Inspection on 21/08/08 for Kilsby House Residential Home

This inspection was carried out on 21st August 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Kilsby House Residential Home 04/07/07

Kilsby House Residential Home 25/05/06

Kilsby House Residential Home 12/01/06

Kilsby House Residential Home 28/09/05

Kilsby House Residential Home 16/11/04

Kilsby House Residential Home 08/07/04

Kilsby House Residential Home 26/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Kilsby House Residential Home Rugby Road Kilsby Rugby Warks CV23 8XX Lead Inspector Ansuya Chudasama Unannounced Inspection 10:00 21 and 31 August 2008 st st 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 Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kilsby House Residential Home Address Rugby Road Kilsby Rugby Warks CV23 8XX 01788 822276 01788 824713 kilsbyhouse@aol.com 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) Advent Estates Limited Mrs Gillian Ann Saxton Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home limits its services to the following service user categories. No person falling within the category DE (E) can be admitted where there are 39 persons of category DE (E) already in the home. As part of the total number the home may accommodate a maximum of two people in the category of OP who have a relationship with a service user in the category DE (E). Total number of service users in the home must not exceed 39. Date of last inspection 4th July 2007 Brief Description of the Service: Kilsby House is an extended period property, situated in the village of Kilsby, which is on the border between Warwickshire and Northamptonshire The home offers care for up to 39 older people who suffer from dementia related conditions and promotes a person-centred approach to dementia care. The house is organised into three units for 15,14 and 10 people, each with its own lounge and a dining room with kitchenette facilities. Group living is practiced and residents are accommodated within a unit following an assessment of individual needs and dependencies taking place. There are single and shared rooms, the majority of which (85 ) have en-suite facilities to include a toilet and sink. There are two passenger lifts, one in the original house and one in the new extension. The home has a two raised (decking) patio areas, accessible to the residents. There is a garden, mainly laid to lawn, which is uneven and not fully enclosed. It is therefore not accessible to older people with mobility problems. Kilsby is a small village with limited public transport to local towns. Visitors to the home will therefore, require transport arrangements. The range of fees is £348.55 to £480 per week. This information was confirmed as current on 04/07/07. Further information about the home in the form of the Statement of Purpose, Service Users Guide or most recent inspection report can be obtained from the Registered Manager or Registered Owner at the home. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This home has 0 star rating and this means that the people using the service receive a poor service. We undertook a key inspection on the 21st of August 2008. We carried out this inspection in direct response to concerns raised to the Commission for Social Care and Inspection (CSCI) on standards of care in the home. CSCI were subsequently contacted with further concerns relating to the locks on bedroom doors and their use. We then revisited the home on 31st August 2008 to look in to the matters that had been raised. We spoke to the staff and the families of the residents living in the home. We talked to some of the residents, and looked at information about policies and procedures, which tells the staff how to do things in the home. We looked at the training staff do to look after the residents. We looked at information about some of the residents to find out how their needs are being met by the home. This is called case tracking. We watched how the residents and staff in the home got along together. We also undertook a Short Observational Framework for Inspection (SOFI) this is when we look at the experiences of people with dementia, by using this special observational tool. This helps us to better understand if the needs of people are being met. We did this over 2 hours. We made two immediate requirements at this visit. This is when something is a serious cause for concern and must be changed quickly to safeguard people living in the home. This was about how staff had been recruited. There is a special check by the Criminal Records Bureau (CRB) that must be carried out each time a person is employed in the home before they start to work in the home. This was not followed by the home and the home could place the people living in the home at a risk if the person was not suitable to work with them. The medication procedures in the home were not being followed properly and this could put the health of residents at a risk from not getting their medication properly. The people living in the home are called ‘residents’ as this is what they are referred to in the home. The report will refer to people using the service as residents. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 6 What the service does well: Some of the residents in the home say they: • • • ‘like it here’ ‘the staff are nice’ ‘like the food’ Some of the staff spoken to say: • • That they enjoy working at the home. They attend training to help them meet the needs of the people they look after. The Inspector observed: Staff were talking to the residents in the home in a positive and caring manner. • The staff were working well together • They know what food people living in the home enjoy The staff were observed asking and assisting those people who needed help at lunch time. • What has improved since the last inspection? What they could do better: The areas that management and staff must improve upon include: • The restrictions through the use of locked doors must stop, so that people have personal freedom and their civil rights and liberties are upheld The use of mattresses on the floor must stop as a preventative measure of injury, when a risk of falling has been identified. People must receive care and support that ensures they are treated with dignity at all times. • Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 7 • People using the service are involved in their care plans and they are updated after having a review for people living in the home to reflect accurate care intervention required Ensure that the staff are employed when satisfactory safe guarding checks have been made Ensure that the safeguarding team of social services are informed of any incidents that are safeguarding of vulnerable adults and arrangements must be made to ensure safeguarding referrals are made when incidents occur that adversely affects the health and wellbeing of people living in the home Structured activities must be undertaken to ensure that satisfactory stimulation and motivation is gained for all the residents living in the home Ensure that there are enough staff on duty to meet the needs of all the residents living in the home all of the time and have enough staff so all the people in the home can do activities and go out Ensure that the medication is safely administered Make sure that advocates are involved in helping residents living in the home to make decisions about their care and living in the home There should be person centred approach to meet the needs of residents in the home Ensure that full assessments are undertaken for all residents • • • • • • • • 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. The summary of this inspection report can be made available in other formats on request. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 8 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 Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,2,3,5,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their families have an opportunity to visit the home prior to moving into the home to see if it suits their needs. EVIDENCE: The service user guide and statement of purpose were available in lobby of the home along with the latest copy of the Commission for Social Care Inspection report. There was no evidence of residents having contracts / terms and conditions within their individual plans of care and discussion with the registered manager confirmed individual residents have not been given contracts. The Annual Quality Assurance Assessment states that there is a comprehensive assessment and involvement of a multi-disciplinary team prior to the admission of any new resident. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 10 None of the residents spoken to were able to recall moving into the home. However there was little evidence of an initial needs assessment within the individual plans of care. This could have a detrimental effect on the care and well being of the resident. Families spoken to stated that they had visited the home and had no concerns about the home. They felt they had chosen the best home. The home does not provide intermediate care. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Systems were not in place to ensure residents are protected by the homes policies and procedures for dealing with medicines. Residents dignity and privacy is not protected by some of the care practices carried out at the home. EVIDENCE: Each service user had their own individual plan of care that detailed how they need and wish to be cared for. The individual plans of care also contain information about people’s likes and dislikes, what is important to them and a life history that had been completed in consultation with family members. The individual plans of care also contained risk assessments for example moving and handling, falls, pressure care and use of bedrails. There was evidence that some were being reviewed but not on a monthly basis. Information read in one care plan stated that a care plan was to be introduced Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 12 for toileting programme and this was to be undertaken every two hours. However this was not being recorded but staff stated that they asked the resident if they wanted to use the toilet. We did not observe this practice. The care plan did not reflect the current care the person needed. In the care plan it stated that the person needed one person to help but it was observed that two staff had to help the person get out of a chair and to walk them to the dining room area. Negative words such as the person has to be’ nagged’ to eat were recorded in the care plan. Evidence observed on the day of the inspection showed that the staff had to feed and encourage the person to eat. Information recorded in the file or in the risk assessment was not always recorded in the care plan. There was no evidence to show that the person’s representative or the resident had been involved in reviewing the care plans. The risk assessments also needed expanding and to ensure that the five steps to risk assessment was completed. The daily record chart showed that all the resident’s names were recorded on this paper with ticks given for meals eaten and for fluid undertaken. This did not give an accurate picture of the amount of drink and food that was eaten by the resident. This chart was not always signed by staff and did not state what time this food was given. Information read that a person had a red sore on their body but it did not state what action the home had taken to meet the person’s needs. Individual plans of care showed that residents had access to a range of health and social care professionals such as consultant psychiatrists, general practitioners, dentists, optometrists, podiatrists and district nurses. There was a routine visit by an optometrists observed during the inspection, and the district nurse visited, however consultations were conducted in the communal lounge areas rather than in the privacy of the individuals bedrooms. There was evidence that some residents weight is monitored on a regular basis. We were very concerned that some of the residents were sleeping on a mattress on the floor. This was discussed with the staff and the manager. It was stated that the district nurse had informed them to undertake this practice and this was also to ensure that the resident did not fall out of bed. This practice was seen as being unacceptable and did not meet the needs of the residents. The staff on duty were spoken to about how they managed to move the person off the floor. It was stated by them that this was not a problem. However this was not a safe practice for staff to carry out as they put themselves and the resident at a risk. This unsafe practice has resulted in a requirement within the management and administration section also, as this practice places both residents and staff at risk of injury. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 13 The home had a medication policy. Medication was stored in a locked trolley, which was secured to a wall when not in use. There was separate provision for the storage of controlled drugs although the home needs to review this to ensure compliance with the revised Royal Pharmaceutical Society of Great Britain guidelines. The home uses a monitored dose system for the administration of medication however the medication administration records showed that there had been a number of occasions where prescribed medication had not been administered at times specified (This was a recommendation at the last inspection) The medication record sheets showed that sometimes staff had not signed to say that they had given out medication to the resident. The date of when medication was being received was not being signed by staff all the time Evidence also showed that the home ran out of medication for one resident and CSCI were not informed of this incident. Information read showed that one resident was not given their morning medication because the person got up late. However the evidence in the daily records showed that the person was got up and had a good breakfast. The information recorded in the medication charts were at times difficult to understand. The staff on duty was also not able to explain this information. One service user was observed being helped to take his medication. A clear explanation was given to him of what the medication was and he was helped to have a drink so he could swallow the tablets. This was done with sensitivity. One service user has a risk assessment for the administration of medication to be done by disguising the medication in her food. The service user had signed to give consent for this and it had been authorised by her general practitioner. Staff were observed speaking to residents in a respectful and courteous manner. They demonstrated a good understanding of each individual’s needs and how each person communicated. They were able to actively engage with people and demonstrated warmth and respect. Residents were addressed using their preferred name. The residents were generally well presented however two male residents on one of the units were unshaven. There were some residents whose hair had not been combed. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The residents living in the home are not provided activities to meet their social, cultural, religious and recreational interests and needs. EVIDENCE: The staff described various activities that were made available to residents such as hair care, make up, nail vanish painting, hand massage, walks around the village and tea dances. Some residents took part in the “Memory Walk” a fundraising event for the Alzheimer’s Society and a certificate displayed in the entrance hall showed the amount of money raised by the home the previous year. The home employs a caretaker who is qualified Daventry Area Community Transport driver. Staff told us how that this meant that residents were able to go out on outings in the minibus. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 15 On the day of inspection there did not appear to be any organised activities and individual plans of care contained very limited information about any regular activities that were available. In one lounge the residents were observed listening to some classical music and in another lounge one service user was observed caring for a baby doll, which they enjoyed. The AQAA describes how one unit has a sensory area. This needs to be developed further as it contained various pieces of old furniture and equipment and was also the area where the medication trolley and filing system is kept. Residents told us that they enjoyed visits from family members and friends. Family member spoken to stated that they were happy with the care provided from the home. It was said that they visited frequently and felt that they had chosen the right home. There was evidence that residents were given choice about what time they went to bed and got up in the mornings, however it appeared that some people were getting up very early. On the day of inspection records indicated that out of ten residents on one unit, six were up by 6:00 a.m. with some rising before 5:00 a.m. Record observed in other units also showed that a large number of people were being washed and dressed by 7.00am when the night staff left. Residents were observed during lunchtime in one of the units. The lunch smelled and looked appetising although there appeared to only be one choice of main course. The manager confirmed that they are currently recruiting a new cook and that the present person is covering until this new appointment is made. Residents were offered a choice of drinks and sweet. Discreet and sensitive encouragement and assistance was given to individuals who required help to eat their meal, however staff were very busy over this period being responsible for collecting and serving the food and clearing and washing up as well as helping individuals. One resident asked for a coffee after lunch time had finished, the staff member she asked went and made her one despite obviously being busy, however records on another unit showed that some residents may not be consuming adequate intake of fluids with seven out of the nine recorded as having six or less drinks in a 24 hour period. Observation in another unit showed that the staff were also very supportive to residents when having their lunch. We observed that one resident was sitting in the lounge because there was no room for them to sit at the dining table. Some of the chairs in the lounge were low and staff were observed helping residents to get up by holding on to each side of their arms. Some service users were also observed sitting in armchairs when having their lunch at the Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 16 dining table. They looked uncomfortable because the chairs were low. The staff and the residents did not know what was for lunch until it arrived. We were shown a menu booklet and the meal that was recorded was not on the menu. Most of the residents enjoyed the minced pork but not many people enjoyed the rice. The staff were observed helping one resident to eat their meal in between doing their other chores and this was not good practice. The inspector sampled the food and found that the mince was tasty but it was not hot. The rest of the food was hot but the cauliflower was a bit hard to eat, which can be difficult for the elderly to manage. There were two choices for pudding, which was ice cream but the staff did not know what the other pudding was called. We checked this in the kitchen but the meal cooked for the day was not recorded anywhere. All the residents enjoyed the pudding. However the staff had forgotten to give one of the residents their pudding. They were given ice cream that had melted. The home did not have any napkins for the residents to use at lunchtime and it was observed that some of the people had not moved from the dining area when they had finished their meal. They were observed having a nap still wearing their dirty blue plastic aprons put on at dinnertime. The lack of communication about what the meal was meant that residents did not have anything to “look forward to” or exercise any level of choice beforehand. Also considerable lack of respect for service users dignity was displayed by allowing residents to continue wearing dirt aprons well after the meal had finished. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management and staff do not inform the appropriate agencies of the accidents and incidents of concerns and therefore put the safety of people living at the home at a risk. EVIDENCE: The Annual Quality Assurance Assessment states that there has been one complaint and no safeguarding allegations made within the last 12 months. A further complaint and allegation has since been received and is currently under investigation by a multi agency team lead by the Local Authority. Kilsby House is divided into three units. All exterior doors to the building are locked as are the lounge / diner areas and the residents bedrooms. No residents hold keys to their own bedrooms, to the lounge areas, garden / decked patio area or to the front door. This means that people are not free to move around as they wish. Staff spoken to explained that this was necessary to ensure the safety of the residents however there were no risk assessments or assessments of individuals capacity to consent to theses restrictions within the individual plans of care. Residents were observed trying to leave the lounge areas and being unable to do so, this on occasions caused obvious distress. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 18 We were also very concerned regarding staff locking some resident’s doors from the outside. The staff stated that this was to stop other residents from going into their room. We were informed that the door from the inside could be opened. However the resident that was locked in the room from the outside was observed not to be mobile and would not have been able to open the door from the inside. There were no risk assessments undertaken for this practice. The management need to review this practice urgently to ensure that any restrictions placed on residents are legal, appropriately assessed and documented and in the best interests of the individuals concerned. Staff complete accident and incident forms for accidents and incidents involving residents. The manager explained that they were particularly vigilant in ensuring that this is done and that medical advice is sought as required. There were however recorded incidents of assaults between residents that should have been referred to the Local Authority under the local Safeguarding Adults arrangements. The manager was also unaware of the need to inform The Commission for Social Care Inspection of accidents or incidents under regulation 37 of the Care Standards Act. A number of incidents such as falls were recorded where medical assistance had been required and a further incident had been recorded where there had been no running water in one wing of the building, the Commission for Social Care Inspection did not have any record of these incidents. The home had a Safeguarding Adults policy. Staff spoken to were aware of the policy and understood their responsibilities within the policy. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 , 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Restrictions in place for the people living at the home means that they do not have freedom of the home or use of facilities. The décor and furnishings in some areas of the home does not provide a homely environment for people to live in. EVIDENCE: Kilsby House is a large, extended period property. It is divided into three separate units called Willow, Primrose and Bluebell. The manager informed us that the residents chose these names. The building is adequately maintained but is showing signs of wear and tear, for example broken tiles in the bathroom, wall paper hanging off the walls in Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 20 one of the toilets, rotten widow frames, uneven / loose floor boards, damaged light fittings, ripped. The communal areas were basically furnished and had been personalised to some extent with pictures and ornaments. Staff were observed struggling taking one resident in a wheelchair to the toilet in one of the units. The property has a lift to access the first floor but is not fully accessible to people with limited mobility having a number of internal steps and slopes, restricted space within some of the bathroom areas and narrow doorways. The manager stated that an occupational therapy assessment of the building had been carried out a couple of years previously and it is recommended that this be reviewed. The home was generally clean but in some areas there was an unpleasant odour and dust and debris could be seen. Residents bedding was stained and the plastic cover from when the mattress had been purchased was still on the mattress on one residents bed. The majority of residents had there own bedroom however two residents on one of the units were sharing a room. Space in this room was very limited and access with access to one of the wardrobes being very restricted. Part of the room had been sectioned off to provide an en-suite toilet for the neighbouring room and it appeared that the extractor fan for the toilet led directly into the bedroom. This arrangement needs to be reviewed to ensure the contractual obligations of the owner are met to meet the contract of terms of residency. It is recommended that thermostatic regulator valves should be fitted to regulate the temperate of the hot water taps used by residents as the water was very hot and presented a risk of scalding. It is recommended that all windows be checked to ensure that they have the necessary opening restrictors in place as these were observed to be missing from some rooms. A number of potentially dangerous items were observed in communal and bedroom areas during the inspection. For example a broken picture frame with broken glass in one lounge area, cleaning products in a cupboard accessible to residents, razors in peoples bedrooms and trailing electrical cables. All of which puts residents at risk of harm. There is an onsite laundry room, although functional this was damp with mould growing on one of the walls and damage to the ceiling where water had leaked through from the decking area above. The property has a large decking area at the rear that can be accessed via the downstairs units. On the day of inspection the doors leading onto the decking area were locked. There was garden furniture on the decking however it Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 21 looked in need of cleaning and the decking area was in places wet under foot and very slippery which could be hazardous to residents. The garden area in general looked attractive however there were items of old furniture and other debris that need to be cleared. A further decked area was accessible from the first floor unit. This was an attractive area that appeared to be well maintained. On the day of inspection no residents were seen using the outside areas. A number of staff live on – site, three in flats on the second floor and a further three in flats in the grounds. Access to the second floor flats is via the first floor unit, following an inspection from the fire safety officer the manager confirmed that the second floor flats are connected to the fire alarm system. A staff member who lives in the flats stated that staff living there are not allowed to have guests visit them as this could compromise the safety and privacy of residents. The manager needs to conduct a thorough review of the premises assessing risk and identifying where repairs are required to ensure that the environment is safe for the people who live there and for the staff. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes recruitment procedures are not robust and therefore put the lives of people using the service at a risk of potential abuse. EVIDENCE: On the day of inspection there were two staff working on each of the three units. The staff were attentive and sensitive to the needs of the residents however at peak times such as meal times and giving personal care, it was very difficult for staff to fully meet peoples needs. There also appeared to be little scope for staff to spend time talking to the residents or engaging them in activities. It was confirmed by talking to residents and staff that there were not enough staff to look after the residents. The staff spoken to stated that they enjoyed working at the home and found management supportive. Staff files showed that staff received an induction programme followed by on ongoing programme of training including dementia care, safeguarding adults, fire safety awareness, administration of medication, Moving and handling and risk assessment. Staff spoken to state that they were doing NVQ level 3 training. Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The people living in the home do not benefit from a well run home and management systems are not sufficient to ensure an acceptable level of service is provided for people living in the home. EVIDENCE: A manager and a deputy manager manage the home. Both were present on the day of inspection. In view of the significant shortfalls in meeting the minimum standards as outlined in all the above sections within this report the management of the home at the time of this inspection was poor. The manager was not aware of the information regarding the recruitment process. It was stated that the director of the home managed this. This information was emailed to the home. Two immediate requirements were made and an Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 24 action plan was received about medication issues but the information about staff recruitment was not adequate. So this was discussed with the Director of the home who stated that the staff files were up to date and POVA first and CRB checks were being undertaken for all staff. The service did not have a quality assurance system that met the standard. No questionnaires had been sent out to people living in the home or their relatives. The recruitment procedures of the home were not robust and put the lives of the people living at the home at a risk. The accidents and incidents that occurred at the home were not being reported to the relevant agencies under regulation 37 of the Care Standards Act and under safe guarding procedures. (see section on concerns and complaints). The staff were not getting regular supervision to monitor their practice. The staffing hours showed that the needs of the people are not being met. There was however no evidence of references being sought or of Criminal Records Bureau (CRB) or protection of vulnerable adults (POVA) list checks being obtained prior to appointment for the staff records inspected. The finance’s of a resident was checked and it showed that the money was incorrect. All of the above to residents being put at risk . Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 25 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 1 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 1 X X 1 Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 26 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 OP2 Regulation 17 schedule 4 Requirement All people living at the home must have a contract of residency so that they are clear on their rights and responsibilities, know the charges of the home and are clear what services are to be included for the fees that are being paid. Assessments of peoples needs must be completed in full and linked to the care plans to make sure that their needs are met in full. Care plans must be reviewed at least monthly and every time there is a change in a persons well being, then changed so that they actually reflect the condition and needs of each person. This is so that staff have relevant and correct guidance to meet the individual needs at all times to maintain the residents safety. There must be suitable handling, recording, and administration of medicines. The storage of controlled drugs needs to comply DS0000012830.V371023.R01.S.doc Timescale for action 30/09/08 2. OP3 14 31/10/08 3. OP7 12 & 15 31/10/08 4. OP9 13(2) 25/08/08 Kilsby House Residential Home Version 5.2 Page 27 5. OP10 12(4)(a) 6. OP10 12(4)(a) 7. OP12 16(2)(m)( n) 8. OP14 12(2) & (3) 9. OP15 12(2) & (3) 10. OP18 12(1), 13(6) (7) with current regulations to ensure the people living in the home are protected. (Immediate requirement made at this inspection) Written records maintained by staff about people living in the home, must be written to maintain the dignity of the person. The use of the word ‘nagged’ must cease. The practice of placing people on mattresses on the floor if they are at risk of falling must cease. Appropriate measures must be taken to maintain the safety of the person as well as treating them with dignity and respect. Activities and social opportunities must be available to meet and support the individual needs and aspirations of the people living at the home. People must have the choice and control in their own lives to decide what time they get up and go to bed and what they would like to eat at mealtimes. This is so that people living at the home maintain at least a minimal level of control in their lives. People living at the home must have the assistance that they require at mealtimes so that they are able to eat their meals without being rushed, in a dignified manner and before their meals go cold. People must at all times have freedom of movement so that they are not restrained at anytime and have free access throughout the home and its external facilities. Care must be provided in accordance with the mental capacity act, to ensure people’s civil liberties and rights DS0000012830.V371023.R01.S.doc 31/10/08 31/10/08 30/11/08 30/09/08 30/09/08 30/09/08 Kilsby House Residential Home Version 5.2 Page 28 11. OP18 12. OP19 13. OP26 14. OP27 15. OP29 are upheld. Management and staff must refer any suspected or alleged abuse in accordance with the local protocols to safeguard vulnerable people. This is to ensure that people receive the support from the multi agency group to ensure people living at the home are protected. 23(2)(a) The décor, furnishings and & (b) layout of the home must change and improve in order to create a safe and homely environment for people to live in. 16(2)(J) & All areas in the home must be (k) & cleaned to ensure that there are 23(2)(d) no odours of urine; this is to make sure people have a pleasant environment in which to live. 18 & 19 There must be sufficient staff on duty at all times to ensure the individual needs of all people living at the home can be met. 7, 9, 19 A POVA first check as a minimum schedule must be secured and two 2 references and all matters listed in schedule 2. This is to protect the people living at the home, from receiving care by someone who may not be suitable to work in a care home. An immediate requirement was issued on the day of inspection. 12(1), 13(6) 37 18 Sufficient monitoring and systems must be in place to ensure the level of competency held by staff is to an acceptable and safe level to provide sufficient care to the people living at the home. The management in the home must be sufficient to ensure the health, well-being and safety of people living there. Management DS0000012830.V371023.R01.S.doc 30/09/08 31/10/08 31/10/08 15/11/08 25/08/08 16. OP30 31/10/08 17. OP31 9(1) & 12(1) 31/10/08 Kilsby House Residential Home Version 5.2 Page 29 18. OP33 24 19. OP35 16 (l) 20. OP38 12(1)(a) must be proficient to ensure people needs are met through systems, supervision and monitoring alongside effective leadership. There must be systems in place including the seeking of the views of people that live in the home, that management then act upon and subsequently change the delivery of care so that they influence the running of the home. Systems for the maintenance of resident’s monies must be changed. So that balances of residents monies is correct and receipts of all expenditure is in place. Measures must be taken by management to ensure that a safe environment is provided for people living at the home, including access through windows, water temperatures and moving and handling of people. This is to reduce the risk of injury to people living at the home and staff. 30/11/08 30/09/08 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kilsby House Residential Home DS0000012830.V371023.R01.S.doc Version 5.2 Page 31 - 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. 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