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Inspection on 07/02/06 for King William Residential Home

Also see our care home review for King William Residential Home for more information

This inspection was carried out on 7th February 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Generally the home presents as being well maintained and there are a range of lounge areas available for service users to use. Service users said they enjoyed the food at the home which also included the provision of a cooked breakfast. Service users said their clothes were well cared for and bedrooms kept clean and tidy.

What has improved since the last inspection?

A door has been fitted to one en suite facility. The five yearly electrical installation had been overdue but has been rechecked.

What the care home could do better:

Staffing levels need to be reviewed to ensure that there are sufficient staff on duty to ensure service users needs are met and there are staff to provide general observation of service users. There is a limited range and inconsistent provision of social activities offered to service users at the home.

CARE HOMES FOR OLDER PEOPLE King William Residential Home Lowes Hill Ripley Derbyshire DE5 3DW Lead Inspector Bridgette Hill Unannounced Inspection 7th February 2006 09:00 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 King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service King William Residential Home Address Lowes Hill Ripley Derbyshire DE5 3DW 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) (01773) 748841 01773 743606 Ashmere Care Group Mr Gerald Poxton, Mrs Sandra R Poxton, Mrs Ann Theresa Poxton, Dr Michael G Poxton, Mr David A Poxton Vacant Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (23), Physical disability (5) of places King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th September 2005 Brief Description of the Service: The King William Care Home provides 24-hour staffed care for 28 older people. The Home is a large detached brick building which is situated on the edge of a Derbyshire market town with good shopping facilities and amenities available within half a mile of the Home. The facilities provided at this Home comprise of 24 single rooms and 3 double rooms many of which have en-suite facilities available. The Home provides a garden area with easy access for Service Users. Services provided to Service users include personal laundry, home cooked and traditional food, social events and leisure activities. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced one which took place over 5 hours. A group discussion with 4 service users was held as part of the inspection process. The acting Manager Gill Wright was on duty at the time of the visit. Various records including care planning records were examined the findings are recorded in the body of this report. What the service does well: What has improved since the last inspection? What they could do better: Staffing levels need to be reviewed to ensure that there are sufficient staff on duty to ensure service users needs are met and there are staff to provide general observation of service users. There is a limited range and inconsistent provision of social activities offered to service users at the home. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 6 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. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 The Statement of purpose is not providing accurate information to service users. EVIDENCE: The requirement relating to the Statement of purpose was checked. This confirmed that this has not been amended and does not accurately record the management structure and name of the person who has been appointed as Manager of the home. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10,11 In general care plans were found to be well personalised and descriptive of how assessed needs were to be met. EVIDENCE: A sample of two service user care plans were examined to assess how standards were being met. The format of the care planning documentation was long and at times repetitive. It was found however that the content of the care plans were individualised and gave a overview of each service users assessed needs. A range of risk assessment tools was in place. One of these the nutritional assessment was not being scored in all sections as it cross-referenced another risk assessment tool that was not used at the home. This affected the scoring of the tool and the interpretation and subsequent planning to meet assessed needs. The frequency of reviews on one tissue viability assessment had also been changed by staff from that recommended on the risk assessment tool to a less frequent timescale. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 10 Care plans had been reviewed monthly and a quality check undertaken by the Manager was completed monthly. The storage and administration of medicines was examined. The temperature of the treatment was recorded and was within acceptable limits. Most handwritten medication administration records were doubly checked and signed but not all. In one bedroom topical preparations were found to be opened but undated. A record of drugs returned was available. The balance of controlled drugs was correct and these were stored correctly. Service users spoke to said they felt staff did protect their privacy when undertaking personal care tasks. One care plan examined did contain details of the service users post death wishes a second did not. The outstanding requirement is therefore considered partially met and additional work is required. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Limited social and leisure activities were being offered to service users and records were not in place to demonstrate that there was a personalised assessment of needs or records that all service users were receiving appropriate social and leisure activities. EVIDENCE: Some social activities were recorded within a book. Some activities were recorded as ‘Residents Choice’ but no positive choice of an activity appeared to have been given as records of activities were typically, watched TV, chatted with other residents, or spoke with visitors. The activities record indicated that typically one activity was offered and this was infrequent. External entertainers were arranged to visit the home. Records indicated that the same service users often declined to take part. This led to the possibility of service users not receiving any social stimulation suitable for their preferences and needs. There was not an individual record of what activities service users had chosen to do or any record of their abilities, responsiveness, functioning and enjoyment of activities participated in. When service users were asked what activities were on offer one service user said ‘not a lot’. Service users did talk about the external entertainers who appeared to be enjoyed by all. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 12 A residents/relatives meeting was planned for the following week and one service use was aware of this. There were social care plans included in care files but these could be improved by increased personalisation of preferences and abilities. Of the care plans examined to track care there was a frequent refusal by service users to join in activities recorded with no records to indicate alternative activities had been offered. This is an outstanding requirement from previous inspections Two service users spoken said they attended a local church on a regular basis. A choice of meal was available to service users at lunchtime. Service user spoken said they enjoyed this. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Service users were aware of how to raise concerns and complaints were recorded but actions taken were not fully recorded. The Protection of vulnerable adults procedure was ambiguous with conflicting procedures given which may lead to inappropriate handling of allegations. EVIDENCE: Information on how to complain was made available to service users on how to complain. Service users spoken to said they had not had any reason to complain but said they felt able to should they have cause. One complaint was in the process of being dealt with at the time of the inspection. There wad a justifiable delay in the investigation of this and whilst the complainant had been verbally informed of this there was no record of a written response being given, this would be good practice. There was also no recording of the verbal action taken. Protection of vulnerable adults training had been completed by staff. There have not been any amendments made to the Protection of vulnerable adults procedure and this containing conflicting advice on how any allegations were to be handled. In one instance advocating investigation through Derbyshire County Council Protection of vulnerable adults procedures and also advocating internal investigation. This is an outstanding requirement from previous inspections. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25,26 The home was to be generally kept in good order and provided a good range of communal areas for service users to use. EVIDENCE: The split flooring in the ground floor sluice had not been repaired as detailed on the last inspection report. This is an outstanding requirement from previous inspections The kitchen remained potentially accessible to service users and the risk assessment in place was oriented to staff activities and did not assess the potential risk to service users. This is an outstanding requirement from previous inspections. Service users bedrooms were found to be individual with personal effects and photographs being evident. Bedrooms were generally in good decorative order with furnishings being suitable for the service users. One bedroom was found to have a strange odour. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 15 Three lounge areas and a smoking area were available for staff to use. These were found to be well maintained and each service user appeared to have their own seat where they chose to sit. Radiators in the home were covered with accessible controls to control the heating. Mops were found to be stored head down in buckets and one was found to be in a particularly dirty state. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,30 The staffing levels at the home fell short of the required number of hours calculated for the numbers and dependencies of service user according to the Residential Staffing Forum EVIDENCE: Staffing levels were examined. These confirmed that for most shifts there were 3 staff including 1 senior care staff member on shifts between 8am and 8pm. For night shifts there were two staff on duty. Some shifts were recorded on duty rota’s where only two care staff were on duty in the afternoon. There were some service users in the home who were identified as needing two staff to meet their personal care needs. It of concern that after 8pm at night when many service users are still up this leaves no staff in the home to meet care needs or observe service users when two staff are required to meet the needs of some service users. Service users said that staff did come when they required assistance but ‘not always quickly’. A calculation was made post inspection of staffing levels according to dependencies based on the Residential Staffing Forum this indicated a shortfall in the number of hours being provided. A copy of the calculation has been provided to the home in order that this can be addressed. The staff team at King William do appear to a stable team with few changes. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 17 Staff training records were examined these confirmed that annual updates in fire safety and moving and handling had been completed. Staff had also completed courses in first aid, infection control and health and safety. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35,36,37,38 Some areas of management of care needs and staffing at the home require work particularly staffing levels, staff supervision and the provision of social needs to service users. The management of the environment to maintain standards appears to be reasonably acceptable with the exception of the requirements listed. EVIDENCE: Whilst an Acting Manager has been appointed an application has not yet been received by the Commission for Social Care Inspection to formally register the Manager. The Acting Manager is supposed to work two days on a supernumerary basis but discussions and rota’s indicate that this was not also being made available. Service users spoke positively of the Manager and staff team at King William. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 19 Some monies were kept in the home safely on behalf of service users. A sample of records relating to these was examined. Transactions were recorded and verified by two signatures and receipts for purchases retained. Balances of a sample of monies correlated. Supervision records were examined. A format for recording supervisions were available these were found to be inconsistently completed and not up to date. Some records, which are required to meet regulations, did not meet standards for example the Statement of purpose. Some personal care records were also again found in unsecured areas of the home as has been found at a previous visit. This has been recorded as a requirement but has not been addressed to ensure service users confidentiality has been maintained. Chemical cleansers were being held securely however they had been diluted as per manufacturers guidelines and decanted into bottles with no labels or labels which were difficult to read due to wear. King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 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. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 x x 3 2 3 2 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x 3 2 2 2 King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement The Statement of purpose must be amended to ensure that it meets the requirements of Schedule 1 Timescale for action 31/03/06 2 OP8 15 Previous timescale 30.11.05 Where trigger tools are utilised 30/03/06 the guidance for reviews of these must be completed in relation to the score Previous timescale 30.10.05 Where medication administration records are hand written these must be signed, checked and counter signed by a second staff member Previous timescale 30.10.05 Topical preparations must be dated on opening and discarded according to manufacturers guidelines Where a variable dosage of a medication is prescribed the actual dosage administered to the service user must be recorded Residents must be consulted DS0000020027.V282298.R01.S.doc 3 OP9 13 28/02/06 4 OP9 13 28/02/06 5 OP9 13 28/02/06 6 OP11 12 31/03/06 Page 22 King William Residential Home Version 5.1 regarding their post death wishes This must be reviewed regularly. Where this is considered inappropriate the reasons for this must be recorded Partially completed Previous timescale 30.12.05 The provision of activities must be offered be offered in accordance with service users assessed needs and be included in a plan of care Previous timescale 30.11.05 The protection of vulnerable adults policy must be clear in what action staff must take following any allegations and refer to locally agreed procedures where service users are funded by local authorities Previous timescale 30.10.05 The home must undertake a risk assessment of the kitchen and area as it is potentially accessible to service users and ensure all appropriate actions are taken to protect the health and safety of residents Previous timescale 30.10.05 10 11 12 OP24 OP26 OP26 16 13 16 Measures must be taken to eradicate malodours from the home Mops must be cleansed regularly and stored in a fashion that limits infection control risks The split flooring in the sluice must be repaired Previous timescale 30.1.05 Staffing levels must be maintained for the number and dependencies of the service DS0000020027.V282298.R01.S.doc 7 OP12 15,16 30/04/06 8 OP18 13 30/03/06 9 OP19 13 28/02/06 28/03/06 28/02/06 30/03/06 13 OP27 18 28/02/06 King William Residential Home Version 5.1 Page 23 14 OP31 8 users in the home in accordance with the residential Staffing Forum A manager must be appointed and an application made to formally register the manager with the commission for Social care Inspection Previous timescale 30.11.05 The registered person must ensure that all staff receive formal supervision which meets the National Minimum Standards for content and frequency All records containing personal data must be held securely in accordance with the Data Protection Act 1998 Previous timescale 30.9.05 Where chemical cleansers are decanted into bottles these must be clearly labelled with the name of the product and the dilution strength 15/03/06 15 OP36 18 30/04/06 16 OP37 17 28/02/06 17 OP38 13 28/02/06 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 2 3 Refer to Standard OP12 OP16 OP33 Good Practice Recommendations The service users abilities, responsiveness, functioning and enjoyment of activities should be recorded on an individual basis Where there is a delay in investigating complaints a written response to explain this should be provided to the complainant Feedback should be formally sought on the home from service users, relatives and visiting professionals King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 King William Residential Home DS0000020027.V282298.R01.S.doc Version 5.1 Page 25 - 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!