Inspection on 15/11/07 for Kesteven Grange

This inspection was carried out on 15th November 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kesteven Grange 17/11/08

Kesteven Grange 09/11/06

Kesteven Grange 21/12/05

Kesteven Grange 11/08/05

Kesteven Grange 09/11/04

Kesteven Grange 06/07/04

Kesteven Grange 11/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Kesteven Grange Kesteven Way Kingswood Kingston upon Hull East Yorkshire HU7 3EJ Lead Inspector Eileen Engelmann Key Unannounced Inspection 15th November 2007 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 Kesteven Grange DS0000031929.V355129.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. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kesteven Grange Address Kesteven Way Kingswood Kingston upon Hull East Yorkshire HU7 3EJ 01482 837556 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) www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited Position Vacant Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Old age, registration, with number not falling within any other category (54) of places Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit four named service users, aged under 65. Date of last inspection 9th November 2006 Brief Description of the Service: The home is registered to provide personal care and accommodation for 54 people of either gender over the age of 65, some of whom may also suffer from dementia. This also includes up to 4 people under the age of 65. Kesteven Grange is a purpose built home situated on a large residential estate on the northern outskirts of the city of Hull. The home has 46 single and 4 double bedrooms. Four bedrooms have en-suite facilities (toilet and wash hand basin). There is a large lounge and separate dining room on the ground floor and a large lounge/dining room on the first floor. There are a number of bathrooms and toilets throughout the home and a passenger lift to access the first floor for people unable to use either of the two stairways. Office accommodation, the kitchen and laundry are all on the ground floor. Outside is a large garden with a fenced seating area for people to enjoy in the good weather. A patio area, which is securely fenced, has been created outside the main lounge. This is the place people using the service go to smoke. Regular bus services stop near the home and local community facilities are a short drive away. The home has a large car park for visitors. Information about the home and its service can be found in the statement of purpose and service user guide, both these documents are available from the manager of the home, and copies are on display in the entrance hall of the home. The latest inspection report for the home is available from the manager on request. Information given by the manager during this visit indicates the home charges fees from £293.50 to £452.00 per week depending on the care needs of the people wanting to come in and the source of funding. People will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last key visit in November 2006 there has been a change of manager within the home. At the moment there is an acting manager in post who is waiting to be registered with the Commission for Social Care Inspection. For the purposes of this report she is referred to as the manager throughout. This unannounced visit was carried out with the manager, staff and people living at Kesteven Grange. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files and records relating to the service. One hour was spent observing the care being given to a small group of people. Informal chats with a number of people and staff took place during this visit; their comments have been included in this report. Information has been gathered from a number of different sources since the last key visit to the home in September 2006, this has been analysed and used with information from this visit to reach the outcomes of this report. Questionnaires were sent out to a selection of relatives, people using the service and staff and their written response to these was poor. We received 3 back from relatives (15 ), 4 from staff (20 ) and 0 from people using the service (0 ). The manager completed an Annual Quality Assurance Assessment and returned this to the Commission within the given timescale. What the service does well: All of the people living in the home were positive about the home and like living there. Three people said they loved living at the home and the care was very good. The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The people working in the home want to make sure that the people who live in the home receive good care. People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The person who owns the home must make the statement of purpose and service user guide better by putting more information into it. People living in the home said that the staff are very good at talking to them and they felt comfortable talking about the service and their needs. The person who owns the home must make sure that the contract given to people who pay for their own care has enough information in it to tell the people living in the home how much they have to pay to live there and how much extra services cost. People working in the home must make sure the information in the care plans shows the life history of those coming into the home, so activities and the care to be given reflects the needs, interests and likes or dislikes of each person using the service. The people working in the home should be talking to the residents more to find out what they like and how they want to be looked after. This helps the residents to have choice in how they are cared for and helps them stay as independent as possible. People working in the home must make sure that the way they record and give out medication gets better. At the moment the way they do this is not safe and could put the people who live in the home at risk. People in the home who have dementia or sensory disabilities must be given a better choice of social activities to keep them happy and able to join in with others. The person who owns the home must make sure there are enough staff on duty at all times (day and night) to meet the needs of the people using the service. People working in the home need to continue to go to different training sessions, which will help them understand more about the different needs of the people using the service. This will make the service better as people working in the home become more confident in what they do and how they do things. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 7 We would like to thank everyone who completed a questionnaire and/or took the time to talk to us during this visit. Your comments and input have been a valuable source of information, which has helped create this report. 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. Kesteven Grange DS0000031929.V355129.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 Kesteven Grange DS0000031929.V355129.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, 2, 3, 4 and 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. EVIDENCE: The Statement of Purpose and Service User Guide are on display in the entrance hall and copies are available from the manager. The information in the Statement of purpose needs updating in a number of areas, including the categories of care provided in the home, the specialist training that staff receive to meet the needs of people using the service and the change in management personnel. The Service User Guide needs to include the price of fees and the statement of terms and conditions must include the costs of additional services. Discussion with the manager indicated the amendments would be completed within the next two weeks and a copy of the reviewed documents sent on to the Commission for Social Care Inspection. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 10 Information from the surveys shows that the majority of people received sufficient information to make an informed choice about the service before accepting the placement offer. These individuals have also received a contract/statement of terms and conditions from the home. Each person has their own individual file and four of those looked at had a need assessment completed by the funding authority or the home before a placement is offered to the person. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the person and their family. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Discussion with four people showed that they were satisfied with the care they receive and have a good relationship with the staff. Observation of the dementia unit during the middle of the day showed that staff understanding of dementia care and interaction with individuals could be improved. There were also examples seen of good communication with individuals and clearly there is a warm and caring atmosphere within the home. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, and have access to a range of more specialised subjects that link to the needs of people using the service. A number of people using the service have dementia needs and staff have undergone a one day training course in dementia, but this may not be sufficient to give them a good, clear understanding of dementia, what the different types of dementia are, how they affect people and how they can help people with dementia’. Discussion with the manager indicated the company has recognised the need to improve the specialist training within the home and is planning more comprehensive dementia training for the staff. Information from the Annual Quality Assurance Assessment and discussion with the people living in the home indicates that the majority of the people are of white/British nationality, and there are a number of people with different faiths and religions. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 11 The staff group are White/British although people from overseas have been employed in the past. People using the service are unable to make a choice of staff gender when deciding whom they would like to deliver their care, as the home has no male care staff due to a lack of suitable applicants. The manager said that she would discuss this with people wanting to use the service during the assessment process. The employment records show that the manager is using a selective approach to recruitment; ensuring new staff have the right skills and attitude to meet the needs of people in the home. The home does not accept intermediate care placements so standard six is not applicable to the service provided. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of staff recording within the medication system is not satisfactory and may put peoples’ health and welfare at risk. EVIDENCE: The care of four people was looked at in depth during this visit and included checking of their personal care plans. The content of the plans is very task orientated, and does not explore fully the personal wishes or needs of the people living in the home. The plans would benefit from additional information about the individuals abilities, strengths, weaknesses, personal preferences, likes and dislikes. Some effort has been made to ensure that a life history of each individual is in place, but a number of these were not detailed enough to give a picture of the person at the centre of the plan. Until recently some of the care plans and risk assessments within them had not been evaluated on a monthly basis. The manager has taken action to make sure this practice is improved. However the evaluation process does not include the views and opinions of the person whose care is being reviewed. This was discussed with Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 13 the manager and she said she would look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. There is a yearly formal review process for the care of people using the service with the funding authorities and family (where the person receiving care consents to this). However checks of the care plans indicate this may not be up to date and the formal review process must be extended to include people who fund their own care. Information from the surveys indicates that the people who responded are satisfied that the staff give appropriate support and care to those living in the home. People spoken to said they are able to make their own decisions about their daily lives most of the time; that staff treat them well and listen and act on what they say. One relative commented that ‘ the staff contact me if my relative has a fall or becomes ill, they get the doctor out when needed and keep me informed’. Responses to the surveys indicated that people and their relatives are satisfied with the level of medical support given to the people living at the home. Three people said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. People have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Checks of the medication show the home is using Boots the Chemist as their pharmacy supplier and their MDS system of medication is in use. Observation of the medication records show that there are some areas of practice that need to improve and these include: • There are a number of missing signatures where staff who have given out medication have not signed on the record sheet. • Not all medication has been signed into the medication record sheet and this makes auditing supplies difficult. • Where staff are hand writing medication onto the sheets (transcribing), they are not following best practice. Staff must include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. • It was noted that medication already held in the home when a new medication sheet is started is not added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out (this is a good practise measure). • On checking the Controlled Drug register it was noted that staff are not always writing in where medication has been picked up by the pharmacy, so pages show medication in stock when it has been returned. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 14 • One medication in the Controlled Drug Register was incorrectly entered as 12mcg strength when in fact it was 25mcg. A number of staff have signed this medication out and no-one realised that the strength recorded was wrong. The recipient of the medication was at no risk as the medication was the correct prescribed strength, but staff practices could place others at potential risk of harm, as they clearly are not checking the strength of medication when administering it to people using the service. When brought to the attention of the manager, immediate action was taken to correct the records, obtain refresher training from Boots the Chemist for all staff and arrange a staff meeting to discuss the poor practice. It is recommended that the manager audit the medication records on a weekly basis to ensure that accurate records are kept and staff practice is improved. People and relative comments show they are very satisfied with the care and support offered by the staff. Chats with people using the service revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 15 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 and 15. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People with dementia or sensory impairment are provided with a limited choice of social events, giving them little opportunity for stimulation or recreational activities to suit their interests or abilities. Improvements are needed to the staff practices at mealtimes on the dementia unit. To ensure people are offered meals and fluids in a way that promotes the individual’s dignity and independence. EVIDENCE: Discussion with three people indicates that they enjoy the activities on offer within the home and attend whenever possible. One person said she particularly likes going out with her family or on trips arranged by the home, and that she keeps herself busy with quizzes, word searches, television, bingo and chatting to others living in the home. The home has an activities co-ordinator who organises and runs a weekly programme of social events; information about this is on display in the reception area. Entertainers from outside to the home are booked on a regular basis to come in and perform for people. Meetings for people using the service and their relatives are held every 4-6 months; these are used as an Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 16 opportunity for individuals to express their ideas of what activities and trips out they want and to give their feedback on events that have taken place. Records are kept of all the social interactions going on in the home and evidence seen at this visit indicates that people are encouraged to celebrate Christian events such as Birthdays, Easter and Christmas. Time was spent observing a small group of people during this visit and it was seen that a number of individuals spent time asleep in their chairs and others just sat watching the daily routines of the home. Staff did talk to individuals as they passed through the room, and in the morning the activity co-ordinator was making Christmas decorations with one individual. However, for those people who have communication difficulties there was little interaction other than when staff asked them a question at lunchtime around their choices of meal and drinks. The lounge/dining room is decorated in different themes and there were a number of soft toys and objects for people to hold and use, however these were all tidied away in a corner of the room and showed little signs of ever being brought out and given to individuals. The registered provider must ensure that appropriate activities are provided for those people with dementia and sensory impairment so they can enjoy social stimulation and interact with others in the home. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family or staff would take them into the town. Visitors were seen coming and going during the day, staff were observed making them welcome and there clearly was a good relationship between all parties. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. There are meetings where the viewpoints and opinions of those living in the home can be expressed and the management team will listen and take action were needed. Visitors said they are kept informed of any important issues affecting their friend/relative and felt that staff did a good job of supporting people to live the lives they choose. There is a range of information and advice on different matters including, advocacy and individual’s rights. This is kept in a folder in the manager’s office and is available on request. It is recommended that advocacy information is put out on display so people and visitors have easy access to it. People in the home were very complimentary about the food being served at the lunchtime meal. Individuals were seen to have good appetites and enjoy the food on offer. Those on the residential unit said ‘the meals are lovely’, ‘food is excellent’ and ‘there is a good choice available at every meal’. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 17 Observation of the lunchtime meal on the dementia unit showed that some staff practices around serving of meals could be improved. The meals came up to the unit in a ‘dumb waiter’ on covered plates. Although there was a hot trolley on the unit the staff did not use this, but put the meals onto a spare dining table. Meals going out to people in their bedrooms, who needed assistance with eating and drinking, were put onto a trolley. As staff assisted people to eat, the remaining meals stayed on the trolley going cold. There was a lack of tables for those people eating in the dining room, who did not come to the main dining tables. Staff were observed sat next to people, balancing the plates on their knees whilst assisting people to eat. These people were not offered a drink or napkin although some were using protective aprons over their clothes. One relative commented in the survey that ‘staff should allow people more opportunity to obtain drinks when they are unable to do this for themselves’. We observed that there were no jugs of juice or glasses of fluid available on the unit except those specifically poured during the mealtime. These concerns were discussed with the manager who said she would look into them and talk to the staff about how practices could be altered to give a better service. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 18 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 and 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples’ views are listened to and acted upon. Staff have good knowledge and understanding of Safeguarding of Adults policies and procedures, which protects people from abuse. EVIDENCE: Checks of the records in the home showed that there have been four formal complaints made to the service since the last inspection. These involved issues around staffing levels, the care provision and missing personal items. The manager has investigated each problem and taken appropriate action to resolve the matters. Her written responses to the complainants are kept on file. People who spoke to us have a clear understanding about how to make their views and opinions heard and three people said ‘the manager comes round every day to see us and will discuss any problems at this time’. Relatives are aware of the complaints procedure and are confident of using it if needed. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 19 The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of resident’s money and financial affairs. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. The staff have received training in Safeguarding of Adults (50 ), management of challenging behaviour (83 ) and basic dementia care (83 ). The manager is aware of the need to provide all staff with safeguarding of adults training and plans to book further training sessions in the near future. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 20 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 and 26. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of environment within the home is good, providing people with a comfortable and homely place to live. EVIDENCE: We walked around the building and found it satisfactory and suitable to two units, one for dementia people and one for older people with personal care needs. The home has an ongoing maintenance and refurbishment programme and the manager was able to show the inspector work that has been completed since the last visit in November 2006 and discuss work that is planned for the next year. The residential unit on the ground floor has one main lounge with a Bar area that is open on Wednesday afternoons and weekends. A door from this area Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 21 leads onto an outdoor paved area, used by people living in the home who smoke. Bathrooms throughout the home are locked, this is for security and also because there is a problem with tiles coming off the walls. The company is aware of this problem and is taking action to replace the damaged areas through its maintenance programme. The dementia unit is on the first floor and is accessible by a passenger lift or two staircases. The lift doors are in need of painting and the lounge carpet is stained and needs cleaning or replacing. In response to people’s requests for showers, the company is creating a shower room from one of the bathrooms on this unit. Other bathrooms have fixed hoists to offer assisted bathing. Plans are in place to update the outside environment and create more person friendly areas, for people to relax in and enjoy the outdoors. Ivy is being removed from the external walls, and relatives and volunteers are planning to create better garden areas over the next year. Overall the environment is clean, warm and comfortable with few malodours present. Discussions during this visit indicate that people using the service find the home to be spotlessly clean and are satisfied with the laundry service provided by the home. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 22 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 and 30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are insufficient numbers of staff, to ensure the needs of the people within the home are met. EVIDENCE: Comments from the relatives and people using the service indicate that the home is extremely busy at times and individuals may wait for attention at peak times, but the friendly attitude of the staff and their willingness to help make up for this. At the last visit in November 2006 a requirement was made that ‘The Registered Provider shall ensure that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. The recommended Residential Staffing Forum figures should be adhered to’. Checks at this visit show that there is still some work to do to ensure enough staff are on duty to meet the residential staffing guidance. The requirement will remain in this report. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 23 At the time of this visit there were 51 people in residence, 30 on the dementia unit and 21 on the residential unit. The staffing rota showed that the following staffing levels are in use 7am to 7pm – 7 care staff are on duty 7pm to 7am – 4 care staff are on duty Information from the Annual Quality Assurance Assessment about the number of staffing hours provided, and information gathered during the inspection about the dependency levels of the people using the home, was used with the Residential Staffing Forum Guidance and showed that the home is around eighty hours short of the recommended guidelines. We discussed our concerns about only having four staff on duty at night given that the shift started at 7pm when many people will want to go to bed or be needing attention. The manager and operations manager told us that they would look at the staffing levels and try to ensure enough staff are available at the peak times of activity within the home. There is an induction course for new members of staff, and 31 of the care staff have achieved an NVQ 2 or 3, with 6 working towards this award. A recommendation in the last report (November 2006) said that ‘The Registered Provider should make sure all staff undertaking NVQ level 2 complete it, to achieve a minimum of 50 care staff with the award’. This recommendation will remain on this report. The home provides a mandatory staff-training programme and this includes some more specialised training to help staff develop their skills and knowledge around pressure care, dementia awareness, customer care, and care planning. Information from the staff training files and training matrix indicates that the majority of the staff are up to date with their basic fire safety training (100 ), food hygiene (90 ), medication (100 ), moving and handling (88 ) and COSHH safe working practice training (98 ), but some need to attend training and/or updates on health and safety (55 ), safe guarding of adults (50 ) and infection control (68 ). Discussion with the manager indicates she has plans in place to book additional training sessions for staff and the company is working on introducing a more robust training programme for dementia care called Yesterday, Today and Tomorrow. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 24 The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 25 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 and 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home reviews aspects of its performance through a programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: The acting manager has been in post for six weeks and is in the process of applying for registration with the Commission for Social Care Inspection. She is doing her Registered Manager’s Award training and has access to management training through the company’s training department. Staff told us that ‘the new manager is very supportive and is always available to give advice and help if needed’. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 26 People we spoke to who use the service are positive about the management within the home and individuals said ‘the home is well run and we can talk to the staff or manager at any time if we have a problem’. The home has achieved the local councils quality award (QDS) parts one and two. Meetings for people using the service are held on a regular basis and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that they are able to express ideas; criticisms and concerns without prejudice and the management team will take action where necessary to bring about positive change. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager completes in-house audits of the home and its service on a monthly basis, and the responsible individual does spot checks and completes the regulation 26 visits. A copy of the monthly visit is available within the home for inspection. Feedback is sought from the people using the service and relatives through regular meetings and satisfaction questionnaires, and the manager is producing an annual development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. The importance of the Commission’s document called Key Lines Of Regulatory Assessment (KLORA) was discussed with the manager, and how it is used in the inspection and report writing process. Checks of the finance systems within the home found that computerised records are kept for people’s personal allowances; the administrator on a daily basis up dates these. Information from the Annual Quality Assurance Assessment indicates the majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the person’s individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 27 Staff have received training in safe working practices or are due to attend later in the year, and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 28 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 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 4, 5 Schedule 1 Requirement Timescale for action 01/02/08 2. OP1 5(b)(c) Amended regulations 2006 3. OP4 18 (1)(c) The registered provider must produce and make available to people an up to date statement of purpose and service user guide. So people receive enough information about the service and facilities to know if the home can meet their needs, before they decide to accept a placement. The registered provider must 01/02/08 ensure the homes service user guide meets the criteria of Regulation 5 of the Care Home Regulations and includes the information asked for in The Care Standards Act 2000 (Establishments and Agencies)(Miscellaneous Amendments) Regulations 2006 (for Regulation 5), which came into force on 1st September 2006. This is so people know how much they have to pay for their care, what they are getting for their money and the cost of any additional extra services they may wish to purchase. The registered provider must 02/03/08 DS0000031929.V355129.R01.S.doc Version 5.2 Kesteven Grange Page 30 OP30 make sure that staff receive appropriate training about dementia. This will make sure that they have a good clear understanding of dementia, what the different types of dementia are, how they affect people and how they can help people with dementia. The registered provider must make sure that the care plans are detailed and individual to the person they are about, putting the person at the centre of it, and giving a picture of who they are as well as what their needs are and how to met them. The plans should meet relevant clinical guidelines produced by professional bodies concerned with the care of older people and those with dementia. This will make sure that staff have access to information that will help them to provide person centred care and support. Accurate records must be kept of all medications, received, administered, leaving the home or disposed of to ensure there is no mishandling. The registered provider must make sure that medications in the custody of the home are handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society, the requirements of the Misuse of Drugs Act 1971. To make sure people receive their medication correctly and their health and safety is not put at risk. The registered provider must ensure that appropriate activities DS0000031929.V355129.R01.S.doc 4. OP7 15 01/02/08 5. OP9 17 01/01/08 6. OP12 16(2)(m) (n) 01/02/08 Kesteven Grange Version 5.2 Page 31 7. OP27 18 are provided for those people with dementia and sensory impairment so they can enjoy social stimulation and interact with others in the home. The registered provider must ensure there are sufficient staffing numbers and skill mix of staff to meet the assessed needs of the people, the size, layout and purpose of the home at all times, and additional staff are on duty at peak times of activity during the day. So people can enjoy a good quality of life and be confident that their health and social care needs will be met. (Given timescale of 28/02/07 was not met) 01/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP7 Good Practice Recommendations The manager should look at how staff could use a variety of different and creative methods to help people using the service to contribute to their own care plan. The manager should make sure that formal care reviews with the person receiving the service, the funding authority (where applicable) and the persons family or representative are in place and up to date. The manager should make sure that where staff are hand writing medication onto the sheets (transcribing), they include the amounts of medication received or brought forward, and have two staff sign the entry to indicate they have both witnessed that the information on the sheet is correct. DS0000031929.V355129.R01.S.doc Version 5.2 Page 32 3. OP9 Kesteven Grange 4. OP9 5. 6. 7. OP9 OP14 OP15 8. 9. OP18 OP19 10. 11. OP28 OP31 Staff should ensure that medication already held in the home when a new medication sheet is started is added to the supplies on the medication record sheets. This should be done so as to ensure a running total is available at all times and an audit of stock is easy to carry out. The manager should audit the medication records on a weekly basis to ensure that accurate records are kept and staff practice is improved. The manager should put advocacy information on display so people and visitors have easy access to it. The manager should ensure that staff practices at mealtimes improve and that food and drink is served to people in a way that promotes the individual’s dignity and independence. The manager should make sure that all staff receive training in safe guarding of adults procedures before the end of June 2008. The registered provider should consider the following areas for refurbishment: • The lift doors are in need of painting • The dementia unit’s lounge carpet is stained and needs cleaning or replacing. The registered Provider should make sure all staff undertaking NVQ level 2 complete it, to achieve a minimum of 50 care staff with the award. The registered provider should ensure the manager is registered with the Commission for Social Care Inspection by April 08. Kesteven Grange DS0000031929.V355129.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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