Inspection on 12/02/07 for Kingfield Holt

This inspection was carried out on 12th February 2007.

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

Kingfield Holt 12/12/07

Kingfield Holt 12/10/05

Kingfield Holt 19/06/05

Kingfield Holt 08/03/05

Kingfield Holt 04/10/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Kingfield Holt 38 Kingfield Road Sheffield South Yorkshire S11 9AS Lead Inspector Stephen Robertshaw Key Unannounced Inspection 12th February 2007 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 Kingfield Holt DS0000002977.V324727.R02.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. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingfield Holt Address 38 Kingfield Road Sheffield South Yorkshire S11 9AS 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) 0114 255 3968 0114 255 3968 none Mr Ibrahim Farid Ibrahim Mrs Celia Norma Ibrahim Miss Susan Iris Walker Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2005 Brief Description of the Service: Kingfield Holt is a home that provides care for 25 older people. The home is situated in the Brincliffe area of the city. The detached building is in its own grounds and is close to a good selection of local amenities including an extensive range of shops, pubs, and a park. The grounds around the home are very pleasant offering a patio area and well established gardens. All but one of the bedrooms are single and many have en-suite facility. There are three dining rooms and three communal areas for service users to sit including a spacious sun lounge. The current fees for the home are between £395 and £485 per week. These fees cover the services identified in the homes statement of purpose and service user guides. Additional costs are made to service users for private services including chiropody, hairdressing, newspapers, magazines and personal toiletries. The previous inspection reports are made available to the service users and to visitors to the home. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was unannounced and took place on the 12th February 2007. The inspector was in the home for approximately six and a half hours. The evidence for the report was gathered through a variety of information that included discussions with the service users, observation of documentation in the home, interviews with management and staff and contact with outside health and social care professionals that are involved in supporting the home with the care needs of the service users. Pre-inspection questionnaires were also returned to the inspector before the site visit took place. Prior to visiting the home the inspector sent survey questionnaires to service users of which six were returned. Some of the comments received by these people have been included in the report. Due to four surveys going astray in the post three of these were requested again by the commission, in total six additional ones were received and comments from these have been included in this report. This has caused some delay in the production of the report, therefore timescales have been amended to reflect this. The inspector also looked around the home and looked at lots of records, including resident care plans and records relating to the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. The inspector would like to thank everyone who completed a questionnaire and/or took the time to talk to him during this visit. Your comments and input have been a valuable source of information, which has helped create this report. What the service does well: The environment of the home is kept very clean and tidy and the service users commented on how well they are looked after in the home. The staff receive a lot of training to make sure that they understand the needs of the service users. The home had a friendly feeling and all the staff were welcoming and knew a lot about the people who lived there. The people that live in the home say that the staff are ‘very helpful’ and understand how they need to be looked after. The home also encourage those who are able to maintain their independence wherever possible, for example looking after their own medication. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 6 Visitors to the home said that they are always made to feel welcome. The atmosphere in the home was very relaxed and the staff support the service users to make decisions for themselves and to make the environment homely for them. The people living in the home told the inspector how kind and caring all staff were to them and felt confident that the manager and care staff would sort out any problems that they had. Staff were observed helping the people who live in the home in a dignified way. The people living in the home said how much they liked the meals and said there was enough choice for them and the portion sizes were good. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 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 Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the service users have their needs assessed before they are admitted into the home to make sure that a placement there would be appropriate and be suitable to meet their needs, however in some instances the quality of the homes assessment would benefit from being more robust. EVIDENCE: At the time of the site visit there were twenty-two service users living in the home and the inspector observed all of the records held in the home for three of the service user’s. The care files seen included either a Local Authority/Health assessment and or a homes assessment of the service users needs prior to admission. Where a service user is privately funded it is unusual for another authority to undertake Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 9 the pre admission assessment, this would be the responsibility of the home. The homes manager completes these assessments and whilst the format does cover all of the required areas the information recorded is very basic and does not clearly identify the level of individual need in each area, other than to say it is needed or not. Obviously when this is supportive of a Local Authority assessment the lack of detail in the homes own assessment is not an issue, however in instances where this is the sole assessment then problems could occur. Identifying the persons strengths and weaknesses is key in maintaining independence but mainly to enable the home to decide if the staff have the required skills to care for them if they move into the home. Care files included a copy of the service users contracts and terms and conditions of their residency at the home. This included a description of what services are provided for the agreed fees. Interviews with the care staff and discussions with the service users demonstrated that in general the home has the capacity to meet the needs of the service users. Service users spoken to by the inspector stated that they had been given the opportunity to visit the home before they made a decision to move there on a more permanent basis. One service user survey form supported this comment by saying “ I came for a day. Then later stayed for a month, so was able to make a proper decision” One service user stated to the inspector that ‘I like it here because I can keep my independence’. The home does not provide intermediate care to service users. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs are generally met, however the basic nature of the service user care plans does not provide enough information on how their needs should be met and could result in service users receiving inappropriate care. EVIDENCE: The inspector observed all of the individual care plans for three identified service users living at the home. The care plans had been drawn up from the homes assessment and as a result there was little information to aid the formulation of a detailed person centred care plan. An example of this is one service user was identified with mobility needs in their assessment and care plan. The registered persons were able to describe the service users changing need and required level of support, but this level of information was not included in the care plan/daily records and there remains some confusion Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 11 whether a hoist should have been used or not. If service user needs and how these must be met are not recorded in sufficient detail there is a risk of inconsistent care being delivered or at worst not occurring. Service users living at the home who are self-funding have their care plans reviewed on a regular basis by staff, however given the basic starting point of the care plans the review process is not effective. In addition it was not clear from the records whether service users had been consulted about the changes or any other relevant person. The manager stated that families and carers have been invited to reviews at the home but they had declined to attend the reviews. There was no evidence to support that the invitations had been sent out, or that the carers had stated that they did not wish to attend. It is important that the service users needs are effectively re-assessed to make sure that they are looked after properly. One service user living at the home had significantly deteriorated and as a result had recently been re-assessed by the local health and social care team and the outcome was that they required nursing care. The Local authority reported that the quality of care plans, review of these, moving and handling documents had not been completed in sufficient detail .The service user despite being funded by the Local authority had not had a formal review of their care for 18 months, the registered persons saw this as the responsibility of the Local Authority and a failure in their system. However registered persons must be clear about their responsibilities to ensure service users needs are being met whilst in the home. Even where it may be the express wish of family that the person remains in the home there remains a responsibility to request a review and follow this up where it is not forthcoming. The registered person is of the view that it was the level of clinical input and an inability to be maintained by district nursing services which required the change to nursing care and not the homes inability to meet the persons needs. There was no evidence that the service users had been consulted in the development of their care plans or that they were in agreement to them. Service users spoken to by the inspector stated that they were ‘very happy with the care’ provided to them at the home and stated that they did not want ‘anything else’. A visitor to the home stated that their mother had been in the home for approximately eighteen months and that the staff ‘do their best’ and that her mother was ‘reasonably well looked after’ there. The care staff and management spoken to by the inspector agreed that the care plans were very basic and anyone new to the home could not deliver the appropriate care to the service users through reading the care plans. The registered persons stated that new care staff upon starting work at the home Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 12 would not look at care plans for several weeks and that as the home does not deploy agency staff then the quality of care plans is not an issue. The manager and staff did appear to understand all of the needs of the individual service users but accepted that most of this information was ‘in their heads’ and was not recorded. The inspector stated to the manager that this system was not acceptable and clear care plans must be developed to ensure the safety of the service users and to make sure that anyone tasked with delivering their care can do so in a consistent and acceptable way to the individual service users. Care plans were also supported with risk assessments once again these included very basic information and did not clearly identify how the risks should be managed and minimised such as where self medication is taking place. There was no evidence to suggest that the risk assessments are evaluated on any regular basis to ensure that they were still appropriate to the individual needs of the service users. The home does have a poster displayed in the managers office which warns of the danger of bed rails and this was supplied by the hospital services, however an individual risk assessment was not in place for the use with individual service users. This is essential as service users react in different ways and behave in different ways and it is those individual behaviours which need to be taken into account in this process. One size assessment does not fit all . One professional survey did express concern that “the hoist was not always used when it should be”, this conflicted with the view of another who said “ they are very safety conscious and show general concern regarding the residents” The service users individual care files provided evidence that their healthcare needs are met at the home. This includes appointments with doctors, dentists, chiropodists and opticians. Two visiting nurses were spoken to by the inspector and they stated that the home were responsive to the healthcare needs of the service users and worked with any care plans that they left at the home to support the care of individual service users. One district nurse stated to the inspector ‘the staff are very good’’ they ‘understand service users behaviours and manage them well’. The district nurse also stated that the home also receives support from the ‘POPS’ team. This team provides training in the local area and provides education for end of life care. The inspector observed the care file for a service user that had recently died at the home and there was evidence that the care that they received was appropriate to their needs. One professional survey said that “Kingfield Holt is an excellent home” & another said “staff are always helpful, respectful and dignified in their conduct. As a community nursing team we feel they really care about their clients” At the time of the site visit one service user was receiving end of life care from the home, the general way in which this care was delivered was observed from a distance and district nurses reported that the home promoted dignity and respect to the person throughout the process. One returned comment card stated “My Mum has just died and I feel the care and consideration given to all Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 13 the family has been extremely good” another said “ I cannot fault the care my aunt has received and is continuing to receive” One service user living at the home had had diverse cultural needs and the manager confirmed to the inspector how their cultural and religious needs were met. This included through meeting their dietary and religious needs. The service user confirmed to the inspector that she was supported to maintain their diet and that they were also supported to celebrate all of the holy days that they wished to keep. The prescribed medication in the home is only administered by the nurses that are employed there or by staff that have completed an accredited medication course. The medication is stored in a cabinet that is located in the main office in the home. All of the Medication Record Sheets observed by the inspector were accurately recorded and were up to date. A NOMAD system is now in position for the administration of medication at the home. The home did not have a controlled medication record book, therefore if a service user was admitted to the home and were prescribed controlled drugs then these would not be appropriately recorded. One service user was prescribed Fentanyl patches and these were stored in her bedroom. The inspector informed the manager that these were not being stored or recorded appropriately and that the inspector would seek guidance on this from a pharmacy inspector. The pharmacy inspector advice was that it was good practice to store & manage Fentanyl Patches as if they were a controlled drug. This means that if the service user continues to be prescribed with this medication the home should consider providing a suitable double locked storage facility for the controlled drugs, receipt and administration and returns should be recorded in an appropriate controlled medication record book. One service user that was case tracked was self-administering medication, medication was being received by the home and staff reported they were checking at various intervals that the service user was taking their medication. There was no obvious risk assessment, risk management plan or recorded evidence of checks being undertaken to support the service user to self medicate. The manager needs to identify the means by which she will monitor and manage the risks and ensure the service users continue to administer their own medication safely. These support mechanisms are essential and allow for a speedy response when problems occur. Direct observations during the course of the inspection supported the evidence that the service users privacy, dignity and respect are upheld at the home at all times. The service users spoken to by the inspector stated that they felt that their health care needs were being supported at the home. Kingfield Holt DS0000002977.V324727.R02.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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users have freedom of choice in their daily lives however the activities available to them in the home are limited. EVIDENCE: The service users are free to determine their daily living activities in the home, this included the times that they rise from and retire to bed. Service users told the inspector that they were happy that they were able to maintain and develop their personal lifestyles in the home. Direct observations, discussions with service users and interviews with management and staff evidenced that there are not many stimulating activities on offer to the service users. One service user commented that ‘I am able to maintain my independence here, although there’s not much to do’ at the home. The staff group and other service users supported this evidence. The inspector raised this issue with the manager of the home and she stated that a new senior care staff was in position and one of her responsibilities was to Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 15 develop a range of stimulating activities for the service users. The senior care staff was interviewed by the inspector and confirmed that she had been delegated to develop the activities that would be made available to the service users. One relatives comment card did also suggest that an area for improvement was “every day entertainment” for service user with dementia related problems. Service users are able to watch the television in various areas around the home. However the main lounge that is used by the service users to watch television is adjacent to the car park. The main entrance to the home is via a sunroom and to access the majority of the home and access the visitor’s book the individuals need to go through the television lounge. Two service users stated that this could be very disturbing for them. The service users also added that when service users die at the home and funeral flowers are donated to the home they are placed on a long table in the same room and this ‘looks like a coffin’ and is upsetting to them. Funeral flowers are also placed in the fire hearth in the same room. The inspector spoke to the manager in relation to this and suggested that alternative arrangements should be made for the funeral flowers due to the negative effect on the service users that the current arrangements provides. The inspector spoke to three visitors in the home. They all stated that they are always made to feel welcome at the home no matter what time they arrive. Their only concern was that at times ‘its difficult to find staff’ otherwise they were very happy with the care provided at the home. They also stated that access to the management was very good. There were no records to support that regular service user and carers meetings are held to identify their opinions on the services being delivered in the home. The service users are provided with nutritious meals. They all confirmed to the inspector that they were very happy with the quality and diversity of the meals provided at the home. The meals were well presented and the dining room although small was well laid out enabling service users with mobility problems to access the tables. The inspector observed the kitchen and found it to be very clean and there were plentiful supplies in the fridge, freezers and dry food stores. Visitors to the home stated to the inspector that the meals that they had seen being offered in the home were very good. One service user commented that the home has ‘two very good cooks’. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 16 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, 17 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the service users feel that they can voice any complaints in relation to the services that they receive at the home and they are protected from abusive situations. EVIDENCE: There is a clear complaints procedure in the home. The inspector spoke to three visitors to the home and four service users who all confirmed that they knew how to make a formal complaint and they were all confident that if they made a complaint it would be taken seriously and the management would act on any issues raised from the complaint. There had been no formal complaints recorded in the home up to the day of the site visit. On the day of the inspection a complaint was received by the Commission, however the visiting inspector was not aware of this until after the site visit had taken place. This outcome of this investigation will be included in the next inspection report. Prior to the site visit taking place the Commission received information from a district nurse stating that she would be making a vulnerable adult referral, this was confirmed through documentation provided by the Local authority. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 17 However after visiting the home the investigating officers did not conduct a Protection of Vulnerable Adults case, alternatively they arranged for a reassessment of the service users needs and it was identified that they needed to be transferred to a home that provided nursing care. The outcome of the reassessment identified that the homes care plans, risk assessments, moving and handling and turning assessments were not followed appropriately and they were all very basic and did not meet the needs of the service users. The registered providers were concerned that they were not made aware of the investigation and were not offered the opportunity to present the facts and defend their position. Subsequently and as a result of additional correspondence/comments with Sheffield PCT, the registered providers have been given written confirmation that “this in no way was a criticism of the care received by X whilst a resident at Kingfield Holt” Interviews with staff supported evidence that they understand what could be seen as abusive situations in a home and they understood how to report this to the appropriate people. Some staff stated that they had received training for the protection of vulnerable adults from the local authority and also through their NVA training. The manager confirmed this to the inspector, however the training records were not available to further support this evidence. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that generally the environment is suitable to meet the needs of the service users however there are some areas that require further development. EVIDENCE: The inspector made a tour of the premises. The home was well decorated, clean and was free of any offensive odours. Four service users invited the inspector to have a look around their personal rooms and these had all been decorated and furnished to their own personal tastes and preferences. The home was exceptionally clean and tidy. The home does not employ domestic staff. The care staff are allocated time in their duties to clean around the home. The kitchen in the home was also very clean and well presented. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 19 The grounds of the home were well kept and there are car-parking facilities to the rear of the building. CCTV is not used in any areas of the home that would intrude on the privacy and dignity of the service users. There is a choice of communal areas that the service users can utilise. These rooms are well decorated and the furniture is comfortable and domestic in character. The only difficulty identified with the communal areas of the home was where funeral flowers were displayed as highlighted earlier in this report. The bathrooms and toilets in the home were all found to be very clean and were free from any offensive odours. Staff are provided with protective equipment and hand cleansing facilities, however in bathrooms and toilets infection control policies and procedures are compromised as a result of blocks of soap and linen towels for use by service users. There is only one piece of moving and handling equipment in the home and the records showed that this is serviced and maintained on a regular basis. A legionella test was completed on the homes water systems in February 2007 and a safety certificate was provided. The home had safety certificates for all of the gas appliances in the home. However the certificate for the electrical systems was out of date. The last certificate was issued in March 2002 and the certificate was valid for three years. The manager of the home informed the inspector that a new assessment of the electrical systems had been sought. All of the fire safety equipment had recently been inspected and approved for use. This included the fire extinguishers and the fire alarm system. The service users confirmed to the inspector that they have freedom of movement throughout the home. The laundry in the home was small but it was well organised. The washing machine was programmable to disinfection and sluicing standards and the walls and floor were constructed with an impermeable surface. Service users spoken to by the inspector stated that they usually got all of their own clothes back from the laundry. They also said that the staff put their names in all of their clothes to avoid any confusion. All of the radiators in the home have been protected with low temperature surfaces to protect the service users from contact injuries. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 20 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, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the service users believe that the staff that care for them in the home have all of the skills and knowledge to help them. EVIDENCE: The staff personnel and training files were not available to the inspector at the time of the site visit. The files were securely stored in the main office at the home and the manager stated that the proprietor has the only key for the unit and they were not available. Five service user questionnaires were returned to the inspector and they were all positive in relation to the abilities of the staff that cared for them at the home. Several of the service users commented that the staff were ‘very nice’ and that they were ‘always available’ however ‘sometimes when other service users need more care you have to wait’ but added ‘this doesn’t really matter because at other times it could be me that they had to spend more time with’. Two surveys were returned which identified an issue with staffing levels one said “The level of staffing, in terms of numbers, is a bit low at the moment which I know they are addressing”, “possibly higher staffing levels at peak times would be beneficial”. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 21 Interviews with the staff and visitors to the home supported that in general they have the knowledge and skills to care for the service users living there. The manager informed the inspector that 44 of the care staff have achieved NVQ 2 or equivalent. This shows that they are working well towards their commitment for 50 of the care staff to have achieved a minimum of NVQ 2. The staff that were interviewed by the inspector suggested that these figures were correct. However the training records were not available to support these facts. The staff also commented that they had undertaken most of the mandatory training however yet again the documentation was not available to support this. Only one member of staff has completed a current first aid course. One member of staff spoken to by the inspector said that the staff group ‘were good’ and offered the 100 care’ to the service users and ‘offer good food’ they said that a combination of all of these helps to make the service users more sociable with each other. The manager of the home stated that a thorough recruitment policy and procedure is in position in the home and stated that no staff are employed to have any contact with the service users until after they have completed the appropriate security vetting. The records to support this process were not available to the inspector, however staff interviewed by the inspector stated that they did not commence working at the home until after they had receive a Criminal Records Bureau (CRB) check or a POVA first. Further evidence to support this was when the inspector was in the office a prospective care worker (who had previously been interviewed) telephoned the manager to see when they could begin work at the home, the manager confirmed to them that they had to wait until their CRB had been returned. Stakeholder pensions are made available to the staff group. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 22 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, 32, 33, 34, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that the management of the home understands the needs of the service users and the staff, however systems need to be introduced in the home to identify how the service users would like to see the services improved, or maintained. EVIDENCE: The manager of the home stated that she was ‘very settled’ in her position there. She is a qualified Registered General Nurse (level one. Completed in 1970) and has completed the Registered Managers Award. The manager has been in position for approximately eight years. She stated that in this time Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 23 there have been a lot of changes in the home including that initially the service users were less dependent on the staff group and said that although the current service users were more dependent on support the home provided care that enabled them to ‘remain as independent as possible’. The manager appears to take pride in the Kingfield Holts friendly and ‘homely approach’. The manager continues with her professional training to maintain her professional membership. She also stated that she joins in some of the mandatory training with the staff to make sure that she is up to date with current practices. Staff interviewed by the inspector supported that the manager of the home attends ‘some of the training’ that is provided for them. All of the visitors, service users and staff spoken to by the inspector confirmed that the management approach to the home is open, positive and inclusive. The manager of the home stated to the inspector that previously the home had an effective quality assurance and monitoring system in position. However at the time of the inspection there was no evidence that the system was still being utilised. The manager stated that no questionnaires had recently been distributed by the home and there were no returns that were due to be evaluated before publishing. The home does not have any other systems to identify how other people view the services that are being provided. There were no records of current staff or service user meetings. The manager confirmed to the inspector that these meetings did not occur on a regular basis but said that she sees the staff and service users on a daily basis and they inform her of any issues that they have. There was no documentation that supported that these actions take place. The inspector sampled the service users pocket money accounts and they were all up to date and had been accurately recorded. The staff supervision records were not available to the inspector however interviews with the manager and the care staff identified that supervision is taking place at the home, however the recommended minimum requirements for formal recorded supervision is not being met. This system must be improved to ensure that the staff understand the care needs of the people that they are caring for and to enable them and their manager to identify any training or personal development needs. The manager stated that although the formal supervision was not as regular as it should be, she spoke to the individual care staff on a daily basis and was confident that they understood their roles and had the knowledge and skills to appropriately carry out their duties. Those required records which were available for inspection were maintained and were stored securely in accordance with the Data Protection Act 1998. The only difficulty in relation to the records was the inability of the manager to Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 24 access a number of records for inspection purposes and in the quality of the homes assessments, care plans and risk assessments. All of the homes health and safety requirement were met with the exception of the electrical wiring certificate which expired March 2005. Kingfield Holt DS0000002977.V324727.R02.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 3 2 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 3 2 2 Kingfield Holt DS0000002977.V324727.R02.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 OP3 Regulation 14.2a and b Requirement The registered provider must ensure that all prospective privately funded service users are fully assessed by the home prior to admission. Assessments must clearly identify the area of need and their strengths and weakness in these areas. The registered person must ensure that the quality of the individual care plans in the home is developed to include how the needs should be met in the home. The registered person must ensure that the home undertakes individual risk assessments for the use of bedrails. The registered person must ensure that the home has appropriate facilities to store and record the receipt, administration and disposal of controlled medication. The registered person must ensure that written risk assessments are in place for all service users that self administer DS0000002977.V324727.R02.S.doc Timescale for action 30/09/07 2. OP7 15.1, 2a,b, and c 30/09/07 3 OP7 13 (4) (c) 14/08/07 4. OP9 13.2 14/08/07 5. OP9 13.2 14/08/07 Kingfield Holt Version 5.2 Page 27 6. OP33 24 7. OP37 17.3 a and B, 19 23.2 b and c 8. OP19 OP38 medication and mechanisms are in place to monitor and manage this process. The registered person must 30/11/07 develop a quality assurance and monitoring system for the home that includes gathering information from other people that identifies their opinions on how the services at Kingfield Holt are provided, how to improve them, or how to maintain the current standards. The registered person must 09/09/07 ensure that staff records required by regulation are available for inspection. The registered person must 30/09/07 ensure that the home has an up to date safety certificate for the electrical systems. 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. 4. Refer to Standard OP7 OP7 OP12 OP10 OP11 Good Practice Recommendations The registered person should document when individuals are invited to reviews for the service users and what the outcomes are. The registered person should review the quality and content of all risk assessments in the home, and ensure that they are reviewed and evaluated on a regular basis. The registered person needs to develop the range and diversity of stimulating activities made available to the service users at the home. The registered person should consider an alternative arrangement for the positioning of funeral flowers in the home to minimise the distress caused to the other service users. Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Kingfield Holt DS0000002977.V324727.R02.S.doc Version 5.2 Page 29 - 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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