Inspection on 10/01/07 for Kenwyn

This inspection was carried out on 10th January 2007.

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

The inspector 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

Kenwyn 08/02/06

Kenwyn 03/08/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Kenwyn, Crediton Kenwyn Albert Road Crediton Devon EX17 2BZ Lead Inspector Rachel Doyle Key Unannounced Inspection 10:00 10th January 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kenwyn, Crediton DS0000063516.V310134.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. Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kenwyn, Crediton Address Kenwyn Albert Road Crediton Devon EX17 2BZ 01363 772670 01363 772670 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) Welling Ltd Mrs Sandra Anne Northcott Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: Kenwyn is a long established residential care home for older people situated close to the centre of the market town of Crediton. Kenwyn consists of an original 1930s two storey building on split-levels with a modern extension to the rear and a more recent extension on the west side. It became a home for older people during the 1960s. There is level access into the modern extension through the car park entrance. The original building and its extension combine to form a layout which has a ground, mezzanine and first floor. The home has bedroom accommodation on all floors some of which have en-suite toilet facilities. All floors are accessible by passenger lift. The average cost of care is £368-428 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Previous inspection reports are available. Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector undertook this unannounced inspection on November 30th 2007 and Thursday 10th January 2007. The inspection took place over two days as on the first day the manager was unavailable as they were attending a managers’ meeting and therefore some paperwork was not accessible for inspection. The time delay between the two inspection days was due to the festive season and annual leave. There were 23 residents living at the Home and 1 vacancy at the time of the inspection. It was noted that in total there are 4 staff whose first language is not English employed at the Home and that the skill mix on the day of the inspection was very unusual due to the manager’s meeting. During the inspection the inspector case-tracked 3 residents, which helps us to understand the experiences of people using the service. A number of other residents were met and spoken with during the course of the day. The inspector also spent a considerable time observing the care and attention given to residents by staff throughout the Home and in the communal areas and had lunch with residents in the dining room. Several staff were spoken with during the two days, including care staff, ancillary staff, and the manager. Prior to the inspection surveys were sent to relatives to obtain their views of the service provided; 3 were returned. Seven resident surveys were returned, a further resident who received surveys were unable to fill it in. Staff were also sent surveys, 11 were returned. Health and social care professionals were also contacted prior to the inspection including GPs and community nurses. Two were returned. The inspector toured the premises and a sample number of records were inspected which included care plans, medication records/procedures, staff recruitment files, service and maintenance certificates and fire safety records. The manager had completed a pre-inspection questionnaire and the inspector appreciated the preparation undertaken by the manager to assist with this inspection and found staff very helpful on the day. What the service does well: Meals are home-cooked and the menu discussed with residents. All residents said that the food was good and that alternatives were available. Residents said that they felt that they could raise any issues/concerns with the manager. Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 6 The Home has a lovely homely feel and residents are able to be involved in the local community with their friends and relatives. The environment is well maintained and of a high standard ensuring that residents live in comfortable and clean surroundings. Prospective residents are given good information to ensure that their needs can be met and that they can make an informed decision about admission. Medication and finances are well managed. What has improved since the last inspection? What they could do better: There are issues relating to staff communication skills and use of the English language at times to ensure that all residents are listened to and their needs met. Residents’ choices are not always taken into account and although caring, staff are sometimes making parental choices for residents. This does not maintain independence especially in areas of assisting with feeding and mobility. Care plans need to be followed and individual residents’ identified needs made clear including what actions staff should be taking. Health and safety of residents and staff is put at risk by some staff not following recognised safe manual handling practice despite having had training. Improvement should be made around discussion and resident/representative consent for bed rails. Those residents who are able to self medicate should be monitored using an assessment and review system to ensure safe administration whilst maintaining independence. Some staff need to improve the manner in which they care for residents in relation to ensuring that respect and dignity are maintained at all times. Activities are very well organised. Care should be taken to ensure that residents with limited capacity are also included and that their social needs are met in an individualised way. Improvements should be made in the recording of complaints and concerns and staff awareness of these procedures to ensure that all residents/relatives’ Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 7 issues are addressed clearly. The scope of quality assurance questionnaires should be widened. 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. Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from good admission and assessment practice, which ensures that the Home is able to meet their needs. EVIDENCE: All 7 residents who completed the questionnaire felt that they had had enough information to make an informed choice prior to moving in to Kenwyn. There is a comprehensive Service Users’ Guide and Statement of Purpose, which are given to prospective residents. These are also available in all rooms. This includes topics such as maintaining independence, privacy, provision of nursing care from local nurses as necessary and the admission procedure. People are then invited to spend a day at the Home to see if it would be suitable before they make a decision. There are detailed contracts clearly stating the Home’s terms and conditions and obligations of both the resident and the Home. Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 10 A detailed pre-admission procedure is carried out, 3 were seen, and the manager explained how they go out to visit each prospective resident in their home or in hospital to assess their needs. This includes choice of room as able depending on mobility needs. This assessment is then used to formulate the care plan on admission. Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements could be made to care planning records to ensure that staff are fully aware of all residents’ needs and that residents are involved in the care planning process. The health needs of residents are well met with evidence of multidisciplinary working on a regular basis. Medication is well managed at the Home promoting good health. Residents’ privacy is well maintained and promoted by staff at the Home although residents are not always treated respectfully. EVIDENCE: All residents have a care plan, which sets out aspects of their health, personal and social care needs. The manager said that staff have worked to improve care plans but is aware that more needs to be done to make these working Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 12 documents. All three plans looked at contained basic information. However, identified needs and actions which staff need to take are unclear. Statements are not followed up or expanded on, such as a diagnosis stated but not how this affected the resident’s life or why they had certain medication. One plan stated ‘a few falls’ but there was no follow up, ‘aggressiveness’ at times but no detail as to triggers or actions for staff and no details as to why a resident was admitted. Daily records tended to state ‘all care given’ but what care was unclear in the plan itself. Some aspects of the plans were clearly not being carried out by staff. One resident was self-caring but still had a personal hygiene form filled out when the resident could look after themselves. One resident only needs prompting to do tasks but staff were carrying out all care. This resident told the inspector that they could feed themselves but was fed by staff. Another resident was hoisted when they said they could use their frame and the care plan also said that they used a frame to mobilise with assistance from 1 carer. Another resident was rushed to finish a task when the plan stated ‘to maintain independence themselves’. However, medical professionals visit records were good, including test results and health care was obtained appropriately. All residents felt that their health care needs were met. Risk assessments were good such as ‘at risk from hot taps’ and describing what should happen to minimise risk. All plans had monthly reviews but no resident felt that they had been involved in the planning process. The District Nurse visits the Home every day. Staff were attentive to some personal care needs, such as making sure residents were warm enough. There were excellent social and activity records. Residents had positive comments about the Home in general. One resident knew that the Home was good and was very happy. This resident was independent and enjoyed their freedom. One resident said that they were very fortunate to be at the Home and felt well looked after and pampered by lovely girls. Another resident liked to potter about and had no complaints about the care. Medication administration was looked at and there are good medication records and storage. There is a clear Homely Remedy policy, which had been discussed with local GPs. Staff are about to attend further medication training. Records include resident identification and staff were seen to ensure that residents took their medication before staff signed to confirm this. Medication is well managed. In general residents felt that their privacy was maintained although two staff did knock and enter a room whilst the inspector was chatting to a resident, without waiting for a reply. Residents are able to have telephones in their rooms if they wish and post is delivered unopened. Staff on duty were often seen to treat residents kindly but in a ‘parental’ way by not promoting independence such as not waiting for residents’ answers to questions. Excessive endearments were used other than residents preferred names and tasks were often done for residents when they were able to do Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 13 them themselves, which does not maintain dignity or promote independence. One resident felt that they were given orders. Some care was very rushed and two residents were ignored when they were asking for staff to help, one told to wait until after lunch. However, staff were always kind and obviously cared about the residents. Language used in care plans suggested that residents were ‘done to’ such as ‘got her out of bed’, ‘took her to lounge’, ‘sat her in chair’. Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general social activities are well organised and ensure that all residents’ social needs are met. Residents are not always encouraged to maintain their independence or helped to exercise control and choice over how they spend their day. Menus are varied and healthy and meet residents nutritional needs but improvements in how some residents are helped with their meals will promote their independence and dignity. EVIDENCE: The Home has excellent records of the activities undertaken by residents. There are external activities organised such as singers, tranquil moments, and topical entertainment such as carol singers. One carer organises regular activities with input from other carers. These are well thought out and individualised. Items include a Christmas party, quizzes, bingo, art classes, poetry and newspaper reading, help to write and other one to one sessions. Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 15 Residents were enjoying card making during the inspection. One staff member told the inspector how they had organised a Ukrainian culture day to inform and entertain residents with music and culture from the country. Residents said that they did enjoy the activities on offer. Staff also take some residents out to exhibitions, the park and library. Other residents are able to go out by themselves. Families and friends are welcome at all times. The Home is very much a local home and staff also include residents in local events or family events such as weddings. One resident with deteriorating communication skills had minimal interaction from staff, other than being told to sit down and spent much of the inspection walking about the Home anxiously. Thought needs to be given to how this resident’s needs are met. The Home had tried hard to meet one resident’s complex social needs and were persevering in a sensitive way. The inspector took lunch with residents, most of whom attend the dining room although meals are possible where they wish. Tables are well laid up and there are plenty of condiments. The food was tasty and hot and seconds were offered. Tea and a fruit basket is offered later. All residents said that the food was good as did relatives. However, the way in which staff assisted residents who needed some help to eat their meals was not always appropriate or sensitive. One staff member put spoonfuls in three residents mouths as she went past. Staff did not always follow care plans, for example, one resident was fully assisted with their meal whilst their care plan said that they could manage themselves with one to one help with eye contact and patience. Instead staff were seen to take over this task. Another resident had their spoon taken from them in silence and was then given their meal. Spoonfuls were too big and rushed. Residents were stood over whilst eating. One resident could hold a piece of fruit and eat but the staff member held it for them. The plan said ‘prompt only’. Residents said that they were given choice relating to when they had their baths or when they got up or went to bed. However, those residents with limited mobility or capability were not seen to be offered clear choices by staff. This related to whether they wanted a blanket on their lap, where they wanted to sit, if they wanted help with feeding or their meal and commands were given in an abrupt way. Comments by staff included ‘no, no, no’, ‘sit here please’ and ‘shush, shush’. Some residents’ requests were not heard or ignored by staff, who rushed past and plates were cleared without waiting to see if residents had finished their meal. Kenwyn, Crediton DS0000063516.V310134.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 good. This judgement has been made using available evidence including a visit to this service. Improvements could be made in the recording of complaints although residents felt confident that they can raise any issue of concern, which will be acted upon. Residents are protected from harm or abuse as sound procedures and practices are in place other than in one small area. EVIDENCE: The Home has a comprehensive complaints policy, which is available on the notice board and in the Statement of Purpose. However, on the day of the inspection staff were not aware of the complaints process and did not know how or where complaints/concerns were recorded. The Home does not have a working complaints book, the last complaint recorded being 2005. The Home currently only records official written complaints, which means that verbal or smaller concerns may not be followed up properly. All residents felt that they could talk to most staff about any issues of concern (although see staffing for communication issues) and especially the manager. The Home has a comprehensive Protection of Vulnerable Adults (POVA) policy, which staff sign to say that they have read. This includes the correct procedure for informing other agencies and documentation and whistle blowing. The Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 17 Home has the Alerters’ Guide, which is the official local guide advising staff of what to do if abuse is suspected. Training files were looked at as at the last inspection and the majority of staff have attended POVA training and had completed follow up competency questionnaires, including institutional abuse topics and subtle abuse. Staff were aware of POVA issues and restraint. Two staff questionnaires stated that they were not aware of POVA issues but the manager said that all staff also complete competency questionnaires following training and some were seen to have been filled in. Those residents using bed rails had risk assessments in their care files but as at the last inspection these were signed by staff rather than a multidisciplinary decision involving the resident and representative as appropriate or records as to why this may not be possible, i.e. mental capacity. This should be done to ensure safe use of bed rails. Kenwyn, Crediton DS0000063516.V310134.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 good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is high, providing residents with an attractive, safe and clean place to live. EVIDENCE: The Home has a large entrance hall with new comfortable chairs near a fish tank. The décor throughout is of a high standard in neutral colours. There is a large conservatory area on the ground floor overlooking the town and hills beyond. This leads into a dining area, which is also used as an activity area. Upstairs is a television lounge. There are 11 single bedrooms and a further 10 with en-suite facilities and 2 double rooms, 1 en-suite. The inspector looked at the majority of residents’ rooms. All were decorated to a good standard, many with new bedroom furniture and personalised as residents wished. Each room has a smart new Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 19 name-plate. All residents have been offered keys to lockable storage in their rooms and most rooms have an appropriate locking devise, to which residents may have a key. The Home was clean throughout. The Home employs 2 domestics and residents confirmed on the day that the Home was kept clean and hygienic as did all the returned questionnaires. The commode use policy is clearly displayed in the laundry, where staff use the large sink to clean commodes. Staff also have a copy. Residents had no complaints about how their laundry was looked after and the laundry room was tidy and well equipped. There were plenty of gloves and paper towels available and waste is disposed of appropriately, meaning that residents and staff are protected from risk of infections. Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not always benefit from having skilled and experienced staff who have a good understanding of their needs, although staff are friendly and work in sufficient numbers. The procedures for the recruitment of staff are robust to provide adequate safeguards to people living at the Home. EVIDENCE: On the day of the inspection the manager was attending a meeting outside the Home and it was the team leader’s first day as team leader. They were being supported by another team leader from one of the group’s Homes for the day. On duty with her were 2 carers, 2 domestics and 1 cook. There are 10 carers employed in all, 7 seniors, with a maintenance man, 2 cooks and 4 domestics. Staffing numbers on the rota appeared to be appropriate for the dependency of current residents. All four staff on duty at the time of the inspection were staff whose first language was not English. The Provider has assured CSCI that this is not usual practice and will not happen in future. The manager is usually very aware of the importance of satisfactory skill mix within the staff duty rota. Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 21 Although staff were seen to interact with residents, this was at times very limited, unclear or unproductive with care being given which was not according to care plans. For example, instructions during tasks were spoken briefly, softly or over a resident’s head or too fast meaning that residents did not have their needs met as a partnership but were seen to be ‘done to’. One resident said that some staff were ‘bossy, although they do things in a nice way’ and other residents raised their eyebrows to each other whilst watching another resident being attended to, who was obviously not sure what staff wanted them to do. Resident questionnaires raised the issue of a need for improved communication, saying that staff did listen to what they wanted in general but ‘not always’, ‘the staff are very good but not perfect’ and ‘sometimes good’. Staff on duty were unable to assist the inspector with gathering paperwork such as the accident book, contracts, complaints book, monies, assessments, medication records or training records. One health professional response was that ‘community staff are concerned about these staff being left in charge at times as the community team have had problems communicating’. They felt that information about residents was not always understood. When discussing this issue with the manager they assured the inspector that all relevant staff were attending English language courses outside the Home with a recognised body. They were aware of the issue as the Home’s quality assurance residents’ survey had also raised communication problems. Observation showed that issues remain. However, it was obvious that staff were kind to residents and were trying to look after them in a caring way. One relative said that staff looked after residents well and that the Home was clean and the menu good. Staff felt that they were providing a welcoming and friendly service and there was a homely atmosphere at the Home. One staff member was happy to work in a home with a lovely atmosphere and felt that management were supportive. All residents praised the manager and thought she was ‘lovely’. Three staff recruitment files were looked at and all contained the required documentation to ensure residents’ safety such as work permits and criminal bureau checks (CRBs). All staff felt that the provision of training was very good especially since the new provider had acquired the Home. Over 75 of care staff have achieved the National Vocational Qualification (NVQ) award at level 2 or equivalent, which meets recommendations. Five staff hold a first aid certificate and one is always on duty. All staff have attended a wide range of training and the manager said that there is a good training budget. A mandatory staff training matrix showed that all staff were up to date. Other training attended includes communication skills, challenging behaviour and dementia care. The manager chooses monthly topics and these are discussed in staff meetings. (however, see Management section relating to manual handling training outcomes). Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some practices do not promote and safeguard the health and safety of residents putting them at risk of harm. Residents’ financial interests are safeguarded. The residents and staff benefit from good leadership although this does not always ensure consistent care. EVIDENCE: Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 23 The manager said that they felt well supported by the managing director of Welling Ltd, the Home’s provider. There are regular managers’ meetings with other Home managers in the group. The Registered Provider also sends Regulation 26 monthly audits to CSCI and the Home has a Quality Assurance system. This is currently underway with the manager auditing responses. These can be returned anonymously if residents wish. The form notes if staff have assisted residents to fill it out if residents were unable to manage themselves due to disability or if no family were available to help them at the time. Topics include, care, staff, meals and activities. This will be collated and a summary sent to CSCI as per the National Minimum Standards. It is suggested as at the last inspection that a questionnaire also be sent separately to relatives, especially if residents need assistance to fill them in and also to relevant external health care professionals. Records of residents’ monies were looked at. Three pouches were checked and all were correct with clear itemised records and receipts. The Home is not an appointee for any resident who have private arrangements and there is an invoicing system which ensures that no resident goes without. Monies are now organised by an administrator. All rooms have lockable storage as residents wish. Practices for the health, safety and welfare of residents was looked at. In general residents are well protected. All appropriate fire doors now have automatic door closers fitted and the fire checks and equipments checks were all up to date including staff fire training sessions with competency questionnaires completed following training. There are window restrictors and radiators are covered. The Home is insured appropriately and has correct registration certificates. However, although all staff have undergone mandatory training, staff on duty were all seen to use inappropriate methods of manually handling residents. This included poor communication of instructions and pulling residents up by two hands from a chair. Also staff were seen using the same technique to swivel an anxious resident around to transfer and using a hoist when the resident was capable of using a zimmer frame as per the care plan. One staff member was also seen pulling a resident by two hands and walking backwards to the toilet. These are not approved or safe methods and puts residents and staff at risk. Kenwyn, Crediton DS0000063516.V310134.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 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 1 Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? no 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 OP27 Regulation 18 (1) (a) (c) Timescale for action You must ensure that at all times 10/03/07 there are suitably qualified, competent and experienced persons working at the Home as are appropriate for the health and welfare of residents. You must ensure that all staff receive training appropriate to the work they are to perform. (Not all staff on duty have skills, which enable them to meet residents’ needs). You must ensure that so far as 10/03/07 practicable residents are enabled to make decisions with respect to the care they are to receive and their health and welfare. Proper provision must be made for residents health and welfare taking into account their wishes and feelings. This refers to choice for residents. You must ensure that the Home 10/03/07 has made suitable arrangements to provide a safe system for moving and handling residents. (see textbox) Requirement 2. OP14 12 (2) (3) 2. OP38 13 (5) Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that records clearly state action plans for all residents’ needs such as mobility, communication and that staff are aware of the contents of the plans and follow the appropriate actions. Residents/representatives should be involved in the planning process. It is recommended that all residents who may wish to self medicate are clearly assessed and reviewed to ensure their safety whilst maintaining independence. It is recommended that staff are aware of residents preferred names and that they are treated with dignity and respect maintained at all times. It is recommended that all residents’ social and leisure needs are met in ways appropriate to their capacity. This refers to stimulation and interaction for residents with poor communication skills. It is recommended that staff offer assistance with eating with sensitivity, discreetly and individually and ensure that independence is encouraged as long as possible. It is recommended that there is a clear method of recording concerns and verbal complaints and that staff are aware of the process to ensure that all residents needs are addressed properly. It is recommended that any decisions relating to the use of bed rails are clearly discussed and documented with the multidisciplinary team and include the resident/representative as appropriate. This is carried over from the last inspection. It is recommended that quality assurance questionnaires are also sent separately to relatives/representatives and relevant health professionals to obtain a wider view of their opinions of the service. 2. 3. 4. OP9 OP10 OP12 5. 6. OP15 OP16 7. OP18 8. OP33 Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Ashburton Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 Kenwyn, Crediton DS0000063516.V310134.R01.S.doc Version 5.2 Page 28 - 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. 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