Inspection on 30/04/07 for Kent Lodge

This inspection was carried out on 30th April 2007.

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 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 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 10:00 30th April 2007 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.V334889.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.V334889.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 (Ledbury) Limited Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Kent Lodge DS0000068006.V334889.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 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. 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. 29th November 2006 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 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 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 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 £475. Kent Lodge DS0000068006.V334889.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 30th April 2007 from 10.00am to 5.45pm. The inspection continued on the 1st May from 12.45pm when a meeting also took place with the Manager Designate and the Area Manager to discuss, with an Inspector from the CSCI’s registration team, the application for part of the home to be registered for dementia care. The inspection process took a total of 10 hours. The Manager Designate and the Deputy Manager were seconded to the home in February 2007 from other Shaw homes, following the departure of the previous managers. During this inspection, the Deputy Manager moved temporarily to another home to provide management cover for two weeks. There were thirty people residing in the home and there were nine vacancies. The majority of the people living in the home were met during this inspection and a small number were spoken to in private, either in their bedrooms or in the smaller lounges. No relatives or friends were seen during this inspection but people indicated that there were no restrictions on visiting. A representative of the company supplying the medication was carrying out an audit. A tour of the home took place on the 30th April and again, as part of the dementia care application, on the 1st May. The Manager Designate has identified that seven people may have dementia and referrals are being made for assessments. There are a small number of people who have been admitted with mental illness and variations to the home’s category of registration have been in place for three people. The Registered Providers will now need to demonstrate that they are able to provide sufficient staffing, facilities, activities, professional support and a suitable environment to meet any specialist needs of people whose primary need is outside of the home’s registration category of old age. Surveys from the Commission for Social Care Inspection were sent to people using the service and a total of fifteen replies were received. Seven replies were received from the relatives, carers and advocates’ survey. The responses will be referred to in the body of this report. Although there were positive comments, those replying indicated that there is room for improvement in a number of areas, particularly the provision of activities. There were no organised activities and few examples of one-to-one support observed during this inspection. The person employed to carry out an activities programme was on holiday. The Shaw Healthcare management showed an awareness of the areas where improvements are required. While the ground floor accommodation has been Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 6 upgraded to provide a more pleasant environment, the first floor is in need of refurbishing and this must be considered whether the application for a dementia unit is successful or not. At the inspection in December 2006, there were twenty three requirements of which eighteen have been met. Though the management staff have worked hard, since February, to make improvements, issues remain which will need to be resolved. These are identified in the nineteen requirements made in this report. What the service does well: What has improved since the last inspection? What they could do better: The documentation provided to people wishing to use the service, and their representatives, needs to be more comprehensive in explaining how any specialist needs can be met. Information on contracts and terms and conditions need to be included so that people can make an informed decision. The assessment and care planning procedures, whilst being updated and improved, need to be user friendly to support both staff, people using the service and their representatives, to participate in the process. Training in the use of the full assessment procedures needs to be provided to staff. It needs to be demonstrated that the health needs of the people using the service are fully recorded, with appropriate referrals made to health professionals to ensure all are of their needs are being met with a reasonable timescale. Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 7 The lack of opportunity for activities, outings and entertainment is of concern and needs to be addressed by having sufficient, and appropriately trained, staff providing the leisure opportunities that the people using the service wish to have. Consultation with the people living in the home must be in evidence to show that the meals and choice of special diets is in accordance with their wishes, and meet cultural and health needs. While staff are updated with most of the basic training skills they require, the provision of first aid training, specialist training for dementia and mental health, and the outstanding training for safeguarding adults and fire drills, needs to be undertaken as soon as possible. There are a number of environment issues which need to be addressed including the requirements of the Environmental Health Officer to have suitable ventilation in the staff toilets. Confirmation is required that the heating in the home can be maintained, at levels to suit the needs of the people living there, without the hot water supply being affected. Maintenance and refurbishment, including the provision of radiator covers, is required in a number of bathrooms and toilets. There has been an ongoing problem with malodours in one area of the home which will need to be addressed by the provision of new carpets if the shampooing of carpets is unsuccessful in eradicating this. The Manager Designate must provide evidence that the staffing levels are being kept under review to provide people with the support and activities that are in accordance with their assessed needs. A system to review the quality of care, taking into account the wishes and views of the people living in the home and their representatives, has not been carried out and this is an outstanding requirement. Although the Manager Designate has taken action to make staff aware of their responsibilities, a number of issues were found on this inspection of which showed a lack of staff awareness of their health, safety and infection control responsibilities. One was the inappropriate storage of COSHH materials. A plastic chair, left in a bathroom for these use of the people in the home, was very soiled. This was neither cleaned nor removed. Items for repair, or areas where the cleanliness was not of a good standard, were not reported. The lack of sufficient and suitable waste disposal bins should be of concern to staff trying to enforce infection control. Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 8 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.V334889.R01.S.doc Version 5.2 Page 9 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.V334889.R01.S.doc Version 5.2 Page 10 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 to this home) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Better and more informative documentation should be provided to the people wishing to move to the home to support them to make an informed decision. People using the service, and their representatives, need to know that their specialist needs can be met by the home and that the required professional support is available. Training and guidance on the completion of the assessment procedures would help to ensure all health and welfare needs are fully considered. EVIDENCE: Information about the home and its services has been provided in a Resident’s Guide but additional details are required to support prospective residents to make a decision as to whether the home and its facilities are suitable to meet their needs. Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 11 The home has had a number of variations to its category of registration of “old age” to accommodate people with dementia and mental health issues. However, the Guide does not details how these, and other health needs, are met by the home’s staffing, facilities, services and its environment. There are people who have the symptoms of dementia and this impacts on the levels of care and support that are required. To ensure that people wishing to use the service are fully aware of what the home can offer, the Statement of Purpose and Resident’s Guide must be amended to provide this information. Some of the people replying to the surveys indicated that they were not aware of having had a contract or terms and conditions supplied to them. A copy of the contract should be provided with the Guide so that people wishing to be admitted to the home have the full details of fees, services provided and periods of notice. These were not detailed in the copies seen in the residents’ files. The needs of new residents were seen to have been assessed. However, the new procedures are very comprehensive and some of the assessments for health needs require a level of expertise to complete. It was a requirement at the previous inspection that staff have the training, guidance and professional assistance to assess people with specialist needs. There was insufficient evidence to show that this has been achieved. Not all of the people replying to the surveys were positive about their care and support needs being met, although improvements have been noted in the last few weeks. The Manager Designate was in the process of working with the health professionals to get the diabetic care improved and the need for more specialised support for those with dementia has been recognised by the application for a dedicated dementia unit within the home. Training in the areas of dementia, mental health and common illnesses are required if the home is to fully meet the needs of people already residing in the home. Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 12 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. Although improvements are being made in identifying and managing health and support needs, the introduction of the very lengthy system of assessment and care planning does not aid the involvement of the people using the service or their representatives. A new system of medication administration has improved the procedures. EVIDENCE: A new care planning system has been introduced since the last inspection and work is in progress to complete the care plans. However, the system is, at seventy seven pages, very long and does not provide easy access to the information needed on a daily basis. It would be difficult to engage the people using the service or their representatives in the process. It is recommended that the assessment procedures be separated from the daily care planning sections to provide ease of access for the staff team. In the samples of the care plans, three of which were examined in detail, some work is still required to fully complete all of the documentation. It must be a priority to complete Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 13 the care plans, with the involvement of the people using the service and their representatives. The care planning system was felt by staff to be time consuming. It is recommended that an early evaluation of the documentation is undertaken, to assess its effectiveness and whether it could be streamlined. There were concerns at the last inspection about the recording of health needs. These were insufficient to show how, in some cases, the health and welfare of the people concerned were being managed, particularly those with diabetes. Although these are now being identified, it has taken time for appropriate referrals to be made to the relevant professional services. It has been agreed by the general practitioner that assessments will be carried out shortly for those people who may have dementia. The home retains the services of a general practitioner who visits twice weekly, although some people are registered with other practices. Ongoing liaison with the medical professionals is required to ensure that people using the service are referred as soon as possible to the relevant services to maintain their health and wellbeing. A new 28 day monitored dosage system has recently been introduced, which staff said they were finding easier to use. A representative from the company was in the home, during the inspection, carrying out the first audit of the system. A number of recommendations were made. Improvements have been made to the area where the medication is stored. The people spoken with during the inspection were positive about the way in which they were treated by the staff. No concerns were raised in regard to dignity and privacy and comments included “staff are always willing to help” and “staff are very polite”. Kent Lodge DS0000068006.V334889.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. The lack of activities in the home is of concern to both the people using the service and their relatives. Those people who are less able to choose are not offered sufficient stimulation to improve their daily lives. The use of a standard menu does not take into account the preferences of individual people, particularly those who have special dietary and cultural needs. EVIDENCE: A member of staff has been employed on a part-time basis to provide an activity programme and had recently attended training. Only two people are able to go out of the home unaccompanied and spoke positively about the local amenities. Others people expressed the wish to be able to go out of the home occasionally. As the home is close to community facilities, including a library and cafes, and the busy areas of Ealing Broadway and West Ealing, the opportunities should exist for people to enjoy these. Staff said the activities organiser had arranged trips out of the home for a small number of people to go shopping and from the replies received to the surveys, this would be a popular option. Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 15 No formal activities were arranged during this inspection as the member of staff was on holiday. Some of the people living in the home were unaware that any activities are arranged and one person said that they missed the bingo sessions that used to happen. The majority of negative comments received during the inspection, and from the surveys returned, were about the lack of activities, entertainment and stimulation. Families replying to the questionnaires felt that people were not always supported to lead the life they would choose. One person raised a concern about communication with people who were not able to watch television, for instance. There are sufficient areas on the ground floor for people to have a choice, perhaps to listen to music rather than watch television. However, there is less choice on the first floor where the lounge is used for both watching television and any other activities that might take place. On one visit, a member of staff was trying to get people to participate in a board game in the room which, with its current layout, is not suitable for this purpose. This is also inappropriate if someone in the room wishes to watch television. A small sitting room has been set aside as a quiet area, or for meetings, but only accommodates up to three people. The smaller dining room could be utilised for activities but sufficient staff would need to be on duty to ensure there is support available in each area. While no visitors were met during this inspection, the Resident’s Guide states that there are no restrictions and people confirmed that their families are free to visit as they wish. Those people who have the ability to make decisions about their daily lives were seen to spend time in the communal areas of their choice or to stay in their rooms. Other people have less capacity to make these choices and were generally sitting in lounges with the televisions on but not being watched. The Inspector was informed that a new standard menu has been introduced across the Shaw Healthcare homes and copies of the four weekly rotating menus were supplied. Previously, menus have been compiled in consultation with the people living in the home. Some changes have been made by the Kent Lodge staff to suit the needs of the residents, which included a dessert provided with the evening meal and fresh vegetables, as well as frozen ones. The Inspector was informed that the budget for meals had been reduced by the Registered Providers but that there was no change in quality because of bulk buying. The menu contains an unspecified “vegetarian option” at each lunch time and two choices of main course. In addition to a dessert, yoghurt, ice cream and fresh fruit are offered. There is no indication of diabetic choices. The Registered Providers need to ensure that the variety and choices of menu are in accordance with the preferences of the people using the service and that Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 16 everyone, regardless of their dietary needs, is aware of the choices on offer. This should include the people with diabetes, those who are vegetarian and those with cultural preferences. While the people asked on the first day of the inspection said that they had enjoyed their meal, the response to the questionnaires was more varied. Six people said they always enjoyed their meals, and six said that they usually did. The remaining three said that they only sometimes, or never, enjoyed them. One person would like more Caribbean food to be on offer and another person found that the meals were not hot enough. Improvements have been made to the larger dining room, on the ground floor, which overlooks the garden. This has made a pleasant and spacious room for meals to be enjoyed. The first floor dining area is smaller but has also been improved. Kent Lodge DS0000068006.V334889.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 adequate. This judgement has been made using available evidence including a visit to this service. There is a lack of awareness, by people using the service and their families, of the complaint procedures. People indicated that staff listen to them and the more able people can raise the concerns they have. The protection of vulnerable adults training needs to be extended to all staff to maximise the safeguarding of the people using the service. EVIDENCE: Whilst the more able people spoken to during the course of the inspection felt that they could make their concerns known, the replies to the CSCI surveys indicated that half of the respondents were not aware of the complaints procedures. The reissuing of the amended Resident’s Guide, to residents and their families, would ensure that everyone has the up-to-date procedures. These need to be written in accordance with the requirements of the Care Home Regulations 2001 and include the timescales for the response to complaints. A variety of formats should be available to suit the communication needs of the people using the service. Since the last inspection in November 2006, there have been issues arising from complaints, which have been dealt with under the London Borough of Ealing’s Safeguarding Adults procedures. One of these resulted in the dismissal of one member of staff. Two further issues involved people using the service. These had been concluded satisfactorily by the time of this inspection. Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 18 Training for the staff in the protection of vulnerable adults has been taking place and just over half of the staff team had training recently. However, this needs to be extended to the remainder of the staff team to ensure a good understanding of the procedures. Kent Lodge DS0000068006.V334889.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, 21, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improvements have been made, there is still work to be carried out to upgrade the general environment, particularly for those people living on the first floor. All of the bathrooms and toilet facilities need to be brought up to an acceptable standard of repair and cleanliness. There is a lack of clarity regarding the operation of the heating system which must be resolved. EVIDENCE: Improvements have been made, during the last few months, to the ground floor accommodation. This includes the dining room, which is light and airy, and overlooks the garden. The smaller ground floor lounge, and the lounge designated for people who smoke, have new furniture. Plants and pictures are being used to make the communal rooms more pleasant and homely. The smaller dining room on the first floor has been decorated and the kitchenette units replaced. The lounge was in need of redecoration and the Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 20 work had been agreed to commence. A former kitchen has been made into a small meeting room and it is also planned that there will be a room on this floor for people designated for people who smoke. While some toilet flooring has been replaced in, and the room painted, there are still improvements to be made in other bathrooms and toilets. A number of repairs and replacements are needed, including areas of tiling and a shower screen. Two bathrooms do not have suitable equipment for people with a disability. This reduces the number of bathrooms in use to four for thirty-nine people. The bathrooms that are not in use need to be considered for upgrading to provide more suitable facilities. It is recommended that this is carried out in consultation with the residents so that the facilities are in accordance with their needs and wishes. Following an incident where a person received an injury caused by a hot radiator, the majority of the radiators were covered. A small number are still required to be covered and this work needs to be undertaken as soon as possible. During the summer of 2006, both residents and staff raised concerns about the heating as it had remained on during hot weather. It was not confirmed at this inspection that the heating system can be isolated from the hot water system or turned off in hot weather without affecting the hot water supply. The system does not allow for radiators to be controlled in each room. The Registered Providers must provide confirmation that the current system is suitable to meet the needs of the people living in the home and show how individual needs can be met. The cleanliness of the building has improved since the last inspection, and this had been noted in the responses to the surveys. However, a soiled plastic chair was found in one bathroom, on the tour of the home, which had not been cleaned, removed or reported by staff. There were still bathrooms and toilets without sufficient waste disposal bins. An odour of urine pervades an area on the first floor. This has been noted at previous inspections. Where the shampooing of carpets does not remove the odour, carpets must be replaced. The Environmental Health Officer of the London Borough of Ealing had visited during the inspection in November 2006. Although some of the requirements had been met, the provision of ventilation in the staff toilets has not been actioned and this needs to be carried out. Kent Lodge DS0000068006.V334889.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 majority of staff have the basic training, with the exception of first aid, to support the people using the service but advanced training to support more specialist needs, such as dementia and mental health, has been limited. The target of having 50 of the staff team trained to National Vocational Qualifications level 2 or above has been achieved. EVIDENCE: Changes have been made to the management team since the last inspection in November 2006, with the Manager Designate and the Deputy Manager joining the home in February 2007. Both have worked in other Shaw Healthcare for some years. One part-time senior Team Leader and three Team Leaders complete the senior team on days. There is a Team Leader on each night shift, with two support staff. To support the thirty people in the home at the time of the inspection, there were four care staff on each of the early and late shifts, two working on each floor. Day staff currently work in six-hour shifts. Some staff prefer to work a double shift of twelve hours. The Manager Designate said that they are limited to working double shifts for two consecutive days only, which the rotas confirmed. The rotas do not, however, show the cover when staff have breaks when working long days and these should be shown to provide an accurate Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 22 picture of the staff numbers on duty. There were two care staff vacancies at the time of this inspection. The Manager Designate has provided the Team Leaders with a comprehensive list of their responsibilities to ensure consistency. She is also holding short, focussed staff meetings, on a very regular basis, to give information and improve practice. There is currently one person employed for eighteen hours to provide activities. As only two of the thirty people in the home are able to go out independently, the opportunities for people to go out of the home are limited. As it is recognised that there are people in the home with increasing needs, such as dementia, it must be demonstrated that the staffing levels provide adequate cover, plus the opportunity for people to have outings and one-toone support. New staff undertake a four day induction programme of basic training courses, including manual handling. Each staff member then undertakes one day’s “statutory” training each year to update the courses. The records of training are maintained on the computer system and a matrix was supplied with the dates of training. These included the basic courses of manual handling, health and safety, food hygiene, COSHH, and infection control. Not all of the induction records seen had been fully completed. The Manager Designate is aware that these need to be completed to provide evidence of competency. Limited training has taken place in the courses to support those people with more specialist needs, such as dementia and mental health issues. First aid is not included on the matrix and it needs to be shown that all staff have this training. The matrix indicated that a number of staff have not taken part in recent fire drills and the safeguarding adults training is still required for almost half of the staff team. The Manager Designate said that training needs had been identified and, while staff had been put forward for courses, some courses had been full. The Registered Providers must ensure that there is sufficient opportunity for staff to undertake all of the training they require. Eight of the care staff have a National Vocational Qualification at Level 2 and two have Level 3. Two staff have commenced Level 2 and two have commenced Level 3. The home has met the target of having 50 of the staff team trained to NVQ at Level 2 or above. The information for recruitment is held on the computerised records and those examined were satisfactory. Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management team are making progress in addressing the shortfalls identified. However, to maintain this progress, consistency is required with management staff having the time within the home to carry out the improvements. The financial management arrangements for people living in the home are satisfactory. Staff must be aware of their responsibilities with regards to health and safety. EVIDENCE: A new management team of the Manager Designate and Deputy Manager have been in post since February 2007, both seconded from other Shaw Homes. The Manager Designate is a Registered Mental Health nurse and has worked in dementia units. Her Deputy Manager has National Vocational Qualifications at Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 24 Levels 3 and 4, the Registered Managers Award and worked for eleven years with people with learning disabilities. People replying to the CSCI surveys said that the new management team had already made a difference to the home in the short time they had been in post. However, some adverse comments were made about the staffing at weekends, including “agency staff are not always knowledgeable” and that “more skilled and attentive staff” were needed. While the majority of people using the service said that staff listen to them, more than half said that staff were only “usually” or “sometimes” around, rather than “always”. More positively, respondents to the surveys also said that staff were “polite”, “usually friendly and supportive” and gave “excellent care”. One remarked that there had seemed to be extra staff around in the last few weeks. The Deputy Manager was sent, during the inspection, to another home for two weeks to cover in the absence of the manager. It has been a previous requirement that the home has sufficient management cover and, to progress the development of Kent Lodge, consistent staff management needs to be a priority. No formal review of the quality of care has been undertaken. This is an outstanding requirement and needs to be addressed. The home has an administrative officer who oversees the management of the finances of the people living in the home. The majority of people have only small sums of money held for hairdressing, newspapers and other items, usually brought in by their families. A small number have their finances managed through Shaw Healthcare, and the company holds their pensions in non-interest bearing accounts as there are difficulties in opening individual personal accounts with banks. There are safeguards in the system, such as two signatures for cheques, and audits. From the sample of records seen, the accounts are maintained in good order. A number of materials, which are potentially hazardous, were found to be in an unlocked cupboard in the laundry. It was noted that the majority of the staff have had training in the safe storage of COSHH materials but this had not prevented staff leaving them unlocked and it was not known who was responsible. A system of having known key holders is advised to ensure that this risk is minimised. The fire risk assessment still requires to be completed to show how the precautions, such as the frequency of drills, tests and servicing, are carried out so that monitoring for compliance can be undertaken. Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 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 2 17 X 18 2 2 X 2 X X X 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard 1 OP1 Regulation 4(1)a, 12 (1)a & b Requirement The Registered Providers must ensure that the Statement of Purpose evidences how the home provides for the health and welfare of people whose primary needs are not within its category of registration. The Manager Designate 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 Manager Designate must ensure that there is detailed information in the assessments to show how the specialist needs of service users, in respect of their health and welfare, are managed and the provision made. The Registered Providers must ensure that staff have the training, guidance and professional support to fully assess the needs of the people who are admitted, or already resident, and that the plan for their needs to be met is agreed. The Manager Designate must DS0000068006.V334889.R01.S.doc Timescale for action 30/06/07 2 OP2 5 (1) b 30/06/07 3 OP3 12 (1) a 30/06/07 4 OP4 13 (1) b,18 (1) c (i) 31/07/07 5 OP7 12 (1) a 31/07/07 Page 27 Kent Lodge Version 5.2 15 (1),(2)a 6 OP8 12 (1) a 13 (1) b 7 OP12 18 (1) a 16 (2) m, n 8 OP15 12 (2)(3) 16 (2) i 9 OP16 5 (1) 3, 22 (2)(4)(5) ensure that all persons admitted to the home have a fully completed care plan which reflects the health, welfare and social needs of the service users, and how these are to be met. The care plans must be seen to be agreed with the person using the service and their representative, where appropriate. The Manager Designate must ensure that the health needs of the people using the service are 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. (Previous time timescale of 28/02/07 not fully met) The Manager Designate 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. The Registered Providers must ensure that the people living in the home are offered the opportunity to be consulted about the meals which are provided, with sufficient choices for those who require, or prefer, a different diet. The Manager Designate must ensure that the complaints procedure, as required under the Care Home Regulations 2001, is included in the Resident’s Guide and made available to the people using the service, and their representatives, and in appropriate formats. DS0000068006.V334889.R01.S.doc 30/06/07 31/07/07 31/07/07 31/07/07 Kent Lodge Version 5.2 Page 28 10 OP18 13 (6) 11 OP19 16 (2) j 12 OP19 23 (2) p 13 OP21 23 (2) d 14 OP26 16 (2) k 15 OP27 15 (1) 18 (1) a 16 OP30 18(1) c (i) 17 OP33 24 The Registered Manager must ensure that all staff have the knowledge, by training, or other means, to understand the procedures for safeguarding adults. The requirements made by the Environmental Health Officer, at the December 2006 visit, must be actioned. (Previous timescale of 31/03/07 not fully met). The Registered Providers must provide confirmation that the heating in the home can be maintained, at levels to suit the needs of the people living in the home, without the hot water supply being affected. The Registered Providers must ensure that all the required maintenance and refurbishment, including the provision of radiator covers, must be undertaken in the bathrooms and toilets. 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 28/02/07 not met). The Manager Designate must provide evidence that the staffing levels are being kept under review to provide people using the service with the support and activities they require, in accordance with their assessed needs. It must be demonstrated that staff sufficient training, including first aid, to support them to meet the needs of the service users. (Previous timescale of 31/03/07 not met). A review of the quality of care must be carried out on a regular basis. (Previous timescales of 30/09/06 and 31/03/07 not met). DS0000068006.V334889.R01.S.doc 31/07/07 31/07/07 30/06/07 31/07/07 31/07/07 31/07/07 31/08/07 31/08/07 Kent Lodge Version 5.2 Page 29 18 OP38 13 (4) 19 OP38 13 (4) 23 (4a) b The Registered Providers must ensure that systems are in place to monitor the storage of COSHH materials to minimise risks to the people living in the home. The Manager Designate must ensure that the fire risk assessment is completed, to demonstrate that the precautions in place, such as the frequency of drills, tests and servicing, can be monitored for compliance. 30/06/07 31/07/07 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 2 Refer to Standard OP7 OP7 Good Practice Recommendations It is recommended that the assessment procedures be separated from the daily care planning sections to provide ease of access for the staff team. It is recommended that an early 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. It is recommended that the upgrading of the bathrooms which are not currently in use is considered, taking into account the views of the people using the service, so that the facilities are in accordance with their needs and wishes. 3 OP21 Kent Lodge DS0000068006.V334889.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West London Local 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.V334889.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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