Inspection on 06/08/08 for Kenwood

This inspection was carried out on 6th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kenwood 22/05/07

Kenwood 07/11/06

Kenwood 23/05/06

Kenwood 25/10/05

Kenwood 04/04/05

Kenwood 28/09/04

Kenwood 28/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Kenwood 30-32 Alexandra Grove Finchley London N12 8HG Lead Inspector Ffion Simmons & Sue Mitchell Key Unannounced Inspection 6th August 2008 09:30 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 Kenwood DS0000010457.V368630.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. Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kenwood Address 30-32 Alexandra Grove Finchley London N12 8HG 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 8445 5112 020 8343 7992 New Century Care (Finchley) Limited Najmuddin Khan Mudhoo Care Home 32 Category(ies) of Dementia (14), Old age, not falling within any registration, with number other category (32) of places Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE (maximum number of places: 14) The maximum number of service users who can be accommodated is: 32 22nd May 2007 Date of last inspection Brief Description of the Service: Kenwood Nursing Home is owned and managed by New Century Care (Finchley) Limited. The home has a mission statement, which says that it aims to provide good quality accommodation, nursing and personal care for vulnerable elderly people, who as a result of loneliness, physical disability or illness are seeking an understanding and caring environment. The home is a three storey detached house. There are two lifts between the ground and first floor, which are areas occupied by service users. The third floor has a staff room and storeroom. There is a communal dining room on the ground floor and a lounge on each floor. A small activity room is located on the first floors. There are 22 single bedrooms and 5 shared bedrooms. All the bedrooms have en-suite facilities. There is a small parking area at the front of the building and a large garden at the rear with wheelchair access. The home is situated in a residential area and close to a variety of shops, restaurants and transport facilities located along Ballards Lane, North Finchley. The fees charged by the home range from £580 - £800 per week. Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced key inspection was carried out by two inspectors on the 6th August 2008 and lasted a total of 9 ½ hours. During the inspection, we spoke with residents, relatives and staff and observed care practices. We tracked the care of five residents, and in doing so we checked their personal records. A number of records and documentation was checked during the inspection, including medication administration records, staff files, health and safety documentation, the home’s complaint records and quality assurance documentation. Questionnaires were sent to residents, relatives/carers and advocates, professionals and staff to comment on the service. We have used the information within these questionnaires to contribute to the content of the report. The Registered Manager took time to complete and return the Annual Quality Assurance Assessment (AQAA), which has been used as evidence to inform this report. What the service does well: Detailed information is available about the care home and residents and relatives are able to visit to assist in their choice of home. Residents’ needs are appropriately assessed prior to moving in and staff are trained to meet their needs. Residents are able to take part in a range of activities, which are appropriate to their age and culture. They are able to keep in touch with their family and friends as visitors are warmly welcomed. Residents are offered wholesome, varied and appealing meals, which meet their individual needs and preferences. Residents live in a clean and well-maintained home, which is homely, and comfortable. The home is fresh and clean and is accessible to wheelchair users. Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Kenwood DS0000010457.V368630.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 Kenwood DS0000010457.V368630.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, 3, standard 6 is not applicable. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are given detailed information about the care home and are able to visit to assist in their choice of home. Residents can be assured that their needs are appropriately assessed prior to moving in and that staff are trained to meet their needs. EVIDENCE: The home has updated its Statement of Purpose following the variation in May 2007 to its registration to provide care for 14 people with dementia. There is clear information about the Orchard Unit, which accommodates 14 people with dementia. We were informed by the service manager and staff on duty that training on dementia care has been provided. We looked at the care files of two residents who had recently been admitted to the home. Both were respite placements but one had recently had their placement made permanent. We were able to speak to the relatives of this person. They said they were satisfied with the care provided, the home was Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 9 local and they could visit for as long as they wished. Another relative said that they were given a list of three homes but visited Kenwood first as it was more local. Their visit was unannounced and they were made to feel very welcome. It was chosen as it felt right as soon as they visited. It was “cosy and had a busy atmosphere” and her relative was well cared for there. Another person had also visited three care homes before selecting Kenwood for their relative. The care files contained comprehensive information about the residents from both the homes assessment and other professionals involved. The home’s assessment was detailed and covered areas of need such as: communication, personal and healthcare, spiritual, religious and cultural needs, mobility, nutrition and social interests and activities. Risk assessments had been carried out in a timely fashion following their admission. The care plans were also detailed and linked to the assessment information in terms of individual’s needs requiring a care plan. In addition there was information on each persons choice of lifestyle. One person had their life history written by their relative. Care plans evaluations were noted be carried out monthly. Daily and other records relating to the residents care were also available. The home does not provide intermediate care. Kenwood DS0000010457.V368630.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 People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have access to health care service and residents’ needs in relation to health, personal and social care needs are generally well recorded in the care plan. There were some gaps in recording. The home has a medication policy in place but medication records are not up-to-date for each resident. Improvements are needed in this area to ensure that residents are fully protected. EVIDENCE: We tracked the care of five residents during the inspection and in doing so we checked their personal records including care plans and risk assessments. Each resident has a named key worker and nurse assigned. Staff spoken to were knowledgeable about individual residents. A relative commented, “my relative is totally dependent on nursing care. They are always clean, dry and comfortable.” As detailed in the previous section residents have comprehensive assessments prior to moving in. Care plans for the residents sampled were seen to be up to date and regularly evaluated. Included in the information was the collaborative Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 11 health care record for each person. There were records of all the individual’s health care appointments which included speech and language therapist, physiotherapist, psychiatrist, GP, tissue viability nurse, optician, chiropodist, dentist etc. The notes for one resident had not been updated since November 2007 despite staff confirming that they had been seen since then by members of the multi disciplinary team. Steps must be taken to make sure that these records are kept up-to-date. The notes were in chronological order but should there be a need to track a persons appointments with a certain professional this may take some time. It is recommended that the home review the current system of recording all healthcare appointments on one sheet and consider putting them into groups such as community services, specialist support etc. There are five GP’s that visit residents in the home and the Manager confirmed within the AQAA that “preference of GP is respected where possible”. It was noted that the daily records, activity records and other daily notes are written by different people. The nurses write up the daily log which focuses on the personal and health aspects of the residents care plan, other notes around the residents social activities/ visitors etc are written up by key workers. It is recommended that the home consider having the daily records amalgamated to provide a more holistic view of the residents daily life in the home. The home promotes the health and safety of residents through the use of risk assessments including manual handling risk assessments, falls risk assessments, a tool is used for assessing malnutrition. The risk of residents developing a pressure ulcer is assessed using the Waterlow risk assessment. For one of the residents case tracked, we noted that since the 02/02/08, the resident had been assessed of being at risk of developing a pressure ulcer. We checked their file with the Deputy Manager and found that there was no care plan and management plan for staff to follow to address the risk of developing a pressure ulcer. Steps must be taken to make sure that when residents are identified as being at risk of developing pressure ulcers, that a care plan and management plan is put in place. One of the residents currently has a pressure ulcer. A wound care plan was in place outlining the steps that should be taken to manage the wound including the need to be nursed on a pressure reliving mattress and to change the position of the resident every two hours. Turning charts are in use to record when staff change the position of residents. These were checked during the inspection, and we noted that there were gaps in the recording. There were occasions where staff had not recorded that they had turned the resident for a number of hours for example on one occasion the records showed that the resident had not been turned from 19:00 until 09:00 the next morning. This puts residents at risk of further tissue breakdown. A resident commented that “day staff are more caring than night staff” and went on to comment that “I should be turned on either left side or right side during the night to be comfortable sometimes happens twice or once”. Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 12 Daily records are maintained in relation to the wound, these were checked and should include more information as they did not always clearly illustrate the condition of the wound i.e. comments on its size, exudate or comments on whether the wound was improving. The Deputy Manager told us that wounds are mapped on a weekly or fortnightly but confirmed that there were no wound charts on file for this resident from May 2008. The homes’ management of medication was assessed during the inspection. We found the medication was securely stored. Staff are recording the temperature of the store room and the fridges where medication is stored to make sure that medication is stored within correct temperatures. The home uses the Nomad system and some medication also arrives in loose packs. We attempted to audit a sample of loose tablets to check if the quantity of the tablets could be reconciled against the number of signatures. This was not possible as accurate records of the medication in use in the home was not being kept. For one of the residents checked, the quantity of their medication had not been recorded at all on receipt into the home. For other residents, the quantities of medication did not correspond with the totals documented on the MAR charts. Steps must be taken to ensure that accurate records are kept for all medication received, administered and disposed of. Controlled drugs are in use in the home, and we saw evidence that staff are using the appropriate denaturing kits to dispose of controlled drugs. Accurate records of controlled drugs are maintained and daily balance checks are undertaken. We checked the balances of the controlled drugs in use and found these to be correct. We noted that a liquid medication with a short shelf life of seven days, as well as other bottles with longer shelf life did not have a date of opening on the bottles. It is a recommendation that for auditing purposes and to ensure that medication is not used past its shelf life, that the date of opening is recorded. In several cases, the code 0 was used to indicate that medication had not been administered. The code 0 was defined as “not given”. When codes are used to explain why medication is not given these must be more specific and outline the reason for not administering the medication. Personal care is undertaken in private to maintain the privacy and dignity of residents. On one of the units during lunch time however, we observed staff referring to residents as “good girl”. Care must be taken to address residents appropriately and with respect. Kenwood DS0000010457.V368630.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, 13, 14 & 15. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in a range of activities, which are appropriate to their age and culture. They are able to keep in touch with their family and friends as visitors are warmly welcomed. Residents’ cultural and religious needs are met. Residents are offered wholesome, varied and appealing meals, which meet their individual needs and preferences. Residents’ experiences at mealtimes could be improved with more staff to support them and by being referred to appropriately by staff. EVIDENCE: The home has a programme of activities for the week, which was on display during the inspection. Due to take place on the day of the inspection was nail filing and nail polishing sessions, although this activity was not observed. Staff were observed to be with residents in their rooms supporting them with drinks or meals as many people are bed bound in the home. This takes away staff for carrying on activities in the lounges. Staff did comment that they had little time to do more than just provide care as a number of the residents needs are quite high. In discussion with one relative we were informed that the home provides good activities such as parties, barbeques and trips out which Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 14 she felt were very good. She said that relatives are made very welcome to attend parties etc which she had done. As stated in the first section of the report there was a record of residents lifestyle choices, which included preferred activities. There were individual records kept of one to one and group activities in the home, which was positive to see. These records included activities carried out in the residents rooms such as nail care, chatting with them watching TV and a record of visitors to the resident. The group sessions with entertainers, games etc identified which residents attended and whether or not they participated. There was also an evaluation of the activity in terms of what went well and what would be better next time. The care plan information provided included people’s ethnic needs in terms of activities, religious beliefs, diet etc. This was seen to be comprehensive with a record of personal choices re attendance at particular religious services and diet. Relatives views were also sought for those without capacity in terms of any particular wishes in this area. The manager has also provided staff with a list of different religions and customs to help them when working with someone form a different culture. During the inspection we observed visitors being given a warm welcome by staff. The Manager confirmed within the AQAA that Kenwood “encourage family involvement in all aspects of care and social life. Normalization encouraged by means of welcoming children, animals as desired.” Relatives commented “we are all made most welcome at the care home” and “if any relative visit, they are always impressed by what they see”. Lunchtime was observed on the two floors. Residents were supported to have their meals either in the main lounge area or in their rooms. A relative commented “my relative may stay in their room or go to the lounge if they want to, their meals are served no matter where they are. I am invited to eat with them if I wish.” A resident commented “food is very good and nicely displayed and choice of menus”. The meals are freshly cooked on the premises and menus are varied and nutritious. Arrangements are in place for residents with special dietary requirements. We observed staff sensitively supporting residents with their meals as required. On one of the units however, we observed staff referring to residents as “good girl”. Care must be taken to address residents appropriately and with respect. On one unit, there was not enough staff to support residents with their meals, which resulted in one residents’ lunch being left on their table for a long period of time whilst staff were supporting other residents. Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 15 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. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has an open culture that allows residents and relatives to express their views and concerns. Policies and procedures are in place for safeguarding residents form abuse, which are known to staff. EVIDENCE: In discussion with relatives we found that they had no concerns to raise with us. One person said that he had found the manager very helpful when he complained about a possible fault with the TV in his relative’s room He said the manager acted immediately and replaced the TV. One relative said that she felt able to approach the manager and the admin manager who she said was very helpful. This relative said she also attended the relative and residents meetings where much was discussed and all the relatives felt free to raise issues with the manager. A copy of the last meeting’s minutes was provided. Some concerns about missing laundry were in the minutes. However the homes complaints book wasn’t available for inspection so it was unclear whether this issue had been addressed. A folder with details of previous complaints was available and contained all the related correspondence. It was clear from this information that the manager had responded appropriately to all the complaints. It is recommended that a complaints book, which details all concerns raised with staff be kept so that an audit trail can be kept to ensure all steps to address the complaint can be followed. The manager has also started a weekly surgery for relatives, residents and staff to discuss any issues or concerns. This plus the relatives Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 16 meetings demonstrates the openness with which the home wishes to deal with complaints and concerns. The home has an adult protection policy and a copy of Barnet’s policy is also in place Staff stated that they were aware of how to report any allegation or observations of abuse. The homes training matrix identified which staff had had the training as well as those that needed it. There have been three safeguarding adults investigations carried out within the last twelve months. Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 & 26. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and well-maintained home, which is homely, and comfortable. The home is fresh and clean and is accessible to wheelchair users. Residents feel that the home suit their needs. EVIDENCE: The home is situated in a residential area and is close to a variety of shops, restaurants and transport facilities located along Ballards Lane, North Finchley. During the inspection, we toured the building and viewed communal areas including the bathrooms, dinning rooms, lounges and we viewed three bedrooms, which had been personalised. The home is not purpose built, but provides a homely and comfortable environment. The home has a wellmaintained garden, which is accessible to wheelchair users and is furnished with garden furniture so that residents can sit out and enjoy the outside space. Residents are accommodated on the ground and first floors and there are lifts in place for accessing the upper floors. Residents spoken with were satisfied Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 18 with their accommodation and commented that they felt safe and quite secure at the home. One commented “first impressions – spotlessly clean and friendly – rooms and décor excellent”. Relatives also commented that the home seems to be kept clean and is secure. There are sluicing facilities on the ground and first floors of the home and the home has the appropriate contracts in place for the disposal of clinical waste. There is a separate laundry room on the ground floor and staff have received training in infection control so that the risk of the spread of infection is minimised. The home was clean and fresh and the standard of hygiene throughout the home was good. The home employs domestic assistants to promote cleanliness within the home. Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s recruitment policy and practices. The service recognises the importance of training and tries to deliver a programme to ensure residents’ individual needs are understood and met. People are generally satisfied with their care but the current staffing levels do not fully meet their needs. EVIDENCE: The last inspection had identified that a review of staffing levels needed to be undertaken. The service manager informed us that this had been done and that no staff increases had been identified as being needed. What they had done was to ensure that the work on each shift was shared equally between the nurses and care staff to ensure there was a fair distribution of tasks. In discussion with staff, observation during the day and speaking to residents and relatives, we felt that a further review should be undertaken given that a high proportion of residents were bed bound and needed more care. This plus the fact that they also had a specialist dementia unit, which cares for up to fourteen residents with dementia of varying degrees also supports this requirement for a review. The AQAA confirmed that all residents require help with dressing/undressing and require help with washing and bathing. Some of the comments we received included the following “most time we get sick as the work is hard and demanding” comment from staff Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 20 “staff are very hard pushed – puts others under pressure when staff are sick” and “sometimes short of staff “– comments from residents. We sampled six staff files, which included 3 recent appointments as well as long term staff. All files were well organised with clear records of all required checks, references, start dates completed application forms and interview notes. Terms and conditions of employment were also in the files. The administrator keeps a record of all CRB and POVA first checks separately. We looked at the home’s training records, which also included a comprehensive induction for new staff. Those sampled had been completed in full by both staff and supervisor. There was a training matrix, which the manager compiles on a regular basis to ensure that all staff are enrolled in refresher training such as fire safety, health and safety, first aid, safeguarding and medication. There was a record of staff having undertaken dementia care training. There was a record of the RGN’s training in more specialised areas such as wound care, stoma care and tissue viability. When we asked staff what the home does well, they commented “in-house training and other training conducted outside the home”. A resident commented that, “Staff are very kind and very helpful”. The relatives spoken to also stated that they felt staff were kind and helpful and respectful. One person said about her relative, who was unable to speak, that her face always lit up when she saw one particular staff member. She was unable to comment on the staffing levels as her relative was bed bound but felt that they did pop in to see her regularly. Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36,37 & 38. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is managed by a qualified and experienced Manager. Supervision and appraisal records need to be improved to reflect that staff competencies are assessed. The home is responsive to residents and relatives’ views but improvements are needed in the home’s systems for self-monitoring. The health and safety of residents are not always protected. EVIDENCE: The home has an experienced Registered Manager in post. The Manager is a Registered Nurse and holds a Diploma in Management. The Registered Manager was not available on the day of the inspection but we had the opportunity to meet the home’s senior area Manager. We received positive comments about the Manager from residents, relatives and staff. Some of these comments include the following: Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 22 “the manager of the home asked all relatives if any concerns to please inform him and he will address them, that he always does”. The Manager is supported by a Deputy Manager, who is also a Registered Nurse. We spent time talking to the Deputy Manager throughout the inspection, and found her to be very supportive and receptive to comments made about the service. She demonstrated a very clear understanding of the needs of residents and current best practice guidance. Residents and relatives commented that the home encourages feedback and seek suggestions of ways to improve the service. A relative told us that “Kenwood holds regular monthly/quarterly meetings for friends and relatives”. We noted that the manager also offers open surgeries once per week to allow relatives or friends to discuss any areas of concern. The AQAA confirmed that residents’ surveys are carried out at least annually and that there is a comprehensive quality assurance process in place. The Manager should introduce a process of auditing loose medication to ensure that balances are correct. Staff should also regularly audit the record keeping in the home to ensure that documentation is completed correctly. The home does not manage any money for the residents, but the administrator confirmed that twelve residents have money in the safe for safe-keeping. The AQAA completed by the Registered Manager confirmed that the home has a policy for the safe management of residents’ money. During the inspection we checked the procedures in place for safeguarding residents’ finances through talking to the administrator and checking the records for four residents. The balances of the money held in the home were correct against the home’s records. Receipts were maintained for purchases made on residents’ behalf. The administrator confirmed that the Manager and the administrator undertake weekly audits of the balances of residents’ monies to ensure residents’ financial affairs are protected. We looked at a sample of supervision and annual appraisal records held in the home. We were informed that the manager and senior staff carry out supervision and the manager does the appraisals. The administrator informed us that she carries out supervision of the housekeeping staff, these records were seen to be complete. In the supervision samples seen a number had not been completed in the section where comments about staff performance on certain areas, such as catheter care, should have been. Meetings between the supervisor and the supervisee although signed by both parties had no indication of any actions in the comment boxes. This was felt to be unacceptable particularly if staff were being assessed on their knowledge of care practice, there was no record of any shortfalls or that they were competent in these areas. The appraisals carried out were quite detailed but again some were incomplete in terms of actions/ comments from the person being appraised that they agreed with the assessment. Some had not been signed and dated. Work on improving the quality of supervisions records and Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 23 appraisals is needed. These shortfalls were discussed with the service manager who stated she would inform the manager. We checked a number of records in the home during the inspection, including health and personal care records, medication records, complaint records, supervision records and health and safety records. Improvements are needed in this area to ensure that the home’s records are comprehensive and up-todate, and regular audits should be undertaken to improve quality in this area. During the inspection, we checked the accident books currently in use in the home. The books reflected that the occurrence of accidents in the home is low. Information within the AQAA completed by the Registered Manager confirmed that gas appliances, electrical equipment, lifts and hoists and fire equipment such as fire equipment have been tested. This was supported by certificates in the home. During the inspection, we observed that none of the staff working were adhering to Food Safety requirements as they were not wearing protective clothing when serving and assisting residents with their food. During the inspection we noted that there were three fire doors being propped open with chairs and stools. One of these doors was the fire door to the laundry room, which is a high risk area for fire. Urgent steps must be taken to make sure that the door guards in place are regularly tested and are working and that fire doors are not obstructed. The fire safety record folder was made available for inspection. This was noted to hold records going back a few years. It is recommended that this folder is reorganised and old records archived. The home carries outs weekly fire alarm tests and monthly fire drills for staff. We discussed the reason why drills are held monthly. This was company policy although we felt it might be disruptive to the residents to have drills so regularly. Drills were noted to always be carried out at the same time of day. It was recommended that this be reviewed to ensure that night staff participate in drills at least once per year. A fire risk assessment had been carried out and action on items identified for repair etc had been carried out. Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 3 2 Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? 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 OP7 Regulation 15 Timescale for action To minimise the risk to 01/10/08 residents, action must be taken to make sure that when residents are identified of developing pressure ulcers, that a care plan and management plan is put in place. Action must be taken to make 01/10/08 sure that individual health care appointment records are kept up-to-date so that recent appointments can be easily tracked. Records kept in relation to 01/10/08 wound care, including turning charts must be improved and provide more detail to provide evidence that care is provided as per residents’ care plans. Action must be taken to ensure 01/10/08 that accurate records are kept for all medication received, administered and disposed of. A further review of staffing levels 01/10/08 must be carried out to ensure that the care needs of residents are met. Work must be undertaken by the 01/10/08 Manager to improve the quality DS0000010457.V368630.R01.S.doc Version 5.2 Page 26 Requirement 2. OP8 3. OP8 17 (1) (a) Schedule 3; 3 (k), (m) & 17 (3) (a), (b) 17 (1) (a) schedule 3 (k) & 17 (3) 13 (2) 4. OP9 5. OP27 18(1)(a) 6. OP36 18 (2) Kenwood 7. OP38 23 (4) 8. OP38 13 (4) of supervision and appraisal records. To protect residents in the event 26/08/08 of a fire, urgent action must be taken to make sure that the door guards in place are regularly tested and are working and that fire doors are not obstructed. To minimise risk to residents, 01/10/08 staff must adhere to food hygiene regulation. 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 OP8 Good Practice Recommendations The home should review the current system of recording all healthcare appointments on one sheet and consider putting them into groups such as community services, specialist support etc. The home should consider having the daily records amalgamated to provide a more holistic view of the residents daily life in the home. The date of opening should be recorded on all liquid medication to enable this medication to be audited and to ensure that medication is not used passed its shelf life. To provide clarity, when codes are used to explain why medication is not given these should be more specific and outline the reason for not administering the medication. To ensure the dignity of residents, care must be taken to provide training and supervision in ensuring that staff address residents appropriately and with respect. A complaints book, which details all concerns raised with staff should be kept so that an audit trail can be kept to ensure all steps to address the compliant can be followed. Regular audits of loose medication should be undertaken to ensure that balances are correct. Staff must also regularly audit the record keeping in the home to ensure that documentation is completed correctly. The fire safety folder should be reorganised and old DS0000010457.V368630.R01.S.doc Version 5.2 Page 27 2. 3. OP8 OP9 4. 5. 6. 7. OP9 OP10 OP16 OP33 8. Kenwood OP38 9. OP38 records archived. The procedure of holding fire drills at the same time of day should be reviewed to ensure that night staff participate in drills at least once per year. Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Kenwood DS0000010457.V368630.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!