Inspection on 09/08/05 for Kineton Manor

This inspection was carried out on 9th August 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

Kineton Manor 31/10/08

Kineton Manor 18/02/08

Kineton Manor 01/02/07

Kineton Manor 13/03/06

Kineton Manor 15/12/04

Kineton Manor 11/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Kineton Manor Manor Lane Kineton Warwickshire CV35 0JT Lead Inspector Sandra Wade Unannounced 9 August 2005 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. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Kineton Manor Address Manor Lane Kineton Warwickshire CV35 0JT 01926 641739 01926 642220 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) Mr Ken Inglefield Dr Paula Philippa Du Rand Care Home with nursing 42 Category(ies) of Old age(42) registration, with number of places Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 15 December 2005 Brief Description of the Service: Kineton Manor is a large converted manor house situated in the village of Kineton and is close to the village amenities. It is set in its own extensive grounds with an outlook onto open fields. The home is surrounded by well kept gardens and a large lawned area. The home is registered to provide personal and nursing care for 42 elderly service users. Ample car parking is available to the rear of the home. The service user accommodation is provided on two floors with 31 single ensuite rooms and 5 ensuite shared rooms. There are two lounges and one dining area. A lift is available to access all floors. The current proprietors Mr Inglefield and Mr O’Rourke have owned the home for the past 15 years. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced and took place between the hours of 8.30am and 7.10pm. This was the first visit for this inspection year. The inspection process included the examination of records including care plan records, discussions with services users and staff, a review of policies and procedures of the home, a brief observation of communal areas and discussions with the Manager. On arrival at the home staff were busy preparing breakfasts to take to the residents’ bedrooms. Some of the residents were up and in the dining area. What the service does well: What has improved since the last inspection? The Statement of Purpose and Service User Guide, which contain information about the home, is in the process of being updated. The Service User Guide is given to prospective residents so they can make well-informed choices about whether to accept a placement at the home. Access to the garden area is being improved by the completion of more robust ramps to all external doors. Residents confirmed that they made good use of the garden. Bathrooms are in the process of being refurbished. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 6 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. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 Information about the home is not currently up-to-date so that prospective residents can make well-informed choices about whether to live at the home. A written Statement of Terms and Conditions is made available to each service user. Each service user is assessed prior to moving into the home but they do not receive written confirmation that the home can meet their needs. EVIDENCE: A combined Statement of Purpose and Service User Guide has been developed which contains information about the home and services provided. The manager advised that this is given to prospective service users. A comprehensive Statement of Purpose should be developed separate to the Service User Guide. The Service Users Guide must be available to residents and visitors, which contains a summary of the Statement of Purpose and the most recent inspection report. The manager had identified they these documents needed reviewing and had already started to update them. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 9 Service users are issued with a Statement of Terms and Conditions and copies of these are available in the home. The manager advised that this document was currently being reviewed to ensure it was written in a clear format and contained more specific information on fees payable. The manager visits prospective residents to undertake an assessment of their needs. Records of these assessments are kept within the care plan documentation for residents. The manager does not currently write to residents to confirm that following their assessment the home can meet their needs as required by the Care Home Regulations. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8,9,10 Individual resident care plans are in place but they do not demonstrate that staff are meeting residents needs consistently. Medication systems are in need of review so that staff can demonstrate medications are being administered safely. Service users feel they are treated with respect and most of the time that their privacy is maintained. EVIDENCE: At the time of inspection there were 41 residents in the home. The manager stated that all but two had been assessed as having nursing needs. Residents looked well cared for and stated they were happy in the home although some acknowledged it was not the same as being in their own home. Each resident has a care plan setting out their needs and staff sign the bottom of the care plans each month and state whether there has been any change to these needs. On some occasions staff had written notes on the care plan because a care need had changed, this results in difficulty establishing current care needs in some cases. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 11 On one care plan it stated “refusing baths” and the next month a comment was written “no change to attitude” it was therefore not clear if the resident was having baths although other records within the home could confirm this. One resident spoken to explained a condition, which meant they sometimes were sensitive to hot and cold temperatures. This was not confirmed in their care plan so that staff were aware of it. The manager stated that this resident had not highlighted any problems associated with this condition. The daily records stated a resident had a dressing on their toe but there was no explanation recorded as to why. The daily records written by staff mostly relate to personal hygiene as opposed to reporting on the nursing/care needs as stated in the care plans. Notes in the care plans confirmed access to specialist support such as the community psychiatric nurse but the outcome of these visits was not clear. The manager acknowledged that further work was required to improve the information being recorded in daily records. A resident recently admitted to the home came with detailed care plans so that the home could use these in developing their own care plans. It was not evident from viewing the new care plans devised by the home that all the care needs had been fully addressed. The previous care plan made it clear that the resident liked to be cared for in a routine manner and likes and dislikes were very clear. Then new care plans did not reflect this routine. A note was made from staff of the previous home that fortified drinks were to be given between meals. The manager stated this was an error and fortified drinks were not to be given between meals. It was established during the inspection that this resident had been displaying some inappropriate behaviour; this was not reflected in the care plan. Care plans for this resident were still in the process of being fully developed and it was early days to get a full picture of this residents needs. At the time of the inspection there were two residents with wounds to the skin. The manager advised that contact with the district nurse had been made in regard to treatment and advice. The manager advised that she was in the process of reviewing medication management within the home. Medications are provided to the home by a dispensing GP. The manager currently orders medications so that a monthly supply is received for each resident. It was evident from viewing the medication records that there were some gaps on these records and some medications were recorded as being out of stock. It therefore appeared that these residents had not received their medication. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 12 The current process for managing medication does not allow for medications to be audited. The medication charts does not record the amount of medication received or when it was commenced, confirmation that all residents have received their medication was not clear. The manager is in the process of devising new medication charts these should resolve this matter. Appropriate systems are in place for the management of controlled drugs although one box of medication contained no label and the name had been handwritten which is not considered an acceptable practice. Medication for one person was being crushed with the permission of the GP and family. The manager is aware that it is not appropriate for some medications to be crushed as this can affect the effectiveness and could go against the product license. The manager advised that a review of this person’s medication had been requested with the GP to ensure this person’s medication was still fully appropriate. Residents spoken to felt that staff showed them respect and they were able to independently choose when they got up and went to bed. Residents said that staff did not always knock the door before entering. A mixed view was given about a lock available on the bedroom door. Some were happy without one and some said they would like a lock. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 Most service users find the lifestyle experienced within the home matches their expectations with the exception of preferences in regard to social interests and activities. Service users receive wholesome and appealing meals in surroundings of their choice. EVIDENCE: Social activities are provided within the home and these are confirmed in an activity schedule on the wall. These include bingo, arts and crafts and keep fit. On the day of the inspection, the residents were seen participating in keep fit to music, which was well attended. There is no activity organiser employed, the manager said that a member of staff is allocated to plan activities, which are scheduled for a two-month period. A recent quality satisfaction questionnaire carried out by the home confirmed residents would like to have some outdoor games. Records are not kept of those residents who take part in activities to confirm social care needs are being met and also to confirm they are generating sufficient interest. The manager stated that they try to do four outside trips per year and two had already taken place. One was to the Butterfly Farm and another was to St Patrick’s Park. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 14 There were mixed views in regard to activities provided, there was a comment that there were not enough activities provided and that there were limited opportunities to go out of the home. Other residents stated that they were happy with the amount of activities provided. A resident said they had not been asked what they would like to do but another resident stated that staff are always asking for suggestions for activities. If staff are busy certain activities being provided would not occur. Written menus are available confirming a good variety and choice of meals. These had been reviewed by a Dietician confirming the menus were nutritionally balanced. These menus are not currently displayed but the meals prepared each day are written on the blackboard in the dining area, which cannot be easily viewed by the residents. The manager confirmed that in addition to the three meals provided each day, supper is also provided around 8pm, which can be cheese and biscuits and a hot milky drink. The pre-printed menus currently do not detail the snacks, supper and full range of drinks provided. Many residents were observed to choose to eat in their own rooms as opposed to the dining room and staff took their meals to them on a tray. Meals were attractively presented and looked appetising and consisted of three courses for lunch. All service users were complimentary of the food and they said the food was “excellent”. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service users feel confident that their complaints would be listened to and addressed. EVIDENCE: There have been no complaints received by this home. The manager advised that any concerns reported to her are addressed with immediate effect. It was noted that issues raised with the manager by visitors to the home had been acted upon promptly. A complaints procedure is available in the Service Users Guide, which is issued to residents when admitted. The procedure does not give the full name, address and contact numbers of the manager or proprietor so that any relatives or visitors are clear where to write to. It was also noted that the Commission for Social Care Inspection was incorrectly named in the procedure. The procedure does not make it clear if complaints will be acknowledged in writing or whether the outcome of any investigation will be communicated in writing. The manager is currently updating the Service User Guide, which should address this matter. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 16 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, 25 Service users live in a pleasant environment, which has been well maintained. Some actions are required to the environment to confirm residents live in safe surroundings. EVIDENCE: A full tour of the home was not undertaken during this inspection and the furnishings are of a high standard and the areas seen were pleasantly decorated. There are two communal lounges with comfortable seating and one communal dining room. Bedrooms are located over 2 floors and there is a lift available for residents to access the upper floor. The manager advised that the main lounge is due to be refurbished. During the inspection water leaked through this ceiling; this was coming from the ensuite shower in the bedroom above. The manager was advised to take immediate action to address this matter. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 17 Both bathrooms in the home have assisted facilities for those residents who have mobility difficulties. Residents are able to easily access the gardens and patio areas and there is sufficient seating available that residents said they regularly use. At the time of inspection there were various building materials in the garden as work was taking place to improve the ramps leading into the garden from the home and also to refurbish bathrooms. Since the last inspection, the manager has taken action to record hot water temperatures and these have now been adjusted on baths and showers within safe guidelines. Hot water in wash-hand basins in resident areas still remains above the recommended guideline temperatures of 43°C. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 18 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) 27,28,29,30 There are not always appropriately trained staff available to the meet the needs of the service users. Not all staff have completed the necessary training to confirm they are competent to meet the needs of the service users. Service users are not supported and protected by the homes recruitment procedures all of the time. EVIDENCE: On the day of inspection there were 41 residents in the home. The manager confirmed that they aim to have 10 staff on duty during the morning (two of these being nurses) and 7 staff in the afternoons (two of which are nurses). And one nurse and two carers on night duty. Duty rotas viewed showed that care staffing levels are met most of the time, however nurse staffing levels are not being met consistently; on several days only one nurse is indicated on the day shift. Duty rotas indicated that on 31 July and 7 August no nurse was on night duty. On some occasions care staff working day shifts are indicated under the “night care assistants” section. Some staff are noted to work split shifts on the same day or long shifts in excess of 12 hours. One carer worked a day shift from 7.30 – 12.30 followed by a night shift. Another carer worked a night shift finishing at 8am and then work a evening shift from 4 – 9pm. These working patterns are not considered good practice as they can impact on staff effectiveness, which could affect resident care. There are three nurses who work days and nights in the same week. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 19 The manager acknowledges that they have been operating with reduced nursing cover and advised that actions are being taken to address this. There are dedicated staff to do washing up and laundry duties for five days per week and night carers also do some of the laundry duties. It was not clear from the number of hours that night care staff taake to do the laundry and therefore not possible to confirm precise care hours being provided. Staff are employed to undertake the cleaning and cooking within the home. The rota has “wash up” and “wash up cook” written next to some of the carers names. It is not clear how many care hours are being allocated to these duties. This manager has the support of administration staff and the home employ a gardener to maintain the extensive gardens. There are eight nurses and 30 carers employed at the home. Six of the carers have attained a “National Vocational Qualification (NVQ) II in Care” and two carers have attained a NVQ level III in Care. There is still many care staff that are to complete an NVQ qualification to bring the homes ratio up to 50 . This qualification is considered necessary for the home to demonstrate they employ both qualified and competent staff to deliver care needs of the residents. Staff files were viewed to confirm recruitment practices are being carried out appropriately to safeguard the residents. Files viewed contained references and criminal record checks, for overseas staff these had been obtained from their home country as opposed to this country. The manager advised that the Criminal Records Bureau stated these were acceptable. One file did not contain details of the persons health to confirm they were both physically and mentally fit to carry out their role within the home. Photographs were not on files and one file did not contain an employment history to confirm the references provided had been provided from their previous employers. Training information for staff is held on the individual files so it was not possible to confirm that all staff had completed appropriate training. Staff spoken to confirmed that they had attended statutory training but some staff still had further training to complete. The manager advised that statutory training is addressed for staff on an ongoing basis. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 20 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, 37 The manager is both experienced and competent to manage the care home. Systems are in place to ensure the home is being run in the best interests of the residents. Some of the record keeping, policies and procedures are in need of further review to demonstrate the home do what they say they do. EVIDENCE: The registered manager is an experienced qualified nurse with a PhD in nursing and has been in post as a manager at Kineton Manor for 18 months. She is currently taking the Registered Managers Award and should complete this by the end of 2005. In addition to this training the manager also participates in periodic training to update her knowledge, skills and competence. Both residents and staff were positive in their comments regarding the manager and felt well supported. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 21 There are systems in place to monitor the quality of service within the home including the use of quality questionnaires. Responses seen to these questionnaires were positive in regards to staff and the care provided. Some comments suggested that residents would like to get to meet other residents more and use the lounge and dining room more. The manager wwwould like to introduce an independent person to the home who can speak with the service users to obtain their views on what the home is doing well and what they are not doing well. Some of the record keeping within the home is in need of review and this is detailed within the appropriate sections of this report. The manager stated she had already spoken to staff about record keeping at a recent staff meeting. Meeting notes confirmed discussions had taken place on admission forms, care plans and documentation in the home in general. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x 2 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 3 x 3 x x x 2 x Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 23 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 OP1 OP37 Regulation 5, 4 Schedule 1 Requirement The Manager is to review the Statement of Purpose against Schedule 1 to ensure this contains all of the required information. The Service User Guide is to be updated as appropriate and must include a copy of the summary inspection report for the home. Revised copies of both documents are to be forwarded to the CSCI for review. 2. OP4 OP37 14 (1) (d) The manager must write to all residents following their assessment to confirm the home can meet their needs. Care plans must identify service user needs and staff actions required to meet these needs consistently. Care plans need to clearly indicate changes made as part of the review process so that current care needs can be easily identified. Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 24 Timescale for action 31.10.05 30.9.05 3. OP7 OP37 12 (1) (a) 15 30.9.05 Daily records need to demonstrate that care needs prescribed are being met. Outcomes of any specialist visits need to be clearly documented. 4. OP9 OP37 17 (1) (a) Schedule 3 The registered person shall make 31.8.05 arrangements for the recording, handling, safe keeping,safe administration and disposal of medicines received into the care home plus a record of all medicines kept in the care home for the service user, and the date on which they were administered to the service user. To comply with the above the manager must ensure:All medications taken are appropriately signed for on the medication administration charts (MARs). Any medications refused or not required must be appropriately coded on the MARs. All incoming medications must be recorded on the MAR charts. Start dates and details of medications carried over also need to be indicated on the MARs. All medications must contain appropriate labels. Details of medications recorded on the MARs must reflect accurately what is written on prescribing label of the bottle or box. The manager is to confirm the Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 25 date for the review of the medications for the one resident as discussed during the inspection. The outcome of this review is also to be communicated to the CSCI. 5. OP10 12 (4) (a) The registered person shall make 31.8.05 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. Staff need to be reminded to knock service user doors before entering. Service users must be consulted regarding their wishes to have locks on their doors and responses recorded. Actions need to be taken to address outcomes accordingly. 6. OP16 22 (7) (a) 17 (2) Schedule 4 (11) The complaints procedure is to be reviewed to ensure the correct details of the CSCI are detailed. Names, addresses and contact numbers of the Registered Manager and Provider should also be documented. The manager is to confirm actions to address the water leak in the main lounge originating from an ensuite bathroom. The manager is to confirm that the areas affected are structually safe. 8. OP25 13 (4) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from 31.8.05 30.9.05 7. OP19 13 (4) 23 (2) (b) 31.8.05 Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 26 hazards to their safety. Unnecessary risks to the health or safety of service users must be removed. The manager must ensure actions are taken to ensure hot water temperatures in resident areas are within the recommended guidelines. 9. OP27 OP37 18 (1) (a) (2) (3) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The manager must ensure that there are sufficient numbers of nursing staff on duty consistently to comply with previously agreed staffing levels. Duty rotas must clearly demonstrate any carer hours allocated to non caring duties such as laundry and washing up. A review of staff working hours/patterns is to be undertaken in particular for those working split shifts, long shifts (ie 12 hours) and day/night shifts in the same week. The home need to demonstrate that shift patterns can maintain the effectiveness of staff. The home must ensure that at all 30.9.05 times suitably qualified, competent and experienced persons are working at Version 1.40 Page 27 31.8.05 10. OP28/OP30 18 (1) (a) Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc the care home in such numbers as are appropriate for the health and welfare of service users To demonstrate that staff are suitably qualified, the home are to:Forward an action plan to address the additional care staff who are to complete the NVQ II in Care (this standard stipulates 50 of care staff should achieve this by 2005). Devise an at a glance training schedule detailing all staff and dates of training completed and training planned. 11. OP29 7,9,19 Schedule 2 The manager is to review care staff files to ensure they contain all of the required information. This is to include up-to-date photographs, employment history and evidence they are both physically and mentally fit to carry out their role. The manager should keep interview notes on file to demonstrate equal opportunities has been exercised. 30.9.05 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 OP2 Good Practice Recommendations The manager is requested to confirm that the new contract contains details on the rights and obligations of the service user and provider and who is liable if there is a breach of contract. E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 28 Kineton Manor 2. OP15 It is advised that the full range of snacks/drinks and supper provided are confirmed on the menus for the home to demonstrate that these are being provided. It is advised that menus are more prominently displayed within the home. 3. OP19 The manager should consider obtaining a suitable device that residents could use to alert staff that they need assistance when in the garden (eg if a resident should fall). Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Kineton Manor E53 S4398 Kineton Manor V243209 090805 Stage 4.doc Version 1.40 Page 30 - 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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