Inspection on 25/07/05 for Keswick

This inspection was carried out on 25th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Keswick 13/08/07

Keswick 25/04/06

Keswick 13/06/05

Keswick 27/01/05

Keswick 30/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

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 Keswick Eastwick Park Road Great Bookham Surrey KT23 3ND Lead Inspector Sandra Holland Unannounced 25 July 2005 10:20 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 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. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Keswick Address Keswick, Eastwick Park Road, Great Bookham, Surrey, KT23 3ND Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01372 456134 Anchor Trust 1st Floor, 408 Strand, London, WC2R ONE Ms Shona Bradbury Care Home (CRH) 51 Category(ies) of Old age, not falling within any other category registration, with number (OP), 51 of places Dementia - over 65 years of age (DE(E)), 15 Physical disability over 65 years of age (PD(E)), 10 Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 Of the 51 Residents accommodated, up to 15 may fall within the category Dementia (DE(E)). 2 Of the 51 service users accomodated, up to 10 may fall within the category of Physical disability (PD(E)). Date of last inspection 13 June 2005 Brief Description of the Service: Keswick is a care home which is owned and operated by Anchor Trust. It is situated in the Surrey village of Great Bookham, a short distance from the high street, which has a range of shops and serivces. The home is adjacent to a health centre and a junior school. The home is arranged into seven units, each with six to eight bedrooms, a communal lounge/dining room with open plan kitchenette and bathroom and toilet facilities. The building is of two storeys with a passenger lift providing access to all areas. A wheelchair lift enables access to one residential unit. There is a large lounge/dining room on the ground floor which is used for activities. This room is also used as a day centre for non-residents. A spacious conservatory overlooks the rear garden which has a patio area, lawn and flower beds. The main entrance lobby is light and airy with a reception desk and a seating area for residents. Car parking spaces are provided to the front of the property. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the second to be carried out in the Commission for Social Care Inspection (CSCI) year April 2005 to March 2006. The inspection was carried out over six and three-quarter hours by Mrs. Sandra Holland, Lead Inspector and Mrs. Geraldine Yates, Pharmacist Inspector. Ms. Shona Bradbury, Registered Manager was present representing the service. The last inspection of Keswick took place on 13th June 2005. This inspection on 25th July 2005 has taken place to follow up issues that have been raised at a Protection Of Vulnerable Adults (POVA) procedure strategy meeting. These issues included the non- administration of prescribed medication, the management of complaints, the recruitment, training and supervision of staff and communication between the home’s staff, general practitioners (G.P’s), pharmacy and resident’s representatives. A number of records and documents were examined, including medication administration records, staff files, staff training records and the complaints procedure. The methods of ordering, storing, administering and disposing of medication were specifically examined by the pharmacist inspector, as were the medication storage facilities. What the service does well: What has improved since the last inspection? A requirement was made at the last inspection that the receipt of controlled drug medications is recorded upon receipt into the home. This is now being carried out. Another requirement was made that staff must not be employed until the required records and documents have been obtained. This is now being carried out. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 6 Risk assessments have been carried out in respect of any member of staff who has a conviction or caution recorded on their Criminal Record Bureau (CRB) disclosure. Two further requirements were made at the last inspection, but these were still within the timescales for action and were not assessed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed during this inspection. EVIDENCE: Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 9. A review of medication handling was undertaken by a CSCI pharmacist inspector, who concluded that the systems for the administration of medication are poor and potentially place service users at risk. EVIDENCE: It was of concern to the inspectors that staff involved in a recent medication mishandling, incident, were still administering medication in the home. An immediate requirement was made that these staff do not handle medication, until their competency to do so, has been reassessed by the manager. Medication stocks and records were sampled and failed to show that service users were receiving their medication as intended by their doctors. There were six omissions in completing the medication administration records in the 36 hours that the current charts had been in use, resulting in no record being kept of whether these medicines had been administered or not. There was a system in place to detect and correct such omissions, but these omissions had not been picked up. Written procedures for the safe handling of medication were provided for staff. However these lacked detail in some areas and did not fully reflect the current practices in the home. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 10 A new training package had been obtained following the medication mishandling incident but the manager had decided not to use this. The manager stated that another training provider had been approached to provide training to all staff. No date for the training had yet been obtained. Service users who were administering their own medications all had risk assessments completed to support them in this activity. Medication was being stored securely for the protection of service users, although Temazepam was not being stored in the controlled drugs cupboard. The stock was moved to the correct cupboard during the inspection. Requirements have been made - please see page 21. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) These standards were not assessed at this inspection. EVIDENCE: Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16. A complaints procedure is in place, but this needs to be reviewed. EVIDENCE: A written complaint has been made to the home since the last inspection and concern was raised at the POVA meeting about the home’s handling of it and specifically the delay in responding to the complainant. The procedure was discussed with the manager and she explained her reasons for the delay in sending a written response. The letter of complaint and the manager’s response were seen. The complainant asked for a copy of the home’s response to be forwarded to another family member, which was not carried out. The manager advised that this request had been overlooked but would be carried out and sent with an apology. It was noted that the home’s response letter did not refer the complainant to the full complaints procedure or what action to take if dissatisfied with the outcome. The manager was advised that reference to the CSCI and Ombudsman should be included as part of the standard procedure in responding to any complaint. Enclosing a complaints procedure leaflet with response letters is also recommended, to convey this information. The home’s complaints procedure is displayed in the entrance hall. This is a general procedure drawn up by the Anchor Trust, which owns and operates Keswick. The procedure states in the first few lines, in small print, that complaints should be addressed to the home in the first instance. The next Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 13 three stages are in larger print, are much more prominent and request the complainant to write to an Anchor office. As the residents of Keswick are all older people, some of whom may have physical disabilities or dementia, it is required that this is reviewed to make it more suited to the needs of the residents. A greater emphasis on aiming to achieve resolution of complaints within the home and the timescales for action is recommended. A requirement and a recommendation have been made – please see page 21. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The home is well presented, clean and hygienic. EVIDENCE: 26. A limited area of the home was assessed, as all areas of the home had been thoroughly inspected at the previous inspection, six weeks ago. All areas seen were attractively presented, clean and freshly aired. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29 and 30. Recruitment records need to be more thorough. A schedule of training is maintained but needs to be updated. EVIDENCE: Staff recruitment records seen contained the majority of the documents required but not all. Documents to confirm identity were not present for one member of staff and photographic confirmation of identity was not present for two members of staff. A schedule of training for staff is maintained and showed training that had already taken place and that planned. This covered some but not all mandatory training requirements. Individual training records are also held for each member of staff, but these had not been updated. The personal training record for one senior member of staff was not available for inspection. Medication training for all staff administering medication is urgently required. The manager decided not to proceed with a medication, training package that had been obtained, as it did not meet the needs of the home. Training by the pharmacy supplying the home with medication is awaited and the date of this training is to be forwarded to CSCI, Eashing office. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 16 It is of concern that staff members involved in the mishandling of medication incident have been permitted to continue administering medication without any further training or reassessment of competency. This must not continue. Staff involved in this incident must be reassessed and not be permitted to have any involvement in medication administration until confirmed and recorded as competent. Requirements have been made – please see page 21. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36 and 37. The management of Keswick needs to be more robust. Formal supervision of all members of staff is not being carried out. EVIDENCE: It is positive that the home is open about the incident that has occurred and is seeking ways to improve to prevent recurrence. To help achieve this, more stringent and frequent checking of staff actions by the management team must take place and be recorded, including formal supervision of staff. The manager stated that she has responsibility for supervising the senior staff, and senior members of staff supervise care, and other staff members. A formal supervision meeting has taken place between the manager and one senior staff member the manager advised, and a record of this was seen. Supervision meetings between senior staff and other staff members, have yet Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 18 to be carried out. This is not acceptable, as this requirement has been carried forward from the last two inspections. Formal supervision of all staff must take place at least six times a year to meet the National Minimum Standard. Lines of responsibility of the management team must be made known and the manager must communicate a clear sense of direction and leadership. Communication between staff at the home, residents’ general practitioners, the pharmacy and residents’ representatives must be effective to ensure that residents receive prescribed medication and treatment as directed. The home must ensure that arrangements are in place to record any reasons why medication or treatment are not provided as prescribed, what actions are taken in response to this, by whom and when. The manager showed the inspectors a communication form that has been developed. Residents will be asked to take this when seeing their G.P. or other healthcare professionals. This enables the doctor (or others) to record the outcome of the meeting and any directions which the staff at the home need to be aware of. Record keeping in relation to medication, recruitment and the management of complaints, needs to be strengthened to ensure the health and welfare of residents. Requirements have been made – please see page 21. Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 x 28 x 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 x x 2 2 x x x 1 2 x Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Timescale for action The registered person shall make With arrangements for the recording, immediate handling, safekeeping, safe effect from administration and disposal of 25th July medicines received into the care 2005 home. Specifically, staff involved in the recent medication mishandling incident must not handle medication until their competency to do so has been reassessed by the manager. Additionally, all staff involved in the administration of medication must receive training to ensure they are able to administer medication safely. The registered person shall 24th establish a procedure (the October complaints procedure) for 2005 considering complaints made to the registered person by a service user or person acting on a service users behalf. Specifically the complaints procedure shall be appropriate to the needs of the service users. The registered person shall not 26th July employ a person to work at the 2005 care home unless all the information and documents specified in Schedule 2 of The Version 1.40 Page 21 Requirement 2. 16 22 3. 29 19 Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc 4. 30 18(1) 5. 31 and 32 12 6. 36 18(1) Care Homes Regulation 2001 (As Amended), have been obtained. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users, ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. The registered person shall ensure that persons working at the care home are appropriately supervised. THIS REQUIREMENT HAS BEEN CARRIED FORWARD FROM 30/7/04, 27/1/05 AND 13/6/05. 29th August 2005 29th August 2005 29th August 2005 7. 37 17 and 19 8. 9 17 (1) (a) 9. 9 13(2) The registered person shall maintain in respect of each service user and each member of staff, the records specified by Schedules 2,3 and 4 of The Care Homes Regulations 2001 (As Amended). Complete and accurate records must be kept of all medication administered to service users. The number of entries left blank on the medication administration record charts is not acceptable. Additionally, when variable doses of medication are prescribed a record must be made of the actual dose administered to the service user. The policies and procedures relating to the handling of medication must be reviewed and updated to ensure they 29th August 2005 29th August 2005 5th september 2005 Page 22 Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 provide detail to the staff and reflect the practices in place in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 9 Good Practice Recommendations It is recommended as good practice that when it is necessary to handwrite on a medication administration record chart in the home, that the member of staff writing the chart signs and dates the chart and that a second member of the care staff, checks the entry for accuracy and then initials the chart. In addition the entry should include a reference as to where this information was sourced, such as the prescriber’s name. It is recommended that the complaints procedure is reviewed. 2. 16 Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Keswick H58-H09 S13691 Keswick V240821 250705 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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