Inspection on 23/05/07 for Kestrel House

This inspection was carried out on 23rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Kestrel House 06/10/09

Kestrel House 14/04/09

Kestrel House 15/04/08

Kestrel House 18/04/06

Kestrel House 17/10/05

Kestrel House 10/05/05

Kestrel House 08/11/04

Kestrel House 25/05/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Kestrel House 220 Willingdon Road Eastbourne East Sussex BN21 1XR Lead Inspector Elizabeth Dudley Key Unannounced Inspection 23rd May 2007 09.30a 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 Kestrel House DS0000014006.V337498.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. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kestrel House Address 220 Willingdon Road Eastbourne East Sussex BN21 1XR 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) 01323-431199 01323 649420 potterde@bupa.com ANS Homes Limited Debra Mary Potter Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54) of places Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is fiftyfour (54). Service users must be older people aged sixty-five (65) years or over who are chronically ill and in receipt of NHS Continuing Care Services. To provide care to service users aged between eighteen (18) and sixty-five (65) years who are chronically ill and in receipt of NHS Continuing Care Services. 8th September 2006 Date of last inspection Brief Description of the Service: Kestrel House is owned and managed by Associated Nursing Services (ANS). The accommodation comprises of forty-eight single bedrooms with ensuite facilities and three double rooms. There is ample communal space, which has recently been upgraded. Kestrel house is situated on the A22, and approximately 1-1½ miles from Eastbourne town centre. There is car parking on site at the front of the home and a small garden and patio area is situated to the rear and side of the home. The service provides all service users with a copy of the service users information pack and a brochure as part of the admission process. Copies of inspection reports and the homes Statement of Purpose are available in the reception area of the home. Fees charged as from 1 April 2007 in accordance with the contract with the Primary Care Trust is £582.69. Additional charges are made for hairdressing, toiletries, chiropody, newspapers and outside activities. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 23rd May 2006 over a period of eight hours; it was facilitated by Ms Debra Potter, home manager. During the inspection a tour of the building was undertaken, ten residents, eight members of staff and six visitors to the home spoken with, and documentation examined. The documentation and records, which were looked at, included care plans, medication records, personnel files, health and safety documentation, catering records and policies and quality monitoring documentation. Six care plans were examined in depth and the documented care of the residents checked against the care they were actually being given, these residents were spoken with and their views of the care received obtained where this was possible. The majority of the residents in the home were seen and spoken with if they were able. Prior to the inspection ten questionnaires were sent to representatives of residents in the home and ten to residents. Only two have currently been returned. Four questionnaires to health care professionals were sent and of these currently two have been received. Comments received from the questionnaires and from conversations with residents and visitors were mainly positive; they included ‘ The food is very good and the home comfortable’, ‘The standard of care given seems good and she (the resident) is always well presented’. ‘I feel very isolated in my room and wish that there were more opportunities for conversation’. ‘ Activities could be at varied time as my friend is too tired when they take place’. ‘Excellent food, couldn’t do better anywhere’. What the service does well: The home provides care for mainly older people in a purpose built environment. The home is served by one General Practitioners’ surgery, which gives the advantage of providing regular visits to the home and a continuity of medical care. The Activities programme, which addresses the preferences of the people living at the home and provides one-to-one activities and conversation, has been commenced, residents are consulted about what they would like to do and outings have recently started. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 6 The standard of catering is very good, with a well-balanced menu provided from very clean kitchens. The menu provides a choice of food and is displayed on all tables in the dining room; with staff obtaining peoples choice of food on a daily basis. The chef checks the menu for nutritional balance each day. All residents in the home said that the standard of care met their expectations. One relative stated that ‘ I am very well satisfied with the care here’. A physiotherapist visits the home three times a week, ensuring that all residents receive the benefits of these treatments. The manager is auditing the care plans to ensure that they represent the care that is required to meet the individual’s needs. Comments from a health care professional stated that there is ‘ Good training for all staff and good management, staff are caring and kind’ The home has met six of the ten requirements made at the last inspection. What has improved since the last inspection? The manager and staff have worked hard to implement improvements over all the services provided by the home in the past year. The standard of medication administration has improved following staff training. The standard of cleanliness and redecoration of corridors and some rooms has received attention, there was no evidence of odours and the home appeared clean and bright, making a pleasant environment for those that live in the home. Some members of staff are now attending training to fully implement the Liverpool Care Pathway and the end of life Gold Standards Framework. These are both care methods for residents reaching the end of their lives. A questionnaire received from a health care professional said that staff have had ‘ a steep learning curve re care of the dying and all staff are becoming very competent’. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 7 What they could do better: Although care plans have shown some improvement there is still room for more. One care plan showed that staff had not completely addressed the need of a resident with a chronic / acute disease, there was no evidence that staff had any knowledge of this and the care planning was not addressing important elements which could affect the treatment given. Part of a registered nurses duty of care is to research any illness with which they are unfamiliar, and it was clear that this had not taken place. The manager must arrange a secure method of delivery for medications brought to the home at times other than the monthly medication delivery. Staff said that there were sufficient staff when the home is not fully occupied, whilst registered nurses said that there were now enough staff at all times. However it was noticed that even though staff said that they were not busy, no staff were seen in residents rooms talking or spending time with residents other than when care was being given. Residents were seen in the dining room waiting for their meal with staff talking amongst themselves when this would have been an opportunity for staff to engage them in conversation. Likewise a member of staff was seen talking to another staff member when a resident clearly needed some assistance. Activities are provided mainly on a Monday to Friday basis but residents may benefit from social interaction at weekends. One resident said ‘ I feel so isolated, they rarely ask me if I would like to go to the lounge or leave my room and it would be nice to have people to talk to, and my sight is not good enough to watch television, and who wants to do that all the time?’ whilst another said ‘ The only people I see are the staff and that is so quick, they are too busy to talk, all I can do is lie here and sometimes I get quite scared’. The manager must ensure that staff close doors or lock them to prevent residents entering areas which could prove hazardous such as serverys and the laundry. Please contact the provider for advice of actions taken in response to this Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 8 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. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 9 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 Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4,5,6 People who use the service experience Good quality outcomes in this area. Prospective residents receive sufficient information to enable them to be sure that the home can meet their needs. Staff receive ongoing training to enable them to meet the physical needs of the residents in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The statement of purpose requires some amendment to ensure that relevant information regarding the category of resident the home admits is emphasised and that the complaints procedure has the correct information regarding the Commission for social care inspection. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 11 All residents have a copy of a Service User Guide, which is produced to be both easy to read and to give the information required by those living at the home. No residents have a statement of terms and conditions of residency, although the provider has produced this. The manager commenced making these available to residents during the inspection. The home assesses all residents prior to their admission. Assessment details are documented and form the basis of the care plan. The manager does not generally take the full information about the home on assessment therefore residents are unable to be fully informed about the home prior to their admission. As the home admits those who have a chronic or end stage illness, in some cases they would be unable to process this information, but residents or representatives would benefit from having full information. However residents admitted to the home can often be admitted within a few hours of being assessed, therefore often the timescales are insufficient for them to be able to make a choice over whether they wish to live there. The majority of the staff at the home have received some training in care, with 20 of them having attained their National Vocational Qualification level 2 in care. Some staff have commenced study to enable the Gold Standards Framework and Liverpool care pathway to be used in the home and also the Macmillan nurses come and give study days once a week, but staff in general have not received much specialised care in the needs of the dying resident, and there was little evidence available to show that the psychological and emotional needs of residents in the home were being attended to. The home does not admit residents for intermediate care. Kestrel House DS0000014006.V337498.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): 7,8,9,10,11 People who use the service experience adequate quality outcomes in this area. The standard of care planning does not address some of the assessed needs, including the emotional and psychological needs of people living in the home. Lack of nursing knowledge in some areas could put residents at risk. Medication administration within the home fully safeguards the residents, however the method of delivery and receipt of medications does not safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of six (10 ) residents were examined, three from each unit in order provide a balanced view of the care given. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 13 Care plans are formed from a preadmission assessment. The care plans examined showed evidence of regular review and actions required to meet residents assessed needs. There was evidence of consultation with the resident or their representative on the initial formation of the care plan but none on review. In general the documentation in the care plans was of a good standard. The care plans contain risk assessments and these had been reviewed regularly. Nutritional care plans were formed in conjunction with recording of resident’s weights but information in the care plan of one resident did not address the dietary requirements necessary to support the ongoing treatment currently being given. Neither was there any evidence that staff were fully conversant with or had researched the illness to ensure that correct care was put in place. There was little care planning associated with sensory impairment such as sight or hearing impairment. There was no information to identify that the tissue viability specialist nurse was contacted in the first stages of tissue damage, although contacted at later stages. Not all staff have received wound care training. There was no guidance available for the staff to monitor the access sites for recurrent invasive hospital treatment required by one resident, and there was little reference to the care and diet required in this instance. There was evidence that pressure-relieving equipment was documented in the care plans along with relevant risk assessments and that this is checked regularly. The use of bedrails had also been risk assessed. The majority of the moving and handling assessments had been signed but some required more detail to staff in the using of these, some did not specify number of staff required or the type of sling to use. There was evidence of residents with highly complex physical needs, PEG feeds and end of life care being given. In general the care planning addressed these needs, and conversation with staff identified that they felt competent in their care of the residents. Most staff have received training in challenging behaviour. Residents do not generally keep their own General Practitioner whilst at the home, their care being undertaken by one practice in the area. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 14 Staff and management gave assurances that this took place solely in accordance with the wishes of the residents. Staff were seen to be interacting with residents as required but there seemed to be no spontaneous interaction i.e. when residents were sitting ready for a meal or sitting alone in a room, staff were talking amongst themselves and none were seen to be talking with residents in their rooms. Residents and visitors commented that staff do not have the time to come and talk to them much. Residents spoken with generally stated that they were well cared for and that staff were very kind but too busy to talk to them. Visitors said that in general the care was good and that staff were very kind and kept them informed of any changes in the residents condition. One visitor said ‘I am very satisfied with the care she (the resident) receives. There is a physiotherapist visiting the home three times a week therefore all residents who need this service can access it. Medication policies and procedures are in place, no residents self medicate at present, but staff demonstrated awareness of the required risk assessments. All medication had been signed for following administration and the storage of medication and controlled drugs are satisfactory. It was noted that when the pharmacist delivers the drugs to the home that these are left on the desk in the middle of the unit, this practice may endanger residents. All records relating to the equipment used by the nurses were in order and identified that these had been serviced or examined regularly and the temperatures of the drug fridge were recorded. The home admits residents requiring continuing or end of life care; it has commenced implementation of the Liverpool care pathway with some staff attending training in this. Macmillan nurses also provide some training at the home, the manager should ensure that this includes the importance of psychological care. Care plans showed that appropriate physical interventions and care were undertaken for those residents who were very ill. Kestrel House DS0000014006.V337498.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): 12,13,14,15 People who use the service experience good quality outcomes in this area. Whilst much work is being undertaken to ensure a varied activities programme, not all staff appreciate the importance of the social aspect of resident care and the impact that feelings of being isolated in rooms may have on some residents. The standard of catering provides a varied and nutritious menu, which allows individual choice and is well presented to ensure that residents enjoy the meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home now employs two activities co-ordinators, one full and one part time. An activities programme is in place with each resident getting a copy of this. Due to the complex needs of the residents in this home, the activity coordinator working the lesser hours spends the majority of this time on oneto –one talking to residents. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 16 Musical entertainers, board games, craft sessions, and films are provided. An outing to a local pub was recently arranged and some residents participated in this, a further outing to a local park is planned. The activities coordinator keeps records of who attends activities and is at present compiling a list of what activities people previously enjoyed or participated in prior to their coming into the home. All residents receive a copy of the activities programme. One resident said that ‘ I feel very isolated left in my room all the time, staff do not ask if I would like to go to the lounge’, another resident said ‘ When I start enjoying something the nurse will come and take me back to bed’. A member of staff also said that residents had activities interrupted by nursing staff saying that they had to go back to bed. It is essential that all staff are involved in planning and enabling residents to take part in the activities and that care routines are flexible to enable residents to participate in this important element of holistic care. A relative said ‘He (the resident) does enjoy being involved, but his nursing care makes this impossible, he always has to go back to his room’. Whilst another resident stated ‘ the activities should be earlier when my relative is not so tired’. Four residents spoken with said that they feel lonely and unable to have a chance to take part in conversation. Several residents were seen using the garden on the day of the visit. Residents spoken with said that they had choices over the times they went to bed at night and got up in the morning and that staff respected their choices. The standard of catering appears satisfactory with a varied daily menu and fresh fruit on all units, individual menus on table and sample of menu in service user guide. The kitchen was clean and all staff have suitable training. A member of kitchen staff assists with serving the meals on each floor. Residents said the food is very good and they are able to choose what they want.’ The food is beautiful’. ‘I really enjoy my meals’. ‘We can choose what we want’. ‘ I wish they would provide more salad dressing’. Visitors in the home also said the food was ‘very good’. The cook was aware of various medical diets and also aware of what each resident wanted to eat on a specific day. . Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 17 Evening snacks are available and the chef uses a scoring system for each menu to ensure that the meals are nutritious and a food survey taken from residents has been collated to ensure that the meals meet their expectations, The dining rooms are pleasant with the meals being served in two shifts to accommodate those who need assistance when eating. However, although staff were seen assisting residents in a discreet and unhurried manner, one member of staff used in appropriate terminology for residents that require assisting. The dining room is pleasant and tables are laid with tablecloths and condiments on all tables. Kestrel House DS0000014006.V337498.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): 16,17,18 People who use the service experience good quality outcomes in this area. People living in the home are confident that any complaints they may make are addressed in a confidential and fair manner. They are protected by the staff’s awareness of their responsibilities towards those in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints procedure in place and this is included in the service user guide. There have been three complaints received by the home over the past year these related to cleanliness issues in the home, a complaint about a questionnaire given to a resident as part of the quality monitoring programme and a complaint from a medical practitioner comparing the facilities in the home adversely against those offered by a hospice. These have all been dealt with by the manager and actions recorded, these complaints were either fully or partially substantiated. A complaint made during the inspection regarding the care of a resident had already been addressed by the manager and actions put in place to rectify it. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 19 The manager has received some minor verbal complaints during the past year, however records of this were not available and the recording of these and their audit is part of the manager’s action plan for the home for the coming year. This should be put in place and audited along with other complaints to assist the improvement to the service offered. Residents and visitors to the home said that they were of whom to complain to and felt comfortable doing so, with those residents and visitors who had made a complaint saying that these had been addressed in a fair and open manner. There have been two adult safeguarding allegations made in the past year, two of which were instigated by the manager and are in the process of being dealt with. One of these involved staff sleeping on duty and she has referred these members of staff to the Protection of Vulnerable Adults, whilst the second one related to factors outside the home but involved the safeguarding of a resident by the home. All staff have undertaken training in safeguarding adults Kestrel House DS0000014006.V337498.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): 19,20,21,22,23,24,25,26 People who use the service experience good quality outcomes in this area. Cleanliness in the home continues to be monitored by senior staff to ensure that residents live in a clean and pleasant environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some areas in the home have undergone redecoration and the home appears light and welcoming. There is evidence of maintenance work being undertaken with the ground floor kitchenette undergoing refurbishment. The manager said that some renewal of furnishings will be taking place on an ongoing basis. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 21 The garden is accessed from the ground floor and on this day was in need of attention although the maintenance person said that he was in the process of doing this. Residents were sitting out in the sun and enjoying the garden. Communal areas were clean and the furnishing was suitable for purpose, although call bells are not available to all residents in the lounge areas, the manager said that a member of staff is always present when residents are in there. The bathrooms were clean and fit for purpose. All residents’ bedrooms were clean and comfortable and no obvious areas were seen to be in need of redecoration. Water temperatures in outlets used by residents are checked and recorded on a regular basis and these were within recommended parameters. The home has under floor heating so no radiators are in place and the maintenance person provided information to show that these are checked regularly. The home provides a range of equipment and aids for residents including mattresses for pressure relief; full body hoists and grab rails in bathrooms and toilets. The home has a range of infection control procedures . The laundry facilities were well placed and residents said that laundry came back in good condition and was always clean and ironed. Staff must ensure the laundry door is kept locked when not in use to ensure resident safety. Kestrel House DS0000014006.V337498.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): 27,28,29,30 People who use the service experience good quality outcomes in this area. The number of staff on duty over a twenty four hour period is sufficient to meet the assessed needs of the residents at this current time. Staff are receiving ongoing training to enable them to meet the needs of the residents in their care. Residents are safeguarded by the homes’ recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing rota showed that a consistent number of staff is being maintained and that agency staff are used to cover staff absence. Conversations with staff identified that they thought that there were sufficient staff on duty the majority of the day but on one floor they required extra staff at peak times of day to assist with meals, which the manager is addressing. Care staff said that staffing was sufficient to meet the needs of the residents when the home was not full but sometimes they were very busy, however registered nurses said that they thought that the staffing was ‘about right’. The manager should continue to monitor staffing levels to ensure that staff are Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 23 well supported when the home is fully occupied in order to ensure that the complex needs of the residents can be met, this should include time for staff to spend time with residents and talk to them. All staff receive induction training and further training is made available to staff following this. Registered nurses said that they are undertaking training in the Liverpool Care pathway and are receiving End of Life training incorporating the Gold Standards Framework. Some registered nurses said that they had received further training in wound care. Staff would benefit from having training to meet the emotional and social requirements of the residents in their care. Staff have received further training in the administration of medication. Training for staff to National Vocational Qualification standard continues, with six members of staff (20 ) having attained the National Vocational Qualification level 2 in care. A further seven staff are working towards this. Six personnel files were examined (10 of total staff) and these contained all information and documentation as required by the regulations. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,26,37,38. People who use the service experience good quality outcomes in this area. Management systems are in place to safeguard staff, residents and visitors to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for two years, she is a Registered General Nurse level 1 and has recently attained the Registered Managers Award. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 25 She states that she is aware that continual improvement is needed around the home, but that both herself and the staff are committed to ensuring that residents receive a good standard of care and quality of life. She also stated that she felt far more confident in her management role in the past year and has been well supported by the company. Ethos around the home is good, with many staff having been employed at the home for a number of years. A comment from a health care professional was that ‘the home will continue to improve with the good training and (current) standard of management ‘. Visitors to the home spoken with said ‘ They always are very kind and make me feel at home when I come to visit’. ‘ It’s a good home and its not always very easy for those who run it’. ‘ I think that under the circumstances and given that there are many poorly people here, that the staff do very well and they are always very friendly’. Staff stated that they felt well supported by the manager. Quality monitoring takes place, with audits being undertaken on an annual basis. Views from residents or their relatives are obtained shortly after the resident’s admission to the home, but these are not collated although suggestions from these are used to improve the service offered. The manager should elicit the viewpoints of other stakeholders in the home i.e. health and social care professionals. Relatives and residents meetings are not held due to the nature of the category of residents coming into the home, however given that many residents have been living in the home for a long time this may benefit residents. Likewise relatives and visitors may wish to have an opportunity to make their views and suggestions known. Staff meetings are held on a regular basis with staff feeling able to participate freely in these. Regulation 37 (incident) reports are received by the CSCI and Regulation 26 (provider monitoring visit) reports are kept in the home. Staff supervision is being held on a regular basis as directed by the National Minimum Standards. All insurances as required by law are in place. The business plan and other financial records relating to the business were not examined on this occasion, however records appertaining residents finances were seen. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 26 Resident’s monies given in for safekeeping and residents use are held in a specific bank account. The home does not get involved in resident’s finances. Receipts are available to support any transactions incurred for residents. All records relating to the residents and staff and business of the home are up to date and securely held. Records were in place to show that all utilities and equipment throughout the home had been serviced, that fire alarm checks and fire training have taken place and that checks on portable electrical equipment has taken place. All staff have received mandatory health and safety training. The staff must ensure that the laundry room, serverys and other rooms, which may endanger residents, are locked when staff are not present. Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 10 11 3 3 2 3 3 3 3 3 STAFFING Standard No Score 27 28 29 30 2 2 2 3 2 3 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 3 3 2 Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 28 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 OP8 Regulation 13(1b) 17(1a) Sch 3 Requirement That care planning considers the psychological and emotional needs of the service user Timescale for action 30/07/07 2 OP9 13 (2) That practices around delivery of medication to the home are reviewed to ensure residents safety That planned activities are flexible to reflect the service users needs and preferences. That the time of activities be reviewed so as to reflect all residents lifestyle. (Previous timescale of 18/06/06 and 30/01/07 not fully met.) That the home ensures that staff keep doors to areas such as serverys and laundry rooms closed or locked when not in use to prevent service users accessing these and being put at DS0000014006.V337498.R01.S.doc 30/07/07 3 OP12 16 (2) 30/07/07 4 OP38 13(4) 30/06/07 Kestrel House Version 5.2 Page 29 risk 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 Kestrel House DS0000014006.V337498.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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