Inspection on 27/05/09 for Kilkenny Residential Care Home

This inspection was carried out on 27th May 2009.

CQC 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 CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kilkenny Residential Care Home 04/06/08

Kilkenny Residential Care Home 08/05/07

Kilkenny Residential Care Home 27/06/06

Kilkenny Residential Care Home 05/01/06

Kilkenny Residential Care Home 23/08/05

Kilkenny Residential Care Home 03/02/05

Kilkenny Residential Care Home 20/07/04

Kilkenny Residential Care Home 26/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Kilkenny Residential Care Home 6 Third Avenue Frinton On Sea Essex CO13 9EG Lead Inspector Francesca Halliday Key Unannounced Inspection 27th May 2009 09:00 DS0000017862.V375597.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kilkenny Residential Care Home Address 6 Third Avenue Frinton On Sea Essex CO13 9EG 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) 01255 672253 F/P 01255 672253 Mr Rajalingum Valaydon Mrs Christine Joan Emmamdeen, Mr Mamode Farouk Emmamdeen Mr Rajalingum Valaydon Mrs Teresa Rosaline Jones Care Home 11 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (11), Old age, not falling within any other of places category (11) Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 11 persons) Persons of either sex, aged 65 years or over, who require care by reason of dementia (not to exceed 11 persons) One person, under the age of 65 years, who requires care by reason of dementia, whose name was made known to the Commission in April 2005 The total number of service users accommodated in the home must not exceed 11 persons 4th June 2008 Date of last inspection Brief Description of the Service: Kilkenny is situated in a residential area on the outskirts of Frinton on Sea town centre, close to the sea front and within walking distance of all local amenities. The home has two shared rooms and seven single rooms. Five bedrooms have an en-suite bath or shower and all have an en-suite toilet and basin. Bedrooms upstairs can be accessed by means of a chairlift. There is a hardstanding area at the front of the home, with space for two or three cars. There is an enclosed garden at the rear of the property. The home provides care for 11 older people, aged over 65 years, some of whom have dementia. The weekly charge was between £400 and £450 per week depending on the care needs of the individual and the size of the room occupied. Additional charges were made for private chiropody, visits to day centres, manicures, hairdressing, toiletries, newspapers and confectionary. Information about the fees was provided to the Care Quality Commission in May 2009, for more up to date information please contact the home directly. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. This key inspection was carried out on 27th May 2009. The term resident was used throughout this report to describe people living in the home and the term we refers to the Care Quality Commission (CQC). All the key national minimum standards (NMS) for older people were assessed during the inspection. The report was written using evidence accumulated since the last key inspection on 4th June 2008, as well as using evidence found during the site visit. This included looking at a variety of records and inspecting parts of the premises. The report was written using evidence provided by the managers and this included the annual quality assurance assessment (AQAA) sent to us prior to the inspection. The AQAA is a self assessment document required by law and it gave us information about how the service met the standards and data about the service. During the inspection we had chats of various lengths with four residents, one relative and three members of staff including the two registered managers. We sent out surveys prior to the inspection and we received six from relatives and three from staff. Comments from the surveys and conversations have been included in the report where appropriate. What the service does well: Residents told us that they were happy with the standard of care and support from staff. A resident told us that staff were “very friendly, they always have a chat with you. You get help when you want it”. One relative described the staff as “absolutely first class”. A relative who completed a survey said “I feel they are cared for as well as possible. The home is kept clean and tidy with no unwanted smells”. One member of staff who responded to our survey said “the management provide a home from home atmosphere”. What has improved since the last inspection? A relative told us “A new sensory garden has been added which has been constructed professionally and is excellent”. The home had been made safer for residents since the last inspection. Radiator guards had been installed, windows on the first floor had window restrictors fitted and the access out of the home had been improved by levelling the surface and by the purchase of more substantial ramps. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 6 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 5 People using the service experience good quality outcomes in this area. Prospective residents can be assured that their needs will be assessed before moving into the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had a range of information for potential residents and their family, friends or representatives. This included a statement of purpose and service user guide. The service user guide needed some minor amendments including the removal of the statement about the home not having a lift and residents who needed a lift having to find another home if a ground floor room was not available. The managers confirmed that they always carried out the assessments prior to offering a place at the home, in order to ensure that they could meet the prospective residents’ needs. We looked at the assessments of Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 9 two residents who had been admitted since the last inspection. The assessments seen had an adequate amount of detail about potential residents’ physical needs. However, the mental health section of the assessment needed to be expanded in order to assess the needs of potential residents with either symptoms or a diagnosis of dementia. The managers said that this would be done immediately following the inspection. Potential residents were encouraged to spend a day at Kilkenny in order to meet other residents and familiarise themselves with the services and care provided. A trial period of between four to six weeks was offered in order that the resident could assess whether their needs were being met and they were satisfied with the care and services provided. The managers said that if they had a spare room they would offer it to the relative of a new resident if this would help the settling in process. They said that relatives sometimes stayed at the hotel opposite the home for a short period if a room was not available. One relative told us that they had visited the home and had been given sufficient information to enable them to make a decision about accepting a placement. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 People using the service experience adequate quality outcomes in this area. Residents are satisfied that their health and care needs are met but the risks to their health and welfare are not always assessed or minimised. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Residents we spoke with said that they were happy with the standards of care and the support they received from staff. One resident said “you get the help when you want it” another resident told us “I’m being well looked after”. Two relatives who responded to our survey told us that staff “always” met residents’ care needs and four relatives told us that staff “usually” met their needs. Relatives surveyed were asked whether staff gave the support or care expected or agreed, one said “always”, four said “usually” and one said “sometimes”. Staff told us that the ways they shared information about residents within the home “usually” worked well. During the inspection we Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 11 noticed staff interacting in a caring and friendly manner towards residents. One relative told us “I’m very pleased with staff interaction and manner towards residents”. We sampled the care plans for four residents. There was evidence that residents and relatives where appropriate, had been involved in providing information about residents’ needs, preferences and interests. One relative we spoke with confirmed that they had been consulted about the care needs of the resident they visited. The care plans we looked at documented the residents’ care needs and how staff could support them and meet the needs. Care plans were being reviewed on a monthly basis, however, they were not being updated when changes to needs were identified. One resident had fallen nine times in the past eight months but this was not mentioned in the care plan. The care plan stated that staff should encourage them to use a frame but there was no frame in their room and they told us they didn’t like using a frame or a stick. The risk assessment for falls had not been updated following their falls. Another resident’s condition had deteriorated considerably in the past year but no changes had been made to the care plans that had been written twelve months previously. The care plans seen were generally dated but were not signed. Since the last inspection the daily care records for day and night had been combined and a separate record was being made for each resident. However, the daily records were generally brief and needed more evidence that staff were monitoring the needs identified in the care plans on a daily basis. Residents’ weight was being monitored on a monthly basis. Residents’ weight was seen to be steady in the records we looked at but the home was not able to weigh residents who could not weight bear. The home was not using a nutritional risk assessment that would assist them to monitor residents whom they could not weigh. The home did not use a pressure sore risk assessment tool to identify residents at particularly high risk of developing sores. According to the records we looked at two residents had developed pressure sores in the past month. None of the staff had received training in the prevention and management of pressure sores. Moving and handling assessments had been completed for some residents but one had been completed in 2004 and not been reviewed since. The manager said that the resident’s moving and handling needs had remained the same but this was not documented. A number of risk assessments we looked at had not been dated or signed. The home did not have a tool for monitoring residents’ psychological health. This was particularly important for residents with dementia, as there was no method of systematically monitoring their condition, their responses to changes in medication or any periods of challenging behaviour. A requirement was made in the last inspection report for systems to be put in place to assess residents’ risk of developing pressures sores and malnutrition and to monitor residents’ psychological health. However, this had not been implemented. Following the inspection the managers provided Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 12 evidence that a nutritional assessment, a psychological assessment and a pressure sore risk assessment had been introduced. The managers said that they had medical services from two GP practices and that they received a very good service. They told us that they had excellent support from local district nurses. The diabetic nurses visited the home twice a year to monitor residents with diabetes. Residents had an annual optical check and chiropody every five to six weeks. The managers said that dental checkups were arranged when needed. Three relatives who responded to our survey told us that staff “always” kept them informed if there were any health concerns or accidents and two said that staff “usually” kept them informed. The service user guide stated that residents would only be considered for self medication if they had been assessed as safe to do so. However, a risk assessment had not been carried out for one resident who was self medicating and there were no systems in place to monitor their ability to continue self medicating safely. We were told that this resident had short term memory loss and was no longer able to use a call bell. Following the inspection the managers provided evidence that a risk assessment had been completed. The medicine records we looked at had been well completed. Residents were only on a relatively small amount of medication and the managers said that no sedatives were being used. There was evidence that one resident had been gradually taken off an anti-psychotic medication they were prescribed prior to admission. The paracetamol for one resident was being used for other residents and it was not possible to accurately audit its use in the home. A medicine prescribed for one resident is their property and must not be used for any other resident. The manager told us that they would obtain agreement from the GPs to hold paracetamol as a stock item to be used as a homely remedy in future. Staff who administered medicines had received training and a refresher session in 2009. The home did not have any residents on controlled drugs (CDs) and did not have a CD cupboard. The managers said that they would obtain a cupboard in order to be able to store CDs safely if any residents were prescribed the medication in future. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 People using the service experience good quality outcomes in this area. Residents can expect a range of social activities including access to the local community. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had a part time activity coordinator who was a qualified drama therapist. In the AQAA the managers told us “We have seen several residents acting out their feelings, emotion and happiness through the drama sessions. These activities have proved very successful and have been enjoyed by most of the residents”. Residents’ interests, hobbies, preferences and abilities were documented but the records were not dated or signed. A record was made of the activities that residents had taken part in. The managers said that they took a number of residents out when the weather was good and visited the sea shore, Frinton town centre and a local garden centre. The managers told us that a member of staff had brought some puppies in and that residents had really enjoyed this. A member of staff told us that they did provide some Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 14 activities such as hand massages and reminiscence. Two members of staff who responded to our survey told us that they would have liked to have more outings for residents. One relative told us “There should be more activities and stimulation for individual residents”. Relatives told us that they were made to feel very welcome when they visited the home. There was a day centre near the home and one resident made use of this facility. The managers said that current residents had not requested any visits from ministers of religion but that this could be arranged if needed. All relatives who responded to our survey told us that staff “usually” supported residents to live the life they chose. Two residents we spoke with told us they liked to remain independent and said that staff only gave them help when they wanted it. One said “I’m quite happy doing my own thing”. Residents who could respond told us that they got up and went to bed at a time that suited them. One resident told us “the food is very good”, another described the food as “quite good but very samey”. The managers told us there were choices at each meal including three choices at lunch time. The home did not have a chef staff carried out the cooking as part of their care role. The managers said that they knew what each resident’s likes and dislikes were because it was a small home. The kitchen looked clean and well organised. There were records of fridge and freezer temperatures and the temperature that hot food was served. The managers told us that there had been no requirements following the last environmental health inspection. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 18 People using the service experience good quality outcomes in this area. Residents are confident that their concerns will be promptly addressed and that they will be protected from abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had a complaints procedure, which was on display in the home. In the AQAA the managers told us they had not received any complaints. However, they were not recording concerns or the action taken to address them, which could be part of a good quality assurance system and assist communication within the home. Four relatives surveyed told us that they knew how to complain and two said that they did not know how to make a complaint. Three relatives told us that staff “always” and two relatives told us that staff “usually” responded appropriately to any concerns they raised. The residents we spoke with told us that they did not have any complaints about the home. A relative said “I’ve not had one single reason to make any adverse comment about care in the home”. Staff we spoke with and who responded to our survey all said that they knew what to do if anyone raised concerns about the home. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 16 The home had a safeguarding vulnerable adults policy and a whistle blowing policy (reporting of bad practice or abuse). The majority of staff had received training in safeguarding vulnerable adults in the previous twelve months. One member of staff we spoke with had a good understanding about the types of abuse that could occur and their responsibility to report any poor practices or suspicions of abuse. A resident told us “I feel safe here, they look after me well”. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 26 People using the service experience good quality outcomes in this area. Residents benefit from a safe and clean environment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Residents’ rooms were generally well personalised to their individual tastes and preferences. The home had two shared rooms and seven single rooms. All rooms had an en-suite toilet and basin. The three single rooms had an ensuite bath or shower and the two shared rooms also had an en-suite bath or shower. The home had a lounge with a dining area and a separate room with a small dining table. This room was used as a quiet room for residents who wanted to be away from the noise of the television. It was also used for Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 18 meetings with relatives and visiting professionals. Residents’ bedrooms had a lockable drawer for residents to keep valuables, money or medicines. The garden had been considerably improved since the last inspection. It had been professionally landscaped, with paving, an area of lawn and a water feature. A sensory area was being planted and there were wind chimes and a bird table to provide further interest for residents. The managers told us that they had done the work on the garden following verbal feedback from residents and relatives and feedback from the quality assurance surveys. The safety of the home had been improved since the last inspection. The managers confirmed that guards had been fitted to all radiators, window restrictors had been put in place on the first floor and exits that were also fire doors had been fitted with alarms. Access to the garden had also been improved and solid ramps had been made to improve access to the front door of the home. Liquid soap and paper hand towels had been provided in areas where staff provided personal care. The managers said that a paper hand towel dispenser would be installed in all residents’ en-suites. Residents’ clothes we looked at had been well laundered and a resident told us that the laundry service was “good”. The home did not have a washing machine with a sluice cycle but the managers said that staff handled soiled linen in the appropriate red bags and washed on a high setting. A member of staff we spoke with had a good understanding of infection control. On the day of this unannounced inspection the home all areas we looked at were clean. A relative told us “the cleanliness of the home is first class”. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 People using the service experience adequate quality outcomes in this area. Residents are supported by an adequate number of staff but their safety and well-being is potentially at risk by a lack of staff training. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had a very stable workforce. Many of the staff had worked at the home for more than ten years. Staffing levels were two staff from 07.30 – 22.00 and one from 22.00 – 07.30 plus one sleep in at night. In addition there was a cleaner for four hours twice a week and two staff who carried out washing up and cleaning for five hours on four days a week. The home had two members of staff on long term sick leave and the managers were covering their roles. The care staff carried out all the cooking and laundry and the cleaning on three days a week. Staffing was at an adequate level for the dependency of residents. There were eleven residents in the home at the time of inspection. Only one of the residents needed the assistance of two staff with their care and none of the residents with dementia had challenging behaviour. Staff whom we spoke with and surveyed told us that they had enough staff to meet the individual care needs of residents but two would have Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 20 liked to arranged more outings for residents. The managers told us that they were currently recruiting another member of staff. We looked at three staff records. There was evidence that all had received a criminal records bureau (CRB) check and a check with the protection of vulnerable (POVA) list. Two references had been obtained for recently recruited staff although only one reference was available for staff who had been recruited over ten years ago. Staff told us that they had checks carried out such as criminal records checks and references taken up before they started work at the home. The two staff who responded to our survey told us that their induction “mostly” covered what they needed to know to do the job when they started and one said that the induction covered what the needed to know “very well”. Staff told us that their training was relevant to their role and helped them to meet residents’ individual needs. There was evidence that regular supervision was taking place and the managers confirmed that staff received an appraisal every year. All the relatives who responded to our survey told us that staff “usually” had the right skills and experience to look after residents properly. Over 50 of care staff had completed the national vocational qualification (NVQ) at level 2 or above, which met the national minimal standards. The majority of staff had completed fire safety, health and safety and moving and handling training. One of the managers had received training in the Mental Capacity Act and said that training in deprivation of liberty and safeguarding was booked. The majority of staff had not received food hygiene and infection control training or needed a refresher session. Three staff apart from the managers had completed a first aid course but this did not provide a member of staff with a first aid certificate on every shift. None of the staff had received any recent dementia care training, the last training having been in 2004 and 2005. According to the records one member of staff had not received any training since 2005. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 38 People using the service experience adequate quality outcomes in this area. The managers are not proactive in managing potential risks to residents’ health and wellbeing. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home had two registered managers, one of whom was also one of the registered providers. They shared the management responsibilities and worked alongside carers on a daily basis. One of the managers had completed the registered manager’s award and national vocational qualification at level 4. The other manager had completed the assessor’s award. A resident told us Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 22 that the managers were “very good”. One relative said “I’m very happy with the management of the home”. Staff who responded to our survey told us that they received regular support from the managers and had discussions about how they were working. A member of staff we spoke with told us that the managers were “supportive”. The home was generally well managed but although the managers did meet the requirements in the last inspection report for improving the safety of the environment they did not address the requirement in relation to risk assessments for pressure sores and malnutrition and monitoring of residents’ psychological health until this inspection had taken place. The home did not have a formal quality assurance system with audits that could highlight potential risk to residents in the home before they were identified at inspection. The managers told us that they had an open culture within the home and encouraged staff, residents and relatives to come forward with any suggestions that could improve standards in the home. The garden had been developed in response to suggestions from residents and relatives. Relatives said that the managers were very responsive to any concerns raised. The home sent out surveys to residents and relatives once a year. The managers were able to monitor standards in the home as they carried out care alongside the carers. In the AQAA sent to us by the managers identified that the home did not have a number of policies and procedures that would provide guidance for staff, for example on the management of residents’ monies, pressure sore prevention and management, promotion of continence and dealing with violence and aggression. The managers said that they would ensure that the appropriate policies and procedures were available. The home kept a small amount of cash for residents’ day to day needs. Two balances were checked and were correct. Receipts were available for chiropody and hairdressing but toiletries did not have receipts as they were bought in bulk. The managers said that they would photocopy the receipts in future and highlight the purchase for the individual resident. A double signature system was used for receipt of money if this was received in the home. The managers said that they would in future take the residents’ records to the solicitor when they collected money and obtain a signature. The home had systems in place for servicing and maintenance of equipment. Water temperatures, at outlets used by residents, were monitored each month in order to ensure that they remained within a safe range for residents. The home had a fire risk assessment and the fire service had seen the assessment. There was evidence of fire drills and alarms and emergency lighting being tested. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 23 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The managers must ensure that the care plans are updated when residents’ condition changes. In order to provide staff with up to date guidance on the care residents need and to encourage consistency of staff practice. 2. OP30 18 The managers must ensure that staff receive training and updates in food hygiene, infection control, first aid, dementia care and the prevention and management of pressure sores. In order that staff are given the knowledge, skills and understanding to enable them to meet residents’ needs. 3. OP33 24 The managers must develop a quality assurance system for the home. In order to identify areas where improvements to care and services for residents are needed. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 25 Timescale for action 01/09/09 01/12/09 01/12/09 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 OP16 Good Practice Recommendations Staff should record verbal concerns as part of good quality assurance and to assist communication within the home. The managers should ensure that all relatives are made aware of how to raise a concern or complaint. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 26 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Kilkenny Residential Care Home DS0000017862.V375597.R01.S.doc Version 5.2 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!