CARE HOMES FOR OLDER PEOPLE
Kenyon Lodge 99 Manchester Road West Little Hulton Manchester M38 9DX Lead Inspector
Elizabeth Holt Unannounced Inspection 10:00 2 March 2006
nd 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 Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 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. Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kenyon Lodge Address 99 Manchester Road West Little Hulton Manchester M38 9DX 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) 0161 790 4448 Mr Prabhdyal Singh Sodhi Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (59), Physical disability (1) of places Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home accommodates a maximum of 60 service users requiring either nursing care or personal care only. Minimum staffing levels as specified in the Notice issued by the previous regulating authority on 2nd December 1994 shall be maintained. Staffing levels in accordance with the Residential Forum Guidance for Staffing in Care Homes for Older People shall be maintained for those service users requiring personal care only. One named service user who is out of category by reason of age may be accommodated. Should this service user no longer require their place at the home, or reach the relevant age, the category will revert to old age (OP). The service should at all times employ a suitable and qualified experienced manager who is registered with the Commission for Social Care Inspection. 15th September 2005 5. Date of last inspection Brief Description of the Service: Kenyon Lodge is a registered care home providing nursing care and personal care and accommodation for up to 60 older people. Care is provided to 30 residents assessed as residential care and 30 residents who require nursing care. All residential care beds are located on the first floor. The home is set on its own grounds with a designated parking area and a large secure garden area to the rear with patio area. The home is situated on a main route in Little Hulton enabling easy access to Manchester, Salford and Bolton. Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on the 2nd March 2006. During the inspection time was spent talking to the registered manager, several of the residents, relatives and some staff members. In addition residents files, records and other relevant documentation were examined. Since the last inspection the Commission for Social Care Inspection received one complaint regarding care issues. This was not fully upheld and the home dealt with this in an appropriate way. As this inspection only looked at a limited number of standards the report should be read together with the previous and any future reports to gain a full picture of how the home is meeting the needs of the people living there. What the service does well: What has improved since the last inspection?
Since the last inspection the home had worked to improve the care plans and risk assessments particularly on the nursing floor. Further improvements were required following the identification of shortfalls at this inspection detailed in the section below. Considerable improvements had been made to the recording, handling, safe keeping, safe administration and disposal of medicines received into the home. Accidents in the Care Home must be notified to the Commission without delay. During the previous inspection a requirement was made for staff to receive training in the Protection of Vulnerable Adults. The manager has attended this training and is cascading the information to the staff. Further training in Adult Protection is planned following a review of the local policy.
Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 6 There were no staff vacancies at the time of this inspection and staff commented they were working well as a team. 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. Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 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 Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this inspection visit. EVIDENCE: The core standards were assessed during the previous inspection. Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 10 The care planning documentation and risk assessments require improving to ensure all the residents’ health, personal and social care needs are met. Shortfalls in the documentation have the potential to place residents at risk. Residents felt they were treated with respect and their privacy was upheld. EVIDENCE: Since the last inspection there was evidence of improvement in the care plans on the nursing floor however the risk assessments must be linked to the care plans and the action required must be fully detailed. One example included a resident whose reassessment required her to be transferred from personal care to nursing care. The risk assessments and associated care plans did not allow for an audit trail of the preventative measures put in place. Discussion with the staff suggested that the resident’s needs were being addressed even though the documentation did not fully support this. Evidence of detailed wound care plans was present for residents with wounds and there was evidence of input from the tissue viability nurse specialist.
Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 10 It was pleasing to see that following the deterioration of mobility of one resident; the moving and handling assessment had been updated. Staff spoken to had a good understanding of the care needs of the residents. On the personal care only floor the care planning documentation was basic. The following shortfalls were found in the care plans examined; assessments had not been completed, admission details were not available, for example date of admission, significant weight loss had not been adequately followed up/recorded and risk assessments were incomplete. One resident who had a history of falls, had no record to show the frequency of falls and any associated care plan, updated risk assessment or preventative measures taken. It was of serious concern that the staff on duty were not clear about the procedure or when to refer a resident to the dietician. Charts for the record of positional changes, dietary and fluid balance charts were poorly completed over any 24-hour period. A discussion with the manager and the senior care worker highlighted that since the unit had reopened on the first floor that the staffing levels may require reviewing in order to fully meet the needs of the residents. A requirement was made to review the staffing levels in line with the number and dependency of the residents accommodated. A resident had fallen and was sent to hospital the day prior to the inspection, however the senior carer was not aware that The Commission for Social Care Inspection must be notified of any falls occurring. A requirement was made that The Commission must be notified of accidents in the home. It was pleasing to see that the manager took the concerns seriously and since the inspection has planned further care planning training in March 2006. Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 14 Contact with family/friends/representatives and the local community is generally maintained and encouraged. Residents are helped to exercise choice and control over their lives. EVIDENCE: Families and friends were encouraged to visit the home. The activities coordinator is employed for 30 hours per week. Evidence of planned activities and entertainment was available including plans for the month ahead. Staff spoken to said that where possible they did try to play games, chat and do quizzes. Following a families meeting held in February 2006, minutes were available and the concerns raised planned to be addressed by the manager. Staff gave examples of how they encouraged and promoted residents to exercise choice and control over their lives particularly regarding choice of clothes, meals, participating in activities and rising and retiring times. Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Complaints are handled objectively and residents are confident their concerns will be listened to. EVIDENCE: A detailed complaints procedure was available. The homes complaints record showed “issues” raised and these had been actioned appropriately. Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this inspection visit. EVIDENCE: The core standards were assessed during the previous inspection. Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, and 30 Residents are in safe hands at all times. Staff were encouraged to undertake training to equip them with the necessary skills to meet the needs of the residents accommodated. EVIDENCE: At the time of the inspection the home provided care and accommodation for 24 residents requiring nursing care and 14 residents in receipt of personal care only. Following the concerns raised in standards 7-11 the Responsible Individual and the Registered manager must review how the supervision of the staff and the care delivered is managed on the first floor where personal care only is delivered. Residents and relatives commented that the staff were, “very kind, caring and the girls have a good sense of humour.” At the time of the inspection there were no staff vacancies. Staff commented that they were working well as a team and were observed to have a good rapport with residents and relatives. Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 38 The home is run in the best interests of residents. Some practices do not promote the safety and welfare of the people using the service. EVIDENCE: A questionnaire is available and sent out to residents/relatives on an annual basis. Residents/relatives meetings were held as mentioned earlier in this report. Staff meetings had been held on a regular basis since the new manger has been in post. The manager had planned weekly training sessions with the staff to discuss care planning until ”they get it right.” A resident had fallen and was sent to hospital the day prior to the inspection, however the senior carer was not aware that The Commission for Social Care Inspection must be notified of any falls occurring. A requirement was made that The Commission must be notified of accidents in the home.
Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 16 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x X X X X X X X x STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X x Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 17 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 OP7 Regulation 15 Requirement Care plans must fully identify the needs of the residents accommodated. (The requirement remains outstanding from the 30/12/05). 2. OP8 17 and schedule 3 Risk assessments must be provided in detail to minimise the risks to the health or safety of residents. (The requirement remains outstanding from the 15/12/05). Any accidents in the care home must be notified to the Commission without delay. 26/05/06 Timescale for action 26/05/06 3. OP38 37 20/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kenyon Lodge DS0000006713.V275601.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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