Inspection on 12/12/06 for Kentwood House Ltd

This inspection was carried out on 12th December 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

Kentwood House Ltd 18/06/08

Kentwood House Ltd 31/07/07

Kentwood House Ltd 05/12/05

Kentwood House Ltd 10/05/05

Kentwood House Ltd 14/12/04

Similar services:

Wingham Court

Old Hastings House

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

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

CARE HOMES FOR OLDER PEOPLE Kentwood House Nursing Homes Ltd Darenth Road South Darenth Dartford Kent DA2 7QT Lead Inspector Eamonn Kelly Unannounced Inspection 12th December 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kentwood House Nursing Homes Ltd DS0000043103.V320984.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. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kentwood House Nursing Homes Ltd Address Darenth Road South Darenth Dartford Kent DA2 7QT 01322 279771 01322 279131 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) Kentwood House Nursing Homes Ltd Mrs Iqbal Sandhu Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 Brief Description of the Service: The home offers 21 single and 7 shared bedrooms on ground and first floors. Bedrooms (apart from one) have en-suite facilities. The home has a passenger lift. As a care home with nursing, two registered nurses are on duty during the day and one at night. Five care assistants are on duty from 7.30am-2.30pm and 4 are on duty from 2.30-8.30pm. Two care assistants are on duty at night. Other key members of staff also support the running of the home. Fees are as follows: 1. Local Authority funded residents: £482 per week for shared bedrooms and £492 per week for single bedrooms. 2. Privately funded residents: £650 per week. 3. Depending on the outcome of PCT (primary care trust) assessments of the level of nursing care, a refund to meet the nursing care proportion of weekly fees may be applicable. These levels of refund are: £43 per week (low), £83 per week (medium) or £133 per week (high). Additional charges are made for the following: • • • • • • Hairdressing, Chiropody (£9), Private phones and associated costs, Escort charges (£5.50 per hour), TV licence (£5 but free for over 75’s), Costs associated with outings arranged by the home. Prospective residents and their representatives receive a copy of the Resident’s Guide. This guide contains information about services and facilities including fees, additional charges and PCT refunds. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on 12th and 15th December 2006. It consisted of meeting with residents, the owner/manager, the deputy manager, new director, members of staff and visitors. A tour of the premises was made. Care practices were observed and discussed with members of staff, residents and visitors. A variety of records were seen during the visit principally those that supported the care of residents. Residents and their representatives completed and returned ten CSCI surveys to the commission. Three respondents were phoned by the commission to obtain their views. The report contains 9 requirements intended to improve the day-to-day and longer-term care and support of residents. A key strength of the business is that the owners are committed to achieving a range of quality assurance targets so that the comfort and safety of residents is promoted and, in due course, assured. What the service does well: What has improved since the last inspection? What they could do better: Prospective residents and their representatives should receive accurate information about the home’s services and facilities in a written guide to the home. Prospective service users must only be admitted if they meet the criteria specified in the home’s admission guide and in keeping with the home’s registration with the commission. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 6 Care plans should accurately reflect resident’s dependency needs and how their support needs are being addressed. Residents must not be inappropriately restrained and any aspects of appropriate restraint must be recorded and justified. Residents must receive the types of support they need in their retirement years. To do this, a range of procedure changes is necessary including the provision of activities in an organised and progressive way. The home needs to review its recruitment procedure so that, in all cases, a full record of recruitment is maintained and CRB checks for all staff and volunteers are carried out. All members of staff must receive training and opportunities for personal development that is required to support resident’s needs. The home must have an annual development plan based on a systematic cycle of planning-action-review, reflecting aims and outcomes for residents. Policies, procedures and practices must be reviewed and altered to reflect good practice standards. 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. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 6. Quality in this outcome area is poor. This judgement was made using available evidence including a visit to the service. Prospective residents and their supporters have the benefit of receiving initial advice and guidance that enables them to assess the quality, facilities and suitability of the home. A more accurate and up-to-date Resident’s Guide would be of additional benefit to them and the initial assessment should be more thorough. EVIDENCE: Prospective residents and their representatives receive guidance to enable them to decide if the home is able to meet their support needs. This includes receipt of a Resident’s Guide that contains details of services and facilities. The guide contains a range of information but it is in need of updating as it Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 9 contains misleading information and does not contain sufficient information about factors of importance at admission and later stages. The current guide has a variety of information that is confusing for both the home and residents/resident’s representatives. Examples of this are that a claim to “excellence” is made on a number of occasions at one stage claiming (wrongly) that the home has achieved ISO 9000 international quality standard. The staffing descriptions are misleading. This states that all staff are “appropriately trained”, that they have a “continuous staff training programme”, and that care practices are “in line with the latest initiatives and developments”. The inspection did not support these claims. The admission procedure described does not adequately advise on how new residents are admitted and the evidence during the inspection was that inappropriate admission procedures are followed. Each service user receives a personal contract. As part of the home’s commitment to quality assurance measures, the manager said he would review whether this contract contains all the elements included in Standard 2.2 of national minimum standards. The manager said that he would extend the information in the personal contract so that all new contracts issued would be a better statement of the rights and responsibilities of both parties (ie. the resident and the home). The owner/manager carries out an assessment of prospective service user’s support needs. Case tracking exercises indicated that the majority of residents currently at the home were at advanced stages of dementia. Most residents have support needs closely associated with dementia care rather than nursing care. Later in this report the point is made that most members of staff have not received the type of training and on-going personal development to enable them to provide specialist support for people whose primary support need is dementia care. The admission procedure currently followed is out of step with the home’s registration with the commission. In the current circumstances, prospective residents and their representatives are unlikely to be able to rely on any assurance that their specialist support needs would be met. The home provides long-term care and short periods of respite care for residents rather than care for people recovering from hospital stays before returning home. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is poor. This judgement was made using available evidence including a visit to the service. Residents would benefit more if care plan records more accurately reflected the actual support needs of residents. The support needs of the majority of residents who have dementia are not being adequately met. EVIDENCE: A care plan record is maintained for each resident. There is a great deal of information accumulated in these records. However, case-tracking exercises indicated that some residents receive inappropriate support and information that might prevent this or lead to appropriate care practices is not properly recorded in care plans. Observation of practices revealed that residents are inappropriately restrained by being placed in deep chairs with, for example, a Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 11 food tray placed across to prevent them leaving the chair. The owner stated that relatives give permission for these practices. Most residents were in their bedrooms on both days of the inspection and most receive their meals there. This isolation is not in keeping with better practices for supporting people with dementia. As most residents need specialist care for advanced stages of dementia, care plans should reflect their support needs and how these needs were being met. The evidence during the inspection was that this level of continuous assessment and reflection on outcomes of care was not in place. The home is looking at methods of recording care plan information to enable this assessment and review to take place more effectively. The owner/manager is receiving good support and assistance from the new director and manager to enable the support pattern at the home to be substantively altered. This quality assurance review proposes increased mobilisation of residents to help them leave their bedrooms and, for example, to have their meals in the dining area. A full-time activities co-ordinator will, it was said, be employed. Currently, the method of providing mental and physical stimulation does not enable accurate care plan records (and in particular a suitable profile of the resident) to be accessed by an activities co-ordinator. This situation is addressed later in this report. Care plan records have relatively little biographical information about resident’s former lives and how their interests are catered for in retirement. Case tracking exercises indicated that residents have access to local NHS community services, including GPs and health care professionals. Care plan records contain details of access to national health services (apart from to district nurses whose responsibilities are covered in respect of resident’s health care by the home’s registered nurses). During this inspection, a visiting private chiropodist visited several residents. The previous inspection report contained details of the home’s medicines procedures. These were found to have been satisfactory. Medication records were completed and kept with photographs of residents. A signature list for staff administering medication was maintained. Drug storage was secure. Facilities were available for the storage and administration of controlled drugs, although currently none were used within the home. GPs were said to undertake recorded medication reviews, which included homely remedies. Oxygen continues to be stored wrongly. Oxygen cylinders were stored in the manager’s office and on a first floor corridor. During the days of the inspection visit, members of staff treated residents with respect. However, the commission has received information by letter from a relative of a prospective resident that some residents were seen in a partial Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 12 state of undress. The owner/manager said that this issue would be discussed during a staff meeting and, if necessary, procedures would be amended to ensure that dignity and privacy issues are fully understood by all members of staff. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15. Quality in this outcome area is adequate. This judgement was made using available evidence including a visit to the service. Residents would benefit from better support in keeping physically and mentally active. EVIDENCE: Residents may receive visitors at any reasonable time and the home encourages this continuing contact. Two former resident’s relatives continue to visit (now as volunteers) to help with activities. This initiative is supplemented by short visits by an activities co-ordinator who is not an employee of the home. Whilst these inputs appear reasonable, the outcomes are less impressive. As referred to earlier in this report, most residents have dementia and mostly stay in their bedrooms. In shared bedrooms, residents were seen to be confused and isolated with, in some cases, both residents sitting together watching TV but not understanding their surroundings. In single bedrooms, residents were also alone and generally isolated with staff routines based around a bedroom bound model of Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 14 care (as in a care home with nursing where residents were confined because of their medical condition to hospital type beds). It was said that residents “preferred” this type of support and care. Whilst some residents might be able to make this judgement, the majority are likely to have difficulty in properly doing so. The home arranges for residents to be taken out several times each year by rented minibus. This initiative is a positive one but the emphasis in this report is in encouraging the home to move towards a system of resident support that addresses their needs on a day-to-day basis and increases their mobility, reduces their exposure to isolation and helps to improve their mental and physical alertness. As part of new quality assurance measures, the home has undertaken to employ an activities co-ordinator (whose hours will be based on at least one hour per week per resident, that is 35 hours per week) who will enable the proposed changes in working with residents to be achieved and then maintained in the longer term. There is also a commitment by the new director and manager to introducing better care plan records (with appropriate resident profiles, preferably typed for ease of reference by care staff), improved mobilisation of residents and extensive changes in the routines of staff support for residents. The new activities co-ordinator would benefit from membership of an association for such specialists (eg. The National Association of Activities Organisers in Homes for Older People). The proposed arrangements would also entail the activities co-ordinator having access to care plans of each service user and contributing to these records by updating personal profiles and recording resident’s personal progress. As referred to earlier in this report, there is evidence that most residents have early or advanced stages of dementia and their continuing support is not fully appropriate. In addition, inappropriate restraint is practiced. A reasonable conclusion is that residents are not receiving the type of help they need to exercise control and real choice over their lives. The plans for the future as described by the owner/manager, new manager and new director is likely to improve the lives of residents. The method of provision of meals to residents was inadequate. Two thirds of residents received their meals in their bedroom; transport of individual meals by individual carers is therefore a labour intensive procedure and transport of meals without covers was unhygienic and failed to keep the food sufficiently hot. Some meals were seen to become cold before they were collected from the kitchen and these were microwaved before they were taken as they had become cold in the kitchen waiting for collection. The new manager said that, as a beginning to improve meal provision and food safety, he would obtain the Food Standards Agency food provision and safety pack and follow its advice. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 15 Staff gave residents assistance with feeding. Residents’ evening meal comprises a cooked element and a record is kept of alternatives available and provided. Kentwood House Nursing Homes Ltd DS0000043103.V320984.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 poor. This judgement was made using available evidence including a visit to the service. Residents are generally protected from abuse but they would benefit if the home had a more complete understanding of what constitutes inappropriate restraint and how to prevent this. Additionally residents would be further protected if the home’s induction procedure and on-going personal development for staff included up-to-date information on protection of vulnerable adults (POVA). EVIDENCE: The home gives visitors a questionnaire asking for their views. Responses were said by the owner/manager to be positive. Responses to the CSCI survey together with other feedback from relatives of prospective residents indicated that the in-house surveys may not elicit responses that enable the home to adequately review it’s services as part of quality assurance measures. Residents and their representatives returned ten completed CSCI surveys to the commission. Two respondents were phoned by the commission to obtain their views. Some advised the commission that they felt staffing levels at the Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 17 home were insufficient to meet the support needs of residents. One stated that there was some difficulty in reclaiming the PCT assessed refund for nursing care costs. One said that residents had difficulty in understanding members of staff. There was a concern that all residents did not have sufficient access to equipment expected in a care home with nursing (eg. hospital type beds, air mattresses) and that specialist equipment could also be obtained from the NHS for privately funded residents (the example given was an air mattress). The commission was advised that there were sometimes offensive odours that should have been more effectively addressed and prevented. One respondent said that the standard of privacy for residents was not as high as might be expected. During the inspection, examples of inappropriate restraint were discussed with the owner, new manager and new director. The home is not acting in the proper interests of vulnerable residents by accepting direction from resident’s representatives in relation to some procedures followed. The home’s induction procedure does not contain suitable tuition on protection of vulnerable adults. If it did an outcome is likely to have been that inappropriate restraint would have been identified by staff and appropriate action taken including bringing abusive practices to the notice of relevant agencies. Because of the lack of a suitable on-going staff development programme, members of staff who have worked at the home for longer periods are unlikely to have received sufficient support in understanding their responsibilities in preventing abuse of residents. Kentwood House Nursing Homes Ltd DS0000043103.V320984.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, 26. Quality in this outcome area is adequate. This judgement was made using available evidence including a visit to the service. The premises are broadly suitable for the support and care of older people. Residents would benefit from a number of improvements to aspects of the accommodation. EVIDENCE: The premises have 21 single and 7 shared bedrooms. All but one bedroom has en-suite facilities. There are sufficient bathrooms. The home is situated in a rural area and there are extensive surrounding grounds. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 19 Bedrooms are on the ground and first floors. The home has a passenger lift. Three mobile hoists are available. A call bell system is provided. There is a ramp to the garden from the lounge area. Radiators have low temperature surfaces. Hot water outlets accessible to residents are temperature controlled. There are 2 sluice rooms. The home has a medications storage room. The laundry is located in the basement. The home has 17 hospital type beds and 19 divans. The home has good lounge facilities. A number of issues were brought to the manager’s attention during the inspection visit: • • Communal bathrooms were used for general storage and storage of communal toiletries. The “nurse station” on the ground floor was not suitable for its purpose. The manager said he would replace or remove it. Safe sitting or writing positions for staff are compromised by the current work station. A similar structure on the first floor is seldom used. TV’s in resident’s bedrooms were not correctly tuned. Clocks at the home did not show the correct time. Oxygen cylinders were not safely stored. COSSH cupboards were unlocked when not being used. Warning signs were placed on walls and doors throughout the premises. These were difficult to read and in many cases inappropriate. Towels and other items were stored in the open in corridors rather than in cupboards. In some bedrooms, call bell extension leads extended across the room and were a tripping hazard. In shared bedrooms, one resident’s call bell extension lead prevented the other resident from safely accessing the shared en-suite. Some en-suite’s in shared bedrooms were cluttered, for example, with “cleaning in progress” signs and shared commodes. Additionally, there is a concern that there are shared commodes where the bedroom has an en-suite facility. Why are commodes used where the bedroom has full en-suite facilities? DS0000043103.V320984.R01.S.doc Version 5.2 Page 20 • • • • • • • • Kentwood House Nursing Homes Ltd • • • A commode had a broken back support and it was not possible to open the seat properly. The shape of some shared bedrooms would not allow the use of hospital type beds (if available). The room with “Hairdresser” on the door is a small storage room. Hairdressing is carried out in resident’s bedrooms. The sign therefore is misleading. Some baths were scaled and had not been recently cleaned. Some shared bedrooms used by 2 residents did not have 2 armchairs. • • Bedrooms seen had resident’s personal possessions displayed. Laundry and storage facilities are in the basement of the premises. There were odours at a number of locations throughout the premises. Carpets in some areas were being treated during the inspection visit. A respondent to the CSCI survey complained about offensive odours at the home. Kentwood House Nursing Homes Ltd DS0000043103.V320984.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): 27-30. Quality in this outcome area is poor. This judgement was made using available evidence including a visit to the service. Residents are in the care of a staff group that are enthusiastic and hardworking. Residents would benefit if members of staff received additional opportunities for personal development to meet their specialist support needs. EVIDENCE: As a care home with nursing, two registered nurses are on duty during the day and one at night. Five care assistants are on duty from 7.30am-2.30pm and 4 are on duty from 2.30-8.30pm. Two care assistants are on duty at night. Other key members of staff also support the running of the home. The allocation of separate staffing for supporting residents on the ground and first floors is based on a staffing model for care homes with nursing where residents are bed-bound predominantly because of their physical medical conditions. Review of this procedure is likely to contribute to better staff deployment and gradual movement towards better mobilisation of residents. Please refer to earlier sections of this report for information about the need for reform within the home. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 22 A new and clear staff rota system has been introduced. Members of staff met (and others whose practice was observed) were enthusiastic, hardworking and committed to the care of residents. A check of staff files indicated that not all staff had been CRB checked. In other cases, copies of references were not available. The home retains CRB checks in staff files and a spreadsheet showing the names of all staff, the CRB reference number, date of receipt of check and the outcome of the check was not available. The resident’s guide makes a number of claims that all members of staff have received appropriate training. A check of staff files and meetings with some members of staff indicated otherwise. All members of staff have not received adequate training in the subjects regarded as “mandatory” including safe movement and handling of frail older people. During the inspection, a member of staff was identified as having the skills to carry out in-house training in moving & handling when the member of staff has completed a trainer’s training course. Members of staff were seen on the first day of the inspection working as kitchen assistants and on the second day as home cleaning staff. These members of staff need to have completed food hygiene certificated training and infection control training. It was difficult to ascertain if members of staff had completed appropriate training because the training matrix in respect of each only referred to named staff being “appropriately qualified” and having access to “a continuous training programme”. Staff files seen indicated that the induction procedure was insufficient and not meeting “Skills for Care” standards. In addition, nurses from abroad (but not registered in the UK and not undertaking “adaptation”) working at the home as care assistants have not received opportunities for adequate personal development at the home. Considerable discussion took place during the inspection about the need for appropriate staff knowledge and skills in working with residents most of whom have dementia. These residents have specialist support needs. Currently they are not receiving this type of specialist assistance. The manager undertook to have all members of staff enrolled on the RVQ Certificate in Dementia Care. This is in addition to enabling staff to complete NVQ Level 2 in Care and, where the relevant “mandatory” skill is not taught via this qualification course, the mandatory skill is delivered separately via recognised and certificated training. Kentwood House Nursing Homes Ltd DS0000043103.V320984.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 was made using available evidence including a visit to the service. Residents have the benefit of living in a home where the management team have addressed the need to make radical improvements so that the home is run in the best interests of residents. EVIDENCE: The owner/manager has appointed a new manager and director. They are assisting in identifying essential improvements and have outlined how these improvements would benefit residents and staff. The new manager is nurse trained (RMN) and is undertaking the registered manager’s award. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 24 The evidence advanced in this report indicates that the home’s procedures are not always in the best interests of residents. The areas of concern are that most residents have advanced dementia and are not receiving the support they need, staff are not receiving the level of personal development needed to support the resident group, some aspects of recruitment need to be improved and pre-admission written information makes claims that are not met in practice. The level of perceived positive feedback received directly by the home differed from that received by the commission. The owners, new manager and director have undertaken to address the shortfalls in resident support activities. Their commitment to quality assurance measures is likely to improve the comfort of residents and their longer-term care and support. The home holds small amounts of cash on behalf of some residents. This is stored individually and securely. Receipts are kept and accounts of all transactions are maintained. The policy of the home is that residents or, more generally, their main representatives, retain responsibility for their financial and legal affairs. The owner/manager made a declaration in the pre-inspection questionnaire that all safety certificates and checks are in place and up-to-date. The manager was aware that, in respect of new fire regulations, a new fire safety assessment must be completed by a person qualified to do so. Kentwood House Nursing Homes Ltd DS0000043103.V320984.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 1 2 1 1 x 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 x x 3 Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1OP1 Regulation 5 & 6. Requirement Prospective residents and their representatives must receive accurate information about the home’s services and facilities in a written guide to the home. “The registered person shall produce a written guide…” Timescale for action 01/03/07 2. OP3OP3 OP4OP4 14.1 (d) Prospective service users must 01/02/07 only be admitted if they meet the criteria specified in the home’s admission guide and in keeping with the home’s registration with the commission. The revised procedure for admission should have at its core a full pre-admission assessment that ensures that new residents require nursing care. This is to ensure that new residents can be supported properly and that the staff group have the specialist skills to enable that level of care and support to be provided. “The registered person shall not provide accommodation…unless…the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare”. “The registered person shall ensure Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 27 that the care home is conducted so as to promote and make proper provision for the health and welfare of service users…(and)…treatment of service users”. 3. OP7OP7 14 (d). 15. Whilst each resident has a care plan file that contains a great deal of information, the plans do not accurately reflect their dependency needs and how their support needs must be properly addressed. The manager and new director are looking at better ways of making the types of assessments needed and how best to record these assessments and reviews of support needed by residents. All new residents must have a care plan record that reflects his/her full support needs and how these are being met. “…the registered person shall prepare a written plan as to how the service user’s needs… are to be met…(and)…”. “The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users…(and)…treatment of service users”. 01/03/07 4. OP9OP9 13 Oxygen cylinders must be stored safely within the home. “The registered person shall make arrangements for…the safekeeping…of medicines…”. 15/01/07 5 OP8OP8 13 (7) & (8). As part of the need for resident’s health and welfare to be promoted, residents must not be inappropriately restrained and any aspects of appropriate restraint must be recorded and justified. “The registered person shall ensure that no service user is subject to physical restraint unless…” “On any occasion on which a service user is subject to physical restraint, the registered person shall record the 15/01/07 Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 28 circumstances, including the nature of the restraint”. 6 OP12OP12 OP14OP14 OP15OP15 12 (4). 14 (d). Residents must receive the types 01/03/07 of support they need in their retirement years. The report refers to examples of isolation of many residents. The staffing structure whereby registered nurses and care assistants are allocated to separate accommodation floors contributes to the isolation of residents in bedrooms. Most residents do not fit the profile of people who are bed-bound because of their medical condition. Whilst occasional minibus outings are organised, the real need is for significantly improved day-to-day assistance for residents to engage in conversation, remain active and obtain support proportionate to their needs and types of dementia. To do this, a range of procedure changes is needed including the provision of activities in an organised and progressive way. The way food is provided and served must also be improved. The undertaking of senior members of staff to improve the mental and physical agility of residents is acknowledged. “The registered person shall make suitable arrangements to ensure that the care home is conducted…with due regard to…any disability of service users”. “The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users…(and)…treatment of service users”. 7 OP29OP29 Schedule 2 (1-6). Schedule All staff and volunteers must have a CRB check carried out. The manager must make DS0000043103.V320984.R01.S.doc 15/03/07 Kentwood House Nursing Homes Ltd Version 5.2 Page 29 2 (7). available for inspection a list of Regulation staff showing the person’s name, 19 (5) (d) CRB reference check number, date of receipt and a note of the outcome. The home needs to review its recruitment procedure so that, in all cases, a full record of recruitment is maintained. The home’s application form needs to be updated so that, for example, the full name, position, address/postcode and telephone number of referees is obtained. Also, the form should have a clearer section on declaration of offences to ensure that applicants fully understand what they must declare. 01/06/07 All members of staff must receive training and opportunities for personal development that is required to support resident’s needs. The proposed pre-admission information manual will contain a statement referring to the actual position on staff training (ie. the name, job title and certificated training received by each member of staff). The undertaking by the owner/manager, new manager and new director in respect of increased opportunities for staff to obtain NVQ qualifications and for all mandatory training to be given is acknowledged. If the home is to continue with the care of people with dementia, all care staff must receive appropriate training. This would mean that all care staff must complete an RVQ certificate in dementia care at the earliest opportunity. DS0000043103.V320984.R01.S.doc Version 5.2 Page 30 8 OP30OP30 OP18OP18 18 (1) (c) Kentwood House Nursing Homes Ltd “The registered person shall…ensure that the persons employed…receive training appropriate to the work they are undertaking and suitable assistance…”. 9 OP33OP33 OP16OP16 6, 21, 24 & 26. 01/06/07 Requirements and recommendations in the previous CSCI inspection report have not been sufficiently addressed. The home must have an annual development plan based on a systematic cycle of planningaction-review, reflecting aims and outcomes for residents. A strength of the home is that a new manager and director have been appointed and a commitment on achieving quality assurance measures has been given to the commission. If this commitment is realised over the next 6 months and beyond, the home may then claim that it is being run in the best interests of residents and their representatives. Currently there is little evidence that there is continuous self-monitoring and the admission guide makes broad claims to excellence that have not been substantiated through inspection. Policies, procedures and practices must be reviewed and altered to reflect good practice standards. “The registered person shall…revise…the (resident’s) guide…”. “The registered person shall…maintain a system for…improving the quality of care…”. Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 31 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 OP2OP2 Good Practice Recommendations The personal contract for residents should be updated. The new contracts should include information on the rights and responsibilities of both parties to the agreement (ie. the resident and the home). The safety and comfort of residents should be promoted by improvements referred to in the report. Additionally, the feedback from respondents relating to the need to prevent offensive odours should be given consideration. 2. OP19OP19 OP26OP26 Kentwood House Nursing Homes Ltd DS0000043103.V320984.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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