Inspection on 11/04/05 for Kiln Lodge

This inspection was carried out on 11th April 2005.

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

Kiln Lodge 08/06/07

Kiln Lodge 27/06/06

Kiln Lodge 10/11/05

Kiln Lodge 27/10/04

Kiln Lodge 02/06/04

Kiln Lodge 26/04/04

Kiln Lodge 04/08/03

Kiln Lodge 11/09/02

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Kiln Lodge 66 Kiln Road Fareham Hampshire PO16 7UG Lead Inspector Laurie Stride Unannounced 11/04/05 11:20am 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. Kiln Lodge Version 1.10 Page 3 SERVICE INFORMATION Name of service Kiln Lodge Address 66 Kiln Road, Fareham, Hants, PO16 7UG 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) 02380 233 808 Mr Christopher Cowling Mrs Christine Jeanette Hall CRH 20 Category(ies) of DE(E), OP registration, with number of places Kiln Lodge Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27/10/04 Brief Description of the Service: Kiln Lodge provides care for older persons and older persons with mild to moderate dementia. Service users are encouraged to maintain their independence but assistance is given when help with personal care is required. Accommodation is provided in an older house converted to meet the needs of the service users. Bedrooms provide a mix of shared and single accommodation, some with en suite facilities. The home is situated in a residential area on a busy road. The gardens provide a pleasant seating area for service users. Kiln Lodge Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first of two annual inspections of the home and was unannounced. The visit lasted nine hours and included a tour of the premises, inspection of records, observation of working practice, speaking with 2 service users and 5 members of staff. The manager was on leave at the time of the visit and the newly appointed deputy manager assisted throughout the inspection. The proprietor was also present for part of the visit. Since the last inspection a number of management and staffing issues have been highlighted and these will be further discussed with the proprietor. What the service does well: What has improved since the last inspection? What they could do better: Kiln Lodge Version 1.10 Page 6 At the time of the inspection the home was not being managed properly and improvements in monitoring the quality of the service are needed Care planning must improve to ensure that staff are able to know what to do for each resident. A procedure must be written to ensure that if anyone living in the home needs ‘as required’ medication then staff can administer this safely and properly. The complaints procedure must include the contact details of the Commission for Social Care Inspection so that people can take complaints further if needed. To ensure that the home is safe and comfortable for people living there, the nurse-call buzzer alarm system must be improved so that staff can give assistance promptly if needed. The risk of scalding from hot water outlets in several service user’s bedrooms must be assessed to ensure service user’s safety. Records must be kept in the home to show that staff are being recruited correctly so that people living in the home are protected; and staff must have proper induction and supervision to ensure they are meeting service users’ needs. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kiln Lodge Version 1.10 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 Kiln Lodge Version 1.10 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 on this occasion. EVIDENCE: Kiln Lodge Version 1.10 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) 7, 9 and 10 The care planning system is not consistent and does not therefore adequately provide staff with the information they need to satisfactorily meet service users needs. There is no written procedure for the administration of ‘as required’ (PRN) medication and this potentially places service users at risk. Personal support is offered in such a way as to promote and protect service users’ privacy and dignity. EVIDENCE: At the previous inspection evidence was seen that the manager had reviewed and updated service users’ care plans and risk assessments. However, during the period since that visit a number of new service users had been admitted to the home but care plans and risk assessments for the individual support needs of many were not available. A sample of written assessments completed by the deputy manager for those admitted since she had been in post was seen, however there was no evidence available to demonstrate that care plans had been drawn up based on assessments. There is no written procedure for the administration of ‘as required’ (PRN) medication. The home has failed to meet this requirement on three previous Kiln Lodge Version 1.10 Page 10 occasions despite new timescales being given. The deputy manager said she would write the procedure and inform the Commission of Social Care Inspection (CSCI) when it was completed. A service user confirmed that staff were courteous and respectful, worked hard and looked after the residents well. They said that there were some routines in the home but service users could decide things for themselves, for instance when to get up and at what time they went to bed. Staff were observed offering personal care and support in an appropriate manner. Where service users share a room, screening is provided to ensure their privacy. Kiln Lodge Version 1.10 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 on this occasion. EVIDENCE: A previous requirement to consult service users and/or relatives about the programme of activities was discussed and, based on comments given by staff, this has not been carried over in this report. This standard is to be further reviewed with service users at the next unannounced inspection. Kiln Lodge Version 1.10 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 By displaying the complaints procedure and including details of who to complain to, the complaints procedure would be more effective. EVIDENCE: The home has a formal system of recording and responding to complaints within timescales. The complaints procedure needs to include the name and contact details of the Commission for Social Care Inspection, so that people can take complaints further if needed. It is also suggested that the complaints procedure be displayed within the home to ensure service users, relatives and visitors have access to it. Kiln Lodge Version 1.10 Page 13 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) 19 and 25 While recent maintenance and redecoration within areas of the home has improved the quality of the environment, upgrading some of the safety aspects would further protect service users. EVIDENCE: A number of recent improvements had been made to the premises and these were detailed in the previous report. Work had been carried out to repair the damage caused by a chimney collapsing during high winds in December 2004. Staff reported that there had been concerns over the welfare of residents accommodated in the affected rooms following the incident. These will be further investigated following discussion with the proprietor. The home is equipped with an alarm/buzzer system connected to each service user’s room. It was noted that this could not be heard in certain areas upstairs and this raised concerns that calls for assistance might not be heard, especially at night when all the available staff could be working in the affected areas. The proprietor was present at this time and assisted in testing the system. The proprietor explained that service users had previously complained that the Kiln Lodge Version 1.10 Page 14 alarm/buzzer was too loud so it had been modified to sound quieter. Following the test the proprietor said he would take action to provide a more suitable and safe system. A previous requirement to undertake risk assessments in relation to the possibility of service users receiving scalds from hot water taps, and to take any necessary action, had not been met. The hot water taps in each bedroom / bathroom / toilet were tested with the assistance of the home’s deputy manager and the majority of these were found to be unmodified and therefore a potential risk to service users. Service users who were identified as vulnerable had not been risk assessed and had access to unmodified hot water taps, either in their rooms or in nearby bathrooms / toilets. The majority of these service users had been admitted to the home since the previous visit in October last year but individual written care plans were not available. A Notice of Immediate Requirement for action was issued at the time of the visit. This requires the responsible person to take immediate action to address the issue identified and to ensure the safety of all persons within the premises. Kiln Lodge Version 1.10 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) 27, 28, 29 and 30 Consistency of care cannot be provided within the current staffing levels. The recruitment procedures within the home are not thorough enough to protect service users. A more comprehensive induction for staff would better equip them to meet the needs of service user’s. EVIDENCE: Records showed that three carers were on rota for each of the six-hour morning and late shifts. Night staff are employed to conduct routine checks throughout the night. The deputy manager also works in the home during the day until 4pm and a cook and a cleaner are on duty until 2pm. Staff reported that they did between one and two hours cleaning as part of their duties. Staff and a service user said that more staff were needed, particularly with regard to the number of service users requiring support for dementia. An example was given in relation to the afternoon shift: if three staff were on duty, one would be working in the kitchen at teatime and the other two could be assisting a service user upstairs, leaving no members of staff available in other areas of the home. If a member of staff is cooking or cleaning they cannot be counted as care staff. Within the last month a set rota had been devised that will assist senior staff to plan ahead and identify possible staffing level shortfalls in advance. However, the senior staff were aware that the rota could not currently be covered if staff holiday and sick leave were taken into account – then staffing levels could sometimes fall to two instead of three carers on shift. Senior staff Kiln Lodge Version 1.10 Page 16 were also aware that staff working longer hours were more prone to going off sick creating further staffing level shortfalls. A service user also commented that staff worked hard but for too long; and records showed that a number of carers worked double shifts although the deputy manager said she was now monitoring this. Action was being taken to address the issue of staffing levels and it was reported that the home was in the process of advertising for two additional full-time day carers, one part-time night worker and one part-time weekend carer. It was reported that, from May 2005, ten members of staff were registered to undertake NVQ care awards. The deputy manager planned to commence an NVQ level 3 in the near future. This standard will be further assessed at subsequent inspections. A sample of records was seen in respect of two new staff members. Both of these contained evidence that Criminal Records Bureau (CRB) checks had been carried out prior to them commencing work at the home. There was no such evidence in respect of a third member of staff and a number of records did not include photographs for identification purposes. A programme of two or three hour training modules in moving and handling, first aid, dementia awareness, health and safety, abuse awareness, medication awareness and infection control was planned between May and December 2005. A number of staff confirmed that they had training in these and care procedures. One carer had been in post over a year and had not received training in dementia, although this was now booked for May 2005. The carer felt able to meet service user’s needs through the experience gained working with residents and consulting with senior staff. The home had a recorded induction schedule for new staff, but this did not meet the recommended Training Organisation for the Personal Social Services (TOPSS) standards. Staff reported that induction procedures had not been carried out correctly and as recorded for all staff and this will be further discussed with the registered person. It is strongly recommended that the home adopts a structured induction and foundation programme in line with the TOPSS standards, in order to ensure that staff are properly equipped to commence working with vulnerable people. Kiln Lodge Version 1.10 Page 17 Kiln Lodge Version 1.10 Page 18 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, 33 and 36. A review of management responsibilities and practice, including improvements in the quality assurance monitoring system and staff supervision, would help to ensure the home meets its stated aims and objectives and is run in the best interests of service users. EVIDENCE: At the time of the inspection the registered manager was on leave so it was not possible to discuss with her a number of outstanding requirements from previous inspections. The deputy manager had only been in post for four weeks and was being assisted by a former manager within the company. The proprietor visited the home during the morning of the visit to talk to the inspector. Discussion with all senior and care staff on duty raised further concern about management practice within the home, though not in relation to the deputy manager. These issues will be discussed with the registered provider and a number of them have been highlighted within this report. Kiln Lodge Version 1.10 Page 19 Reports of regulation 26 visits carried out by the service provider were on file although copies of these had not been sent to the Commission for Social Care Inspection. These reports did not contain sufficient detail to assess whether adequate quality assurance monitoring was taking place. After discussing this with the proprietor it was advised that a suitable person is appointed to undertake the task of unannounced monthly visits and reporting on the conduct of the home, including the promotion of the National Minimum Standards and adherence to the Care Homes Regulations 2001. This standard will be further assessed on subsequent inspections. Through discussion with the deputy manager and staff it was also apparent that formal recorded supervision of care staff had not been taking place despite verbal reports to the contrary. Contemporary records of staff supervisions were not available. It is essential that all staff are appropriately supervised to ensure that policies and procedures, guidance and training are put into practice. Staff reported that they felt well supported by the current management arrangements and senior staff were accessible and responsive to questions and gave guidance. Kiln Lodge Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 x x x x x 1 x STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x 1 x 2 x x 2 x x Kiln Lodge Version 1.10 Page 21 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 7 Regulation 15 Requirement The registered person must ensure that each service user has a written care plan including any necessary risk assessments. Develop a procedure for staff to follow when administering as required (PRN) medication. (Previous timescales of 01/09/03, 07/06/04 and 05/11/04 not met) The complaints procedure must include the name, address and telephone number of the Commission for Social Care Inspection. The nurse-call buzzer alarm system is improved to enable staff to respond promptly throughout the home. Individual service users are risk assessed in relation to their private accommodation and risk of receiving scalds and thermostatic safety mixer valves fitted to bedroom / bathroom / toilet sinks accordingly. (Previous timescale of 05/11/04 not met) Staff records must contain two satisfactory written references, photographic identification, and Version 1.10 Timescale for action 30 May 2005 30 May 2005 2. 9 13(2) 3. 16 22(1)(7) 30 May 2005 4. 22 23(a) 30 May 2005 12 April 2005 5. 25 13(4) 6. 29 19(1)(b) Schedule 2 30 May 2005 Kiln Lodge Page 22 7. 8. 30 33 18(1)(c ) 26(5) 9. 36 18(2) sufficient evidence of Criminal Records Bureau (CRB) checks in relation to each member of staff. (Previous timescale of 26/11/04 not met) Staff receive proper induction training appropriate to the work they are to perform. Copies of reports of home visits carried out by the provider (or appointed person) must be forwarded to the Commission for Social Care Inspection. (Previous timescale of 05/11/04 not met) The registered person must ensure that staff are appropriately supervised and records are kept. 30 May 2005 30 May 2005 30 May 2005 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 30 Good Practice Recommendations The homes induction programme is reviewed and developed in line with the Training Organisation for the Personal Social Services (TOPSS) induction and foundation standards. Kiln Lodge Version 1.10 Page 23 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton Hampshire, SO15 1GW 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 Kiln Lodge Version 1.10 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. 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!