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Inspection on 18/10/06 for Kingfisher House Residential and Nursing Home

Also see our care home review for Kingfisher House Residential and Nursing Home for more information

This inspection was carried out on 18th October 2006.

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 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

The staff team are well thought of by the residents with a lot of praise for the caring attitude and hard work they do. CSCI received eighteen `have your say` comment cards from residents and the majority of them expressed satisfaction with the care delivered by the team. One commented `the carers are always approachable, kind and considerate`. The daily records in Spillers wing are very well written and contain a lot of information about the residents and how they pass their time.

What has improved since the last inspection?

There have been a number of improvements since the last inspection. Medication practice and storage has been addressed and is much safer with residents receiving medicines in a timely way and MAR sheets completed correctly. A complete review of all residents` care needs has been undertaken and care plans now reflect their needs. When assessments show a resident is at risk an intervention is generated to address the need. Generally record keeping is much fuller and more informative. A room upstairs and one downstairs have been re-designated for use as staff offices. This means that residents` personal files and details are now held confidentially. There has been an increase in the number of domestic and laundry staff working each day. A planned introduction of staff supervision has been commenced. The trained staff have all had training about supervision and have been allocated a number of carers to each supervise. Meetings between the manager, staff, residents and relatives have been commenced and are being held regularly with minutes made available to interested parties. The staff restroom upstairs has been made non-smoking, which gives a better environment for any residents in the area. An activities co-ordinator has been appointed and works several days a week throughout the home.

What the care home could do better:

Records of residents having or being offered a bath or shower are very poorly completed. Records of stock levels of medicines are inadequate to offer an audit trail. Staff training and induction programmes need to be re-established. Several residents commented that the meals are unimaginative and they have little choice if they do not like the main meal offered. Special dietary needs are not catered for properly. The standard of cleanliness is still not good and there remain unpleasant odours in some parts of the home. Some hot water taps were found to be running water well over the safe level of 43 degrees centigrade and the bath water in Spillers was only 36 degrees centigrade. The infection control policy in relation to soiled linen is not being followed properly putting residents and staff at risk. There is no routine for delivering residents` newspapers and mail so residents sometimes do not get their newspaper until the afternoon.

CARE HOMES FOR OLDER PEOPLE Kingfisher House Residential and Nursing Home St Fabians Close Newmarket Suffolk CB8 0EJ Lead Inspector Jane Offord with Iain Smith and Mark Andrews. Key Unannounced Inspection 18th October 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 DS0000024427.V315822.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000024427.V315822.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingfisher House Residential and Nursing Home Address St Fabians Close Newmarket Suffolk CB8 0EJ 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) 01638 669919 01638 669929 kingfisher.house@fshc.co.uk www.fshc.co.uk Four Seasons Health Care Ltd Ms. Debs Canning. Care Home 91 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (33), Old age, not falling within any other of places category (62) DS0000024427.V315822.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd May 2006 Brief Description of the Service: Kingfisher House, Newmarket, is part of Four Seasons Health Care. The house is purpose built to provide nursing and residential care for a maximum of 62 older people. Kingfisher House has two floors with a shaft lift accessing the first floor. The home has a lounge on each floor and a laundry room situated on the ground floor. Both floors have separate dining rooms, which are available for residents to eat their meals. There are 58 single bedrooms and four shared rooms each having the advantage of an en suite toilet and wash basin, shared bathrooms are situated on each floor. A new unit (Spillers) was opened in September 2005 and provides an additional 29 places for people who have dementia. The layout is similar to Kingfisher House in that there are bedrooms and communal areas on two floors. There is a vertical passenger lift for use between the two floors. Meals are transported from the main kitchen. There is a separate staff team consisting of senior carers and care assistants. The fees range between £520.00 and £700.00 per week depending on whether a resident has residential needs or nursing needs and the level of dependency within that. The fees do not include chiropody, hairdressing, transport or newspapers. DS0000024427.V315822.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This second key inspection of the inspection year 2006/2007 took place on a weekday between 9.00 and 15.30. It was undertaken by two regulation inspectors and a pharmacy inspector. The peripatetic manager was available throughout the day to help with the process. A number of staff, residents and visitors were spoken with and a tour of both Kingfisher House and Spillers wing was done. The files, care plans and daily records of six residents in Kingfisher and two in Spillers were inspected. The recruitment records and induction programmes of four new staff were seen. Some maintenance and fire drill records, the activities book and minutes of staff, residents and relatives meetings were all seen. Part of the medication administration round was followed by the pharmacy inspector who also looked at medication storage and some medication administration records (MAR sheets). On the day residents looked well dressed and comfortable. The lunchtime meal was hot and most residents spoken with said they had enjoyed it. Interactions observed between staff and residents were friendly and appropriate. What the service does well: What has improved since the last inspection? There have been a number of improvements since the last inspection. Medication practice and storage has been addressed and is much safer with residents receiving medicines in a timely way and MAR sheets completed correctly. A complete review of all residents’ care needs has been undertaken and care plans now reflect their needs. When assessments show a resident is at risk an intervention is generated to address the need. Generally record keeping is much fuller and more informative. DS0000024427.V315822.R01.S.doc Version 5.2 Page 6 A room upstairs and one downstairs have been re-designated for use as staff offices. This means that residents’ personal files and details are now held confidentially. There has been an increase in the number of domestic and laundry staff working each day. A planned introduction of staff supervision has been commenced. The trained staff have all had training about supervision and have been allocated a number of carers to each supervise. Meetings between the manager, staff, residents and relatives have been commenced and are being held regularly with minutes made available to interested parties. The staff restroom upstairs has been made non-smoking, which gives a better environment for any residents in the area. An activities co-ordinator has been appointed and works several days a week throughout the home. What they could do better: Records of residents having or being offered a bath or shower are very poorly completed. Records of stock levels of medicines are inadequate to offer an audit trail. Staff training and induction programmes need to be re-established. Several residents commented that the meals are unimaginative and they have little choice if they do not like the main meal offered. Special dietary needs are not catered for properly. The standard of cleanliness is still not good and there remain unpleasant odours in some parts of the home. Some hot water taps were found to be running water well over the safe level of 43 degrees centigrade and the bath water in Spillers was only 36 degrees centigrade. The infection control policy in relation to soiled linen is not being followed properly putting residents and staff at risk. There is no routine for delivering residents’ newspapers and mail so residents sometimes do not get their newspaper until the afternoon. DS0000024427.V315822.R01.S.doc Version 5.2 Page 7 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. DS0000024427.V315822.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000024427.V315822.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6. People who use this service can expect to have their needs assessed and be assured they can be met prior to admission. The home does not offer intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Eight residents’ personal files were seen. Five of the residents had been admitted to the home recently and each one had a full pre-admission assessment completed. The assessments were all signed and dated. They covered areas of care such as nutrition, continence, personal hygiene, mobility, communication and sleep pattern. In addition there was information about the past medical history, medication, mental health and hobbies and interests. Residents spoken with said they recalled the manager visiting them before they were admitted to the home. DS0000024427.V315822.R01.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. People who use this service can expect to have their health care needs met and a plan of care in place but cannot be assured that all their wishes in respect of personal hygiene routines will be met. Overall, the statutory requirement notice issued 30th May 2006 has been met. The outcome for the medication standard has improved and is now adequate for residents prescribed medicines. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Pharmacist Inspector Mr M Andrews conducted the inspection of the medication standard. This inspection follows the issue of a statutory requirement notice on 30th May 2006 expiring on 9th June 2006. Medication practice was examined in all three currently occupied areas of the home. Mr D Taylor (Acting Manager) was on duty at the time of the visit. Matters arising were discussed with him. DS0000024427.V315822.R01.S.doc Version 5.2 Page 11 The statutory requirement notice specified that the following action was required; The registered person was required by 9th June 2006 to ensure service users are protected by the home’s policies, procedures, practices and records for dealing with medicines by producing clear written procedural guidance for staff and by having a system in place to ensure these procedures are known, understood and fully adhered to. This must include; Safe and hygienic procedures followed for the administration of medicines. • Ensuring medicines are safely stored and secured. • Ensuring medicines requiring refrigeration are stored within the accepted temperature range. • Keeping medicines on an individual resident basis • Ensuring ophthalmic medicines of limited life are safely handled • Ensuring all MAR chart medicine entries clearly state prescribed dose instructions • Ensuring accurate records are maintained for the administration or nonadministration of medicines The registered person was required by 9th June 2006 to take steps to ensure all prescribed medicines are available for residents and to enable their timely administration as scheduled. Findings of inspection At the time of arrival for inspection medicines were noted to be safely and securely stored. When medicine administration was observed the medicine trolley was secured when unattended by the registered nurse. Temperature records for medicine refrigerators in all areas had been completed on a daily basis. The records indicated that medicines had recently been stored in refrigerators functioning within the accepted range for the storage of medicines. On arrival for inspection, the morning medicine round was underway on the ground floor of Kingfisher. On observing part of the round it was evident that safe medicine administration practice was being adhered to. During the inspection, an audit of current and some previous medicine administration record (MAR sheets) charts was conducted. There was found to have been improvement in the availability of prescribed medicines at the home. There was one medicine, senna tablets, unavailable for the period 09/10/06 to 11/10/06 and therefore could not be administered to the respective resident. DS0000024427.V315822.R01.S.doc Version 5.2 Page 12 Ophthalmic medicines currently in use were noted to have been dated on opening and therefore safely handled to ensure they are not used following their limited expiry times. The home’s record-keeping practice was considered and the findings were as follows; 1. There was found to be continued improvement in the recording of the administration of both oral and external medicines. There was found to be only one omitted record relating to the earlier administration of levothyroxine 100mcg tablet during the morning of inspection. 2 There were also improvements found related to the recording of medicines recently received at the home. There was found to be one exception to this where there was no record for citalopram 20mg tablets received at the home on behalf of a resident on or around 26/09/06. 3 The home keeps separate records for the disposal of medicines, however, on attempting to audit trail the medicines of a resident who was recently admitted to hospital from the home, there were no records confirming that they were sent to hospital with the resident and therefore the medicines could not be accounted for. This was discussed with Mr Taylor who agreed to re-emphasise with members of nursing staff the importance of keeping records for the return of medicines at times when residents leave the home. 4 There continued to be some medicines where full written dose directions are not given on MAR sheets and therefore the dose or frequency of their administration could not be determined when selecting medicines for administration. Inadequate MAR sheet medicine entries for medicines were consistent with those identified during the previous inspection. Examples are given as follows; • • • Movicol sachets where the written dosage directions are expressed as ‘As directed’ only. Lactulose liquid where the written dosage directions are expressed as ‘twice a day as required’ and where the actual dose to be given at such times (e.g. 10ml) was not written Warfarin 1mg, 3mg and 5mg tablets where MAR sheet medicine entries are expressed as ‘As directed’ only. This remains of concern because some records against which the medicines are selected for administration are inadequate. For one resident prescribed warfarin there was noted to be a dose change on 16/10/06 following routine blood testing. The dose was changed from 6mg daily to 6mg/7mg on alternate days. However at the time of inspection there was no evidence from MAR sheet records that since DS0000024427.V315822.R01.S.doc Version 5.2 Page 13 16/10/06 a dose of 7mg had been given to the resident. In addition, there was no audit trail in place for warfarin therefore doses recently administered could not be confirmed from the records (see below). On discussion with Mr Taylor it was requested that the current administration of warfarin for this resident is investigated. It was also recommended that blood test information relating to prescribed doses of warfarin (currently noted to be kept following MAR sheets for residents) is made more prominently available. It is also recommended that warfarin dose schedules are clearly indicated on MAR sheets as far ahead as the time of the next scheduled blood test result. In view of the lack of written MAR sheet dose information for some medicines, the registered person must take further steps to ensure full and accurate dose directions are stated for all prescribed medicines. 5 For many medicines supplied in non-monitored dosage system (MDS) containers there is still no evidence that the home has a system in place for audit trailing medicines and to demonstrate that they have been administered correctly in line with prescribed instructions. Audit trails for some medicines could be conducted, however, and samples taken indicated with a few minor exceptions that there were no discrepancies. This suggests the medicines have been administered as prescribed. In view of the lack of audit trails evident for some medicines, the registered person must take action to ensure records can demonstrate that all medicines have been given in line with prescribed instructions. Records must always provide audit trails to enable this. Residents’ personal files inspected all contained a care plan to help meet the needs of the resident. The care plans covered areas such as personal hygiene, mobility, communication, continence and night needs. One resident had chronic pain but was reluctant to take tablets. The care plan intervention said, ‘if in pain encourage to take pain killers’. All the files had contact details of health professionals involved with the care of the resident. There was a record of visits to or by health professionals and what the instructions had been for care. Preferences for managing personal hygiene were recorded. One resident had requested two showers a week but records showed they had had one bath in eight days. Another record said the resident enjoyed a regular bath but there was no documentary evidence between 26/9/06 and 18/10/06 that they had been offered or had either a bath or a shower. A third record noted the resident had had one bath and refused one bath in a month. DS0000024427.V315822.R01.S.doc Version 5.2 Page 14 The files contained evidence of assessments for areas of risk such as tissue viability, nutrition and moving and handling. If a resident was judged at risk there was evidence that further interventions were commenced for example, a Malnutrition Universal Screen Tool (MUST) to monitor food intake and weight. If a Waterlow score was high the care plan reflected the need for using specialised pressure-relieving equipment and ensuring the resident was turned regularly in bed if they were unable to move themselves. Records showed that residents’ wishes in regard to their health were respected. One resident had been diagnosed with a lump in their breast. The care plan included the intervention, ‘offer XXXX support. Respect their wish not to go into hospital unless absolutely necessary’. Daily records in Kingfisher were brief and concentrated on personal care. There was no record of how the resident was feeling or how they had passed their day. By contrast the records in Spillers were very full including all outings and any changes of mood or behaviour. If a resident went out for a walk a record was made of what they were wearing and that the contact details of the home were given to them in case they became disorientated. Interactions observed in both units between carers, nurses and residents were respectful and caring. Residents were offered choices about where they wanted to be. Gentle encouragement was given to residents in Spillers to go to the dining room at lunchtime but a refusal was respected and the carer returned later to try again. DS0000024427.V315822.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. People who use this service can expect to be encouraged to maintain contact with family and friends and have appropriate activities available to them but they cannot be assured that they will be able to select their meals from a menu or that any special dietary needs will be met correctly. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: CSCI received four comment cards from relatives prior to this inspection and they all indicated that they were free to visit the home whenever it suited them and the resident they were visiting. Visitors were seen during the day of inspection and when spoken with said staff always made them welcome. Each resident’s personal file seen contained contact details of the next of kin and in some cases life history work had been completed by relatives. Information about career, family, religion, favourite holidays and pastimes was recorded. In one resident’s file it said, ‘XXXX would like to see a priest regularly’. In conversation it was confirmed that a Catholic deacon visited them several times a month. DS0000024427.V315822.R01.S.doc Version 5.2 Page 16 Both the ground and first floor of the home were visited during the inspection. There was evidence of an activities programme displayed on the notice boards. The programme included a visit from local school children, an afternoon matinee showing a film and a person visiting the home to play the keyboard. The activities co-ordinator is a recent appointment for the home and a member of staff said ‘ they will integrate the residents from both floors to involve them in the activities’. There was no evidence of organised activities during the visit as the activities co-ordinator was off duty but four residents set up their own card game in the dining room during the morning. In both of the lounge areas residents were seen sitting in chairs with the television on. One resident was asked what the programme was they were watching; they said ‘I don’t know’. There was no evidence of newspapers, magazines or books in the two lounge areas. The manager said that ‘the carers will spend time with the residents when they have time’. One resident spoken with upstairs in Kingfisher said they had no family nearby so relied on post to keep in touch. They enjoyed getting letters and also keeping up to date with the news in their newspaper. However they did not like using the lift alone and this meant they either had to ask a member of staff to accompany them downstairs or rely on someone to bring their paper and post to them. There was no system for regular postal delivery and sometimes their paper did not arrive until the afternoon although it was delivered to the home in the early morning. The lunchtime was observed in one of the dining areas in Kingfisher and the dining room in Spillers. The meal was served at 13.20 by the carers who were plating each meal from a heated trolley. This was located in the dining areas and had been brought from the kitchen, a short distance away from the dining room. One resident said that ‘I do not see a menu but we are asked what we want’. The lunchtime meal was sliced pork with stuffing, vegetables and gravy. One resident said they did not like pork so the carer asked the chef to prepare an omelette. The pudding was an apple crumble and custard. The kitchen was staffed on the day of the inspection by two chefs and an assistant. The two chefs said that they prepare the meals based on what the residents like in preference to keeping to the set four-week menu that the home has introduced. The dry store had sufficient food for example cereals, soup and custard powder. There was meat in the freezer in addition to vegetables and mousse. There was evidence of fresh vegetables in the kitchen and the chefs said that they had bought in cakes for the residents in preference to making them. This was because there had been a recent shortage of staff to undertake this task. DS0000024427.V315822.R01.S.doc Version 5.2 Page 17 Any resident requiring a diabetic diet received the same meals as the other residents, so on the day of inspection a diabetic resident had a portion of apple crumble, with a topping of Demerara sugar, and custard for their pudding. When this was queried with the chefs they said they had been told by the catering officer of Four Seasons that the recipes used were suitable for everyone. In discussion with the manager it seems the advice had been to keep special diets as close to the regular meal as possible to avoid highlighting any resident’s special needs, but that meant cooking separate dishes for people with special diets. DS0000024427.V315822.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People who use this service can expect to have any complaint taken seriously and be protected by staff knowledge from abuse but they cannot be assured that all staff have received up to date protection of vulnerable adults (POVA) instruction. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Comment cards received from residents and relatives indicate that they are aware of the home’s complaints policy and would know whom to approach if they had any concerns. The complaints policy has been seen at previous inspections and met the required standard. CSCI is aware of a recent complaint made to the home about the transfer of a resident to another care home. The manager investigated the circumstances and responded in writing within the time frame to the complainant. CSCI were informed of the outcome of the investigation. Staff spoken with were clear about their duty of care and aware that the home has a whistle blowing policy. One POVA training session has been put on for staff recently so not all staff have been updated. New staff have some instruction in their induction programme and dementia training for staff in Spillers covers some aspects of POVA as well. DS0000024427.V315822.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25, 26. People who use this service can expect to have a bedroom that they can personalise and communal rooms to use with homely furnishings but they cannot be assured that the domestic cleaning routine will keep the home fresh, that there is sufficient moving and handling equipment or that staff follow the infection control guidance for managing soiled linen. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has employed additional domestic staff to work throughout all areas of the home. There was only five domestic staff on duty on the day of the inspection as one member of staff was sick. Their shift times varied according to the work required. One member of staff had commenced at 6.00am and said ‘I clean the communal areas before the residents come down’. Other staff commenced at 8.00am. DS0000024427.V315822.R01.S.doc Version 5.2 Page 20 The domestic staff had a cleaning trolley for each floor in Kingfisher and one in Spillers. One member of staff said ‘we have plenty of cleaning materials and the manager will order more if required’. Two domestics were spoken with who were working on the first floor in Kingfisher and were asked if they were aware of substances that fell under the control of substances hazardous to health regulations (COSHH). They were unaware of what COSHH was and had not received training to include infection control guidance. Five bedrooms were inspected to assess the furniture, furnishings and the cleanliness. There was adequate furniture in each of the rooms with a bed, chair, wardrobe, dressing table and television. There were pictures on the wall of each room and personal possessions around the room, for example family photographs. One of the rooms that the domestic staff had cleaned was inspected and it was found that the waste bin had been emptied and the floor hoovered. However there was evidence of dust on the windowsills and dressing table. Two domestic staff were asked if there was a standard set for staff to work towards when cleaning a room. There was evidence of a list of tasks for the staff to follow but there were no set standards for the domestic staff to achieve. There was evidence that bedroom carpets were cleaned and in one room the carpet was cleaned each week. This cleaning was required as the there were daily spillages by the resident. One visitor accompanied the inspector to their relative’s bedroom. They said the bed linen, although clean, was worn and below standard. The towel in the en suite was frayed and in need of replacement. The room was untidy and the visitor said I don’t know who is responsible for clearing up the room but when I visit I do it’. There was kidney dish lying on the floor of the bedroom for no particular reason. One resident in their room said ‘I have no complaints.’ However there was no evidence of a call bell attached to the wall mounting therefore the resident would not be able to call for assistance. The call bell in another room was tested and a carer attended the call within a short period of time. Two members of staff said ‘we need some slide sheets for the more dependant residents’. One resident was assisted to stand from a sitting position by two carers who aided them by holding them under their arms in preference to utilising a handling belt. In discussion with the manager they said that they had completed a stock take of all manual handling equipment and have placed an order for more equipment from the company. Hot water temperatures were tested in the two sluices in Kingfisher and found to be running at more than 60 degrees centigrade. Although the sluices have keypad entry so residents cannot access them the temperature of the water made it difficult for staff to follow good hand washing procedures. Water in the bathroom in Spillers was found to be only 36 degrees centigrade. DS0000024427.V315822.R01.S.doc Version 5.2 Page 21 On entering the home at the start of the inspection it was noted that there was an unpleasant odour. A number of the comment cards received from residents and relatives remark on the fact that there is frequently an odour in the home, that carpets are not always clean and that bed linen is very worn. The laundry was visited and the laundry supervisor spoken with. There were two other laundry staff, they were folding laundry and hanging clothes on a rail in preparation for taking them back to the residents’ rooms. The laundry had three washing machines, each with a sluice cycle and three dryers were located in an adjoining room. There was soiled laundry on the floor in front of one of the washing machines, in addition to soiled laundry in an appropriate disposable bag. The supervisor said that care staff put the laundry in one bag, transport it to the laundry and the supervisor sorts the bags when they arrive in the laundry. A wash hand basin was attached on the wall of the laundry however the soap dispenser and towels were not located within easy reach. DS0000024427.V315822.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People who use this service can expect to be supported by adequate numbers of staff but cannot be assured that staff have received an induction or updated training for the work they perform. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The arrangements for care staff in the home were based on the requirement to have a registered nurse in charge on the ground and first floor of the main part of the home. A nurse was on duty for both floors and on the first floor, a higher dependency area, there were five carers to support the nurse. On the ground floor there were four carers in addition to the nurse. The ground floor accommodates mainly residential people, however one carer said that residents had higher dependency recently and it took longer to get them up in the morning. In Spillers, the dementia care unit, there were eleven residents with three care staff on duty. One of the members of staff was a senior carer who was in charge of the morning shift. The carer said they had had two dementia care training sessions in the last couple of months and found the information given very helpful in the work they were doing. DS0000024427.V315822.R01.S.doc Version 5.2 Page 23 There was only five domestic staff on duty on the day of inspection as one had reported sick prior to the commencement of the shift. One member of the domestic staff said they would team up to ensure the work was completed by the end of the shift. The files of four new staff members were inspected and showed all had had a criminal records bureau (CRB) check done prior to commencing work. There was documentary evidence that identity checks had been made and references taken up. As noted earlier in this report some domestic staff do not receive a formal induction to cover information required for them to correctly perform their work. A carer’s induction includes communication, confidentiality, care practice, policies, moving and handling, infection control, health and safety and fire awareness. The home employs fifty-two care staff of which fourteen have achieved NVQ level 2 or higher. This gives a figure of 27 with a qualification, which does not reach the 50 required by the national minimum standards (NMS). Staff spoken with said they had not had any sessions of training recently. This was confirmed by the manager who said they were compiling a database to identify the training updates required by individual staff. There had been one session of POVA training that had not been repeated for staff who had been unable to attend. DS0000024427.V315822.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. People who use this service can expect to have their personal monies safeguarded and be consulted about the service but they cannot be assured that all areas of health and safety are promoted. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is being managed by a peripatetic manager who has many years experience of running care homes and has been at Kingfisher house since July 2006. Residents spoken with were able to identify the manager when asked whom they would speak to if they had any concerns. A newly appointed deputy manager is due to take up post in the next few weeks. There is no housekeeper manager for ancillary staff. DS0000024427.V315822.R01.S.doc Version 5.2 Page 25 The system for managing residents’ personal monies was explained during the previous inspection and found to be satisfactory. The acting administrator confirmed that the system remained the same. Since the last inspection a number of meetings have taken place to allow residents and relatives to offer their opinions about the service offered by the home. Minutes of the meetings were supplied to CSCI and showed that a variety of subjects were raised including the food, activities, staffing issues, laundry and the key worker scheme that the home operates. The manager has also held some care staff and trained staff meetings. Again the subject matter was wide ranging and included training needs, supervision, staff sickness and equipment required. The manager explained the proposal for managing staff supervision and the first step of giving trained staff some instruction about how supervision is conducted has been completed. During the course of the inspection some practices were observed that did not follow health and safety policies. Some moving and handling practice was unsafe for both the resident and the carers. The infection control policy in relation to the management of soiled linen is not being adhered to. Domestic staff have not had COSHH training and do not demonstrate an understanding of the regulation. Certificates were seen to show a Loler load test was satisfactorily completed on the homes’ hoists in March 2006 and that the lift was inspected and deemed safe in August 2006. DS0000024427.V315822.R01.S.doc Version 5.2 Page 26 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X X 2 2 STAFFING Standard No Score 27 3 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 1 DS0000024427.V315822.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 (1) Requirement The registered person must ensure that residents’ personal hygiene needs are met as they would wish and accurate records kept. The registered person must take further steps to ensure full and accurate written dose directions are stated for all prescribed medicines. The registered person must take action to ensure records can demonstrate that all medicines have been given in line with prescribed instructions. Records must always provide audit trails for all medicines to enable this. The registered person must ensure that residents who have special dietary needs are served with an appropriate diet. The registered person must provide a call system to all residents’ rooms. The registered person must take steps to ensure the hot water supply provides water at a temperature close to 43 degrees centigrade. DS0000024427.V315822.R01.S.doc Timescale for action 31/10/06 2. OP9 13 (2) 31/10/06 3. OP9 13 (2) 31/10/06 4. OP15 16 (2) (i) 18/10/06 5. 6. OP22 OP25 16 (2) (c) 13 (4) (c) 18/10/06 31/10/06 Version 5.2 Page 28 7. OP26 13 (3) 8. OP26 13 (3) 9. OP28 18 (1) (a) 10. OP30 18 (1) (c) (i) 13 (4) (a) 11. OP38 12. OP38 16 (2) (j) (k) 13. OP38 13 (5) This is a repeat requirement. The registered person must make arrangements to ensure the infection control policy is followed by staff. This is a repeat requirement. The registered person must ensure the hand washing facilities in the laundry are appropriately sited. The registered person must facilitate staff training for staff to achieve appropriate qualifications for the work they do and ensure residents are in safe hands. This is a repeat requirement. The registered person must ensure staff receive induction and training for the work they are to perform. The registered person must make arrangements to remove unnecessary equipment and maintain the home free from hazards. The registered person must ensure that cleaning regimes are established to maintain satisfactory levels of cleanliness and eradicate unpleasant odours. This is a repeat requirement. The registered person must ensure that safe moving and handling techniques are being used by staff. 18/10/06 31/10/06 31/03/07 30/11/06 31/10/06 30/11/06 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000024427.V315822.R01.S.doc Version 5.2 Page 29 1. 2. OP12 OP27 The registered person should establish a routine for the timely delivery of post and newspapers to residents daily. The registered person should review arrangements for managing ancillary staff to ensure that practices are effective, safe and adequately monitored. DS0000024427.V315822.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000024427.V315822.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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