CARE HOMES FOR OLDER PEOPLE
Kilkenny Residential Care Home 6 Third Avenue Frinton On Sea Essex CO13 9EG Lead Inspector
Marion Angold Unannounced Inspection 5th January 2006 11.40 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 Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 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 01206 855219 Mr Rajalingum Valaydon Mrs Denise Valaydon, Mrs Christine Joan Emmamdeen, Mr Mamode Farouk Emmamdeen Mr Rajalingum Valaydon 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.V276617.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 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 Statement of Purpose and Service Users Guide to be revised and edited 23rd August 2005 Date of last inspection Brief Description of the Service: The Kilkenny is situated on the outskirts of Frinton town centre, close to the sea front and within walking distance of all local amenities. Bedrooms upstairs can be accessed by means of a chairlift. There is a car parking area at the front and an enclosed, paved garden at the rear. The home provides care for 11 older people, aged over 65 years. An application by the provider to vary the registration category to include service users with a dementia has been accepted since the last inspection. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 10.40 and 18.40 hours with the assistance of the registered manager and deputy manager. Mr Mamode Emmamdeen, one of the registered providers, was also on the premises, during the morning, but did not take part in the inspection. This inspection focussed on the core Standards not covered in August 2005 and any shortfalls identified at that time. The process involved observation, speaking with residents, management and staff and examination of a number of records. Of the 12 Standards inspected, 5 were met and the remainder presented minor shortfalls. What the service does well: What has improved since the last inspection?
Three staff had attended a session on loss and bereavement and others had attended courses relating to health and safety. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 6 The deputy manager had completed the National Vocational Qualification in management and care, Level 4. 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. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Information provided for prospective residents was comprehensive but could be written more clearly. EVIDENCE: The home’s Statement of Purpose and Service User Guide had been sent to the Commission, as requested, between inspections. These documents contained all the required information but continued to need editing in places. Examples were discussed with management during the inspection. Although the home had admitted one new resident since the previous inspection, it was not possible to inspect their pre-admission assessment of need and care plan because, as reported to the inspector, the deputy manager was working on the file at home. Management were advised that care plans must at all times be available for staff reference and inspection. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10 Residents benefited from a person-centred approach to care planning and the home’s arrangements for administering their medication. One situation occurring in the home continued to compromise service users’ privacy. EVIDENCE: All files available for sampling contained holistic care plans, with detailed instructions to staff. These plans had been reviewed approximately twice a year. Discussion took place with management about evaluating care plans on a monthly basis, as set out in National Minimum Standard 7.4. Two care plans sampled contained relevant information about the residents’ medication, including its purpose, dosage and possible side effects. Prescribed medication was appropriately stored and managed. The pharmacist’s monitoring visit on 19/3/05 had generated a satisfactory report and the deputy manager explained how their two recommendations were being carried out. The deputy manager, who took overall responsibility ordering, storing,
Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 10 administering and returning medication, had attended an advanced training session in the care of medicines. At least one other member of staff had completed the pharmacy’s standard medicines training in 2005, as evidenced from their records. Arrangements for administering and recording given medication were satisfactory, as discussed during the inspection. At the last inspection there was some uncertainty about whether the bedroom at the front of the house had been used occasionally as a visitor’s room. The present occupant of this room confirmed that they were the sole user of their room. The other issue arising at the last inspection was whether staff consistently knocked before entering residents’ bedrooms. Two residents said on this occasion that not everyone knocked before entry. Management showed surprise and reported that they had continued to reinforce this matter with staff on a regular basis. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 15 Residents benefited from an open visiting policy. There was scope for extending the periods when they were involved in meaningful occupation and for promoting their involvement and choice in relation to daily menus. EVIDENCE: One member of staff was employed for 8 hours a week to provide activities. By all accounts this was working well. Several residents also went regularly to a day centre. During the inspection, however, most residents were not involved in any meaningful occupation and several spent all day in the same chair with a table in front of them. The television was varied with some music for a period in the afternoon. One comment showed that a physically active resident would benefit from support to make more constructive use of their time. Staff indicated that they tried to provide stimulation for residents but this depended on other demands on their time. Before the last inspection, the deputy manager and other staff had attended a day workshop on promoting activities and meaningful occupation for people with dementia. Aside from the periods covered by the activities coordinator, there was clearly scope for staff to put this training into practice more generally. Although the Statement of Purpose and Service Users Guide requested that visitors made appointments outside the hours of 9 am and 5 pm., it was the
Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 12 experience of a member of staff and a resident, who commented separately on this aspect of provision, that there were no restrictions on visiting. One resident was positive about meals at The Kilkenny. Meals were prepared according to a cycle of menus covering several weeks although these were not adhered to rigidly. Menus were displayed in the kitchen and therefore not readily accessible to residents. Lunch was served through a hatch, ready plated, according to known preferences. A selection of food was available at for tea but not all residents were able make a decision when presented with a choice verbally. However, a plate of cakes was taken round for people to see. The inspector spoke with management about developing ways of getting service users more involved in menu planning and promoting choice. Although residents were invited to the dining table during the inspection, comments they made demonstrated that this was not always the case. They usually ate at their respective places in the lounge. One person said they did not mind this arrangement. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 There was scope for the home to increase its protection of residents from abuse. EVIDENCE: Three service users confirmed that staff were kind to everyone. A number of copies of the Essex Vulnerable Adults Protection Committee’s booklet were available for staff in the home but the in house adult protection policy, reviewed in July 2004, was found not to be fully in line with EVAPC guidelines. The manager was directed to the free training provided by EVAPC and informed that the need to protect service users must take precedence over the principal of confidentiality. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 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 the following standard(s): 26 Service users benefited from a home that was clean and fresh. EVIDENCE: All parts of the home sampled during this inspection were found to be clean and fresh. Laundry facilities were separate from the kitchen and the washing machine provided a suitable programme for soiled linen. An appropriate policy and procedures were available to staff in respect of the control of infection and related matters, such as the use of personal protective clothing, dealing with clinical waste and hand washing. One person described suitable steps for handling any soiled linen. Not all staff had attended recent infection control training, but this has been addressed under NMS 30 and 38. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 Residents were protected by the home’s recruitment and staffing practices. Not everyone had completed the mandatory training programme, appropriate to their roles. EVIDENCE: Three people were on duty when the inspector arrived, including the manager and deputy manager. Two staff covered the afternoon shift, from 3 pm. Rotas confirmed these arrangements and showed that shifts overlapped by 15 minutes to allow for handover. One of the staff, who lived in the flat above the home, could be available to help off shift, if necessary, as demonstrated during the inspection. They also provided much of the sleep in cover to support the person awake on duty through the night. In addition to these arrangements, one person was employed for 8 hours a week, for activities and two others, for a total of 20 hours, to do cleaning and washing up. The home also had also accepted on placement, for one session a week, a student of social care. This person was there during the inspection and observed assisting in ways, which did not involve personal care. As observed, these arrangements were adequate for me residents’ basic needs, and providing some periods of stimulation. However, as highlighted under NMS 12, residents would benefit from more support to spend longer periods in purposeful or stimulating activity.
Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 16 Two staff files were inspected and found to contain the necessary documentation. The student on placement had supplied a Criminal Record Bureau disclosure and a reference from their college. Since the last inspection, 3 staff had attended a session on loss and bereavement. Staff had also continued to update their mandatory training: 6 staff had attended infection control courses and one had undertaken care of medicines training with the home’s pharmacy. A number of staff were attending a modular course on safety compliance, through Chelmsford College. A letter from a training provider evidenced that the home was awaiting dates for food hygiene and health and safety training. The inspector advised management to consult their fire officer and Skills for Care about whether their in house fire safety training met the requirements for the home. It was also emphasised that all staff must complete the mandatory training, relevant to their roles, and that it might be helpful to make this clear to new staff in their job description and contract of employment. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 The health and safety of residents could be enhanced by attention to identified shortfalls. EVIDENCE: The deputy manager had completed the National Vocational Qualification in management and care, Level 4 and was awaiting their certificate. Staff supervision could not be fully inspected because management said the records were being worked on away from the premises. However, they explained that supervision was based on a shared agenda and lasted between 30 to 45 minutes. One member of staff confirmed that supervision covered various aspects of their work as well as their developmental needs. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 18 Records showed that fire extinguishers, the fire alarm system, emergency lighting, hoist and stair lift had been checked and serviced under contract and that the home had carried out routine testing of fire alarms and equipment and scheduled periodic fire drills. However, it was evident that the advice of the Fire Brigade officer, who visited on 1/9/05, had not been heeded fully because there were a number of obstructions remaining on the second floor staircase. These were removed during the inspection. Management were advised to consult their fire safety officer about the need for automatic closing mechanisms on doors currently wedged open. Management were also advised of the need for specific and up to date risk assessments and action in relation to exposed radiators that were very hot to touch. It was also drawn to their attention that risk assessments needed to be reviewed in line with the Control of Substances Hazardous to Health Regulations (COSHH) 99. The inspector received different reports about the manner in which one resident person was assisted with transfers. One account highlighted that this was sometimes in contravention of moving and handling regulations. Not all staff, involved in giving personal care, had attended moving and handling training and other gaps in mandatory training had still to be addressed. However, it was encouraging to note that the deputy manager and several staff were undertaking a 12-week course on safety compliance. Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 2 Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 20 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 OP3OP7OP 37 Regulation 17 Requirement The registered person must ensure that records required by the Care Homes Regulations, Regulation 17, Schedules 3 and 4, are at all times available for inspection on the premises. The registered person must ensure that staff respect the privacy of service users rooms. This is a repeat requirement. The registered person must make arrangements, by training and other measures, to afford residents maximum protection from abuse. The registered person must ensure that staff are appropriately supervised. This Standard could not be fully inspected due to records not being on the premises. The registered person must ensure that unnecessary risks to the health or safety of service users are identified and, so far as possible, eliminated. Timescale for action 05/01/06 2 OP10 12 (4) (a) 05/01/06 3 OP18 13 28/02/06 4 OP36 18 (2) 28/02/06 5 OP19OP25 OP38 13 (4) 31/01/06 Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 21 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 OP1 Good Practice Recommendations The registered person should edit the Statement of Purpose and Service Users Guide to remove typing and grammatical errors and present the information in a manner, which is easier to follow. The registered person should ensure that residents’ care plans are reviewed at least once a month. The registered person should arrange for residents to spend more time engaged in meaningful occupation. It is recommended that the registered person enable residents to eat their meals at a dining table and have more information and choice in relation to menus. 2 3 4 OP7 OP12 OP15OP20 Kilkenny Residential Care Home DS0000017862.V276617.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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