fees payable. The Registered Person must confirm in writing to the prospective service user that the home can offer them a place. (Previous timescale of 31/07/06 not met). Where service users admitted to the home have specific health needs to be met, it must be demonstrated that staff have the training, guidance and professional support to meet their needs. The care plans of the service users must be compiled in conjunction with the service users, or their representatives. The care plans must accurately DS0000068006.V317937.R01.S.doc Timescale for action 28/02/07 2 OP2 5 (1) b 28/02/07 3 OP3 14 (1) d 31/01/07 4 OP4 12 (1) a 15 (1) 31/01/07 5 OP7 15(1)(2) c 31/03/07 6 OP7 17 (1) a, 28/02/07 Page 28 Kent Lodge Version 5.2 (3) 7 OP8 12 (1) a 13 (1) b 8 OP9 13 (4) b & c (5) 9 OP10 13 (2) 10 OP12 18 (1) a 16 (2) m 13 (6) 11 OP18 12 OP19 16 (2) (j) 13 OP19 23 (2) p reflect the health and welfare needs of the service users, be complete and up-to-date. The health needs of the service users must be accurately recorded, with appropriate referrals made to health care professionals, and guidance in place to show how the health needs will be met. Staff must have the training, where appropriate, to meet the health needs. Risk assessments, including those for manual handling and nutrition, must be compiled by staff who have appropriate training and reduction plans compiled where risks are identified. Action must be taken to ensure that the record of medication to be administrated is accurate, that administration is correctly recorded, stock can be checked and monitoring systems are in place. There must be sufficient staff on duty to provide suitable activities for the service users, which suit their needs. It must be demonstrated that staff have the knowledge and training to understand the procedures for safeguarding adults and of reporting any issues that arise. The requirements made of the Environmental Health Officer, on the December 2006 visit, must be actioned. An Action Plan must be provided for the work on the central heating system to ensure that there is an appropriate level of heating throughout the year. This must include information as to whether or not individual DS0000068006.V317937.R01.S.doc 28/02/07 28/02/07 31/01/07 31/01/07 28/02/07 31/03/07 28/02/07 Kent Lodge Version 5.2 Page 29 14 OP21 23 (2) (d) 15 OP26 16 (2) (k) 16 OP27 18 (1)(a) 17 OP29 17 (2) Sch. 4 (6) 18 OP30 18(1)(c) (i) 19 20 OP31 OP32 18 (1) a 17 (3) a 19 (5) b 21 OP33 24 22 OP37 17 (1)(2) controls can be provided in bedrooms. The toilets and bathrooms must brought up to a good standard, to provide a more comfortable environment for the service users. Systems must be in place to manage malodours (in reference to the 1st floor). Where identified as the case, flooring must be made good or replaced. (Previous timescale of 31/01/06 and 31/07/06 not met). A review of the staffing levels must be undertaken to ensure that the health, welfare and social needs of the service users are being met. The basic information on staff records must be available for inspection if access to the computer, or the staff records, is not available. It must be demonstrated that staff have sufficient training, including first aid, to support them to meet the needs of the service users. Sufficient management cover must be in place when managers are seconded to other projects. There must be improvements in the management of the home to ensure that all staff are fully aware of their responsibilities, particularly in relation to the maintenance of records and reporting health, safety and welfare issues. A review of the quality of care must be carried out on a regular basis, with reports provided the service users and the Commission for Social Care Inspection. (Previous timescale of 30/09/06 not met) The record keeping must be DS0000068006.V317937.R01.S.doc 30/04/07 28/02/07 31/03/07 28/02/07 31/03/07 31/03/07 31/03/07 31/03/07 28/02/07 Page 30 Kent Lodge Version 5.2 & (3) 23 OP38 13 (4) improved to ensure that accurate, up-to-date and completed records are maintained. The fire risk assessment must take into account all of the potential risks to service users and staff and show how they will be minimised. Action must be taken, and recorded, to address any identified short falls. 28/02/07 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 OP7 Good Practice Recommendations That, when the new care planning system is introduced, a distinction is made between the assessment materials and the day-to-day care plans to enable staff to work with the outcomes of the assessments, which document the needs and wishes of the service users, the risk assessments and guidance. That the Registered Manager considers the inclusion of the subject of safeguarding adults as a standing item on the staff meeting agenda, or in supervision sessions. This would reinforce to staff the importance of understanding fully the procedures for reporting as well as recognising potential abuse. 2 OP18 Kent Lodge DS0000068006.V317937.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West London Area Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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.V317937.R01.S.doc Version 5.2 Page 32 - 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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