Inspection on 10/03/09 for Kingfisher Residential Care Home

This inspection was carried out on 10th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingfisher Residential Care Home 02/06/10

Kingfisher Residential Care Home 01/04/10

Kingfisher Residential Care Home 07/01/10

Kingfisher Residential Care Home 06/11/07

Kingfisher Residential Care Home 01/02/07

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Key inspection report Care homes for older people Name: Address: Kingfisher Residential Care Home 43 - 45 Marshalls Road Raunds Wellingborough Northamptonshire NN9 6ET     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kathy Jones     Date: 1 0 0 3 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Kingfisher Residential Care Home 43 - 45 Marshalls Road Raunds Wellingborough Northamptonshire NN9 6ET 01933623028 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): kingfisher.r.h@hotmail.co.uk Kingfisher Residential Home Limited Name of registered manager (if applicable) Mr Sean McCloskey Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: No one falling within category DE(E) should be admitted to The Ferns Care Home where there are 27 persons within the category of DE(E) already accommodated The 5 persons identified in correspondence dated 2nd December 2004 who fall within the category of OP may continue to be accommodated at The Ferns Date of last inspection Brief description of the care home Kingfisher Care Home is registered to provide personal care to 27 older people, most of who have needs relating to dementia. The home is privately owned and is situated in the market town of Raunds, Northamptonshire, close to a range of local amenities. The home is on two floors and has a passenger lift and a stair lift. There are 13 single bedrooms and seven doubles, and four separate lounge/dining rooms. Care Homes for Older People Page 4 of 32 Over 65 27 0 Brief description of the care home The homes statement of purpose and service user guide (which provides information on the range of facilities and services available at the home) is made available to prospective residents and their representatives. This ensures that a fully informed choice can be made as to whether or not the home is suitable to meet the needs of people who use the service. The range of fees as from 1st April 2009 is £355 to £381 per week. The actual fee is dependent on the persons assessed needs and the type of room occupied. Additional costs would include external services such as chiropody and hairdressing. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Standards identified as key standards and highlighted through the report were inspected. The key standards are those considered by the commission to have a particular impact on outcomes for people who use the service. Inspection of the standards was achieved through review of existing evidence and an unannounced inspection visit. Prior to the inspection we reviewed the information we had about the service. This included an annual quality assurance self assessment submitted by the service and information received in surveys which we sent to a sample of people to ask about their experiences of the service. We received completed surveys from three people who use the service, three relatives/advocates, one health professional and four staff. This information was collated and taken into account as part of the inspection. This unannounced inspection visit was carried out by one inspector over a period of a Care Homes for Older People Page 6 of 32 day. The inspection involved a method called case tracking which included selecting samples of peoples care records and tracking their care and experiences. Observations of the homes routines and the care provided were made and views sought from people who use the service, visitors and staff. Because Kingfisher provides care for people with dementia and they are not always able to tell us about their experiences, observations and views from other people were particularly important in helping us understand their experiences. We observed interactions between staff and people who use the service and looked at how peoples dignity is protected. The management of peoples medication was checked through reviewing prescribed medication for a sample of people. A sample of staff files were reviewed to check the adequacy of the recruitment procedures in safeguarding people who use the service and we also looked at the training staff receive. Shared areas such as lounges and dining rooms and a sample of peoples bedrooms were looked at during the inspection. Verbal feedback was given to the responsible individual and the manager during the inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Better record keeping and organisation of records in relation to planning and monitoring of peoples care needs to be in place to reduce the risk of delay in seeking and acting on advice regarding changes to peoples health. Care practices need to be reviewed and monitored to ensure that people always receive personal care in the privacy of their rooms and their dignity protected. Improved care planning and evaluation of activities for individuals may help to improve the daily lives of level of stimulation, particularly for those people with dementia. Some improvements to the management of medication are need to ensure medication is safely managed and that there are clear records including care plans to guide and support staff, with an audit trail to help identify any discrepancies quickly. Due to changes in legislation improved storage is required for controlled drugs. Improved accident recording with evidence of management oversight of injuries would provide further safeguards. However recruitment process need to be more thorough to provide better safeguards for people using the service. Care Homes for Older People Page 8 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the information provided and gathered as part of the admission and assessment process would help ensure people had more informed choices and to be confident that all of their needs can be met. Evidence: There is a detailed statement of purpose and service user guide which provides information about Kingfisher care home and the services provided. It is also clear within the statement of purpose that the care home provides care for people with dementia. Although the information is quite detailed the range of fees is not included. The service user guide states that fees are negotiable depending on the care needs of the individual. It is important that people have as much information as possible to enable them to make informed choices when choosing a care home. Part of this is knowing the reasons for any difference in charges made, which may include the size and facilities in the room occupied or the amount of care they need. Three surveys received in October 2008 identified that two people felt they had enough information Care Homes for Older People Page 11 of 32 Evidence: to make a decision, while the third didnt. We looked at the care file for someone who had been admitted to Kingfisher recently. We found that prior to admission an assessment had been carried out and information had also been gathered in the form of an assessment from the county council who were funding the care. Sufficient information had been gathered during the assessment process to determine if peoples physical care needs could be met and that individual preferences including preferred name and dietary preferences had been discussed as part of the assessment. We did note that the pre-admission assessment form used by Kingfisher did not include racial, cultural, linguistic or religious needs or sexual orientation. Although in this case the information was contained in the county council assessment, we would expect this to be checked to ensure any needs can be met. It is important that the assessment takes account of peoples needs in relation to these areas as well as their physical care needs to ensure that their needs and expectations can be met as far as possible. The annual quality assurance self assessment (AQAA) submitted to the Commission for Social Care Inspection and the service user guide refer to people being invited to visit the home prior to admission. A comment received in a survey from someone in October 2008 confirmed that visits are encouraged and also trial periods are offered. Information received in a survey confirmed that a trial stay had helped someone to make up their mind that the home met their needs. Kingfisher does not provide intermediate care therefore this standard was not assessed. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a satisfactory level of care and support, however improved record keeping in relation to planning and monitoring of peoples care and the management of medication would reduce the risk of delay in the event of changes to health. Evidence: We looked at the care files for two people to see how their care is planned and supported and how their health and well being is monitored. We found that the care plans provided staff with clear information about peoples care and health needs. This is important as the purpose of these documents is to act as a guide to staff helping to ensure that people get consistent and appropriate care. The plans took into account what people were able to do themselves which is important in helping people to maintain as much independence and dignity as possible. This was noted particularly in the personal care plans. We did however find that care plans are not always updated in relation to current skin condition and the prescence of pressure ulcers. Since the last inspection improvements have been made in that there are now risk assessments in place to identify people at risk of developing pressure ulcers. Further Care Homes for Older People Page 13 of 32 Evidence: work is required on the organisation of records and the evaluation of care plans as it was difficult to ascertain the current condition of the persons skin and if they actually had a pressure ulcer. The care plan stated turned 2 hourly at night as sometimes gets pressure sore. The manager did find in some archived daily records an entry following a visit by the District nurse which said that the pressure sore had healed. The record also contained advice given by the District Nurse about ongoing treatment. This advice had not been incorporated into the care plan creating a risk that the advice would not be followed. Advice was given regarding the need for a more effective system of monitoring changes to the skin condition of people identified as being at risk of developing pressure ulcers. Although records were in some cases difficult to follow, there was evidence that advice and support is obtained from health professionals such as the General practitioner, District nurse and Community Psychiatric Nurse. As discussed above advice given needs to be incorporated into the care plan to ensure needs are met. Comments in surveys from relatives indicated that people usually get the care and support that they need, however one comment was that staff do not always pick up quickly on illness. While we did not find any evidence of this during the inspection the fact that it is difficult to track changes to peoples health thought the records may contribute to this. Nutritional assessments have also been implemented since the last inspection and new scales purchased, enabling the weight of people identified as being at risk to be monitored. One of the care files we looked at was for someone who had been identified as losing weight. However we could find no record of weight since 17th January 2009. Given that there was concern about weight loss we would have expected records to be in place to monitor food intake. Some daily records referred to what had been eaten though not all. We advised that where concerns are identified that a separate food intake record is put in place. We did observe that the person refused lunch and was offered and encouraged to have an alternative. We looked at a sample of records relating to the management of peoples medication and the storage of medication. We found that the majority of medication is supplied in a monitored dose system with records of administration being signed by the member of staff administering the medication. We checked a sample of this medication and found that there were some cases where the medication had been taken from the monitored dose pack and there was no signature to confirm it had been given making it difficult to confirm it had actually been given as prescribed. For medication not supplied in the monitored dose system we found that in some cases there was no record of medication received making it difficult to establish how Care Homes for Older People Page 14 of 32 Evidence: much medication should be in stock. This then makes it difficult to check that medication is being given correctly and also to track any errors. We found one person who was prescribed Promazine 25mg/5ml liquid (can be given for agitation and restlessness) recorded on the medication administration records as to be given at a dose of 5mls twice a day when required. The pharmacy label on the bottle had become damaged and although we were able to read the persons name we were unable to confirm the dosage. Advice was given to return this to the pharmacist and get a replacement to ensure correct instructions are being followed. There was no additional information placed in the care plan to support carers on when this as required medicine could be appropriately used. Controlled Drugs are being stored in a locked cupboard within a locked cupboard but it does not conform to the stricter storage rules which are now in place. Advice was given of the need to improve storage arrangements for these drugs. During the inspection we observed interactions between staff and people who use the service. Staff spoke to and treated people with respect. We did however observe a member of staff standing over someone while feeding them rather than sitting with them at the same level. Discussion with the manager and observations of other staff indicated that this was not usual practice. We also observed a carer applying cream to someones legs in the lounge. We would consider this to be part of the personal care routine and expect it to be carried out in the privacy of the persons room. The manager confirmed that staff practice would be monitored to ensure that peoples dignity is respected in all areas. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are flexible visiting arrangements and most people able to express a view are generally satisfied with their daily lives. More thorough evaluation of individual care plans with consideration to peoples daily lives may stimulate ideas for daily occupation enhancing peoples lives. Evidence: Surveys received in October 2008 from three people who use the service identified mixed views and different expectations in relation to daily life and social activities at that time. One person felt that there are not enough activities, while the other two didnt wish to take part in any activities. A visiting professional commented in a survey that there was no dedicated activity organiser and felt there was a need to engage people in diversionary activities to alleviate boredom. Since that time a part time activity organiser has been employed to provide activities in the afternoons, however was not working on the day of inspection. Records of activities are kept and a sample check of these included watching a DVD, morning television, coffee morning, film morning, music, wizard of Oz, story telling, sing along, classical music and a newspaper review. The annual quality assurance self assessment acknowledges the need to continue to review and improve on the range of Care Homes for Older People Page 16 of 32 Evidence: activities and in particular external activities. One person spoken with was happy with her own company and spent a lot of time reading and had access to a quiet lounge to do this in. We looked at a care plan for social interests for someone who had been at Kingfisher for six months and found that it referred to the person as having been socially isolated, which can sometimes be the case for people prior to moving into residential care. A more thorough review of the care plans and discussion with people or their relatives about past interests may stimulate further ideas to engage or occupy people, particularly those with dementia who may not be able to express themselves so easily. Staff were observed to engage people in conversation throughout the inspection,providing a friendly and relaxed environment. The service user guide identifies that people are able to have visitors at any time and reminds people that it is their right to decline visitors if they wish. A visitor spoken with during the inspection confirmed that there is a flexible visiting policy and that they are made welcome. The lunch on the day of inspection was minced beef, potato, carrot and cabbage. The meal looked appetising and people spoken with said they had enjoyed it. People confirmed that they were offered alternatives if they didnt like what was on the menu. We observed someone refuse a meal and be encouraged to have an alternative. Under the health and personal care section we have raised the need to monitor more closely food intake for people identified as being at nutritional risk. Staff were aware of peoples individual preferences in relation to meals and the level of assistance being given. We did observe one incident whereby a member of staff was standing over someone feeding them rather than sitting at their level, though another member of staff did come and take over assisting the person more appropriately and sitting at the same level. This issue has been raised in the previous section and a recommendation made about monitoring staff practice. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaint procedure which people are aware of and staff are aware of their responsibilities in relation to safeguarding vulnerable adult procedures. Improved accident recording with evidence of management oversight of injuries would provide further safeguards. Evidence: There is a complaint procedure in place and people told us in surveys that they know how to make a complaint. We spoke with someone during the inspection who confirmed that they had no concerns but were happy that they would be addressed if they did. A visitor we spoke with also had no concerns regarding the care or the way their relative is treated. We looked at the record of complaints which confirmed that complaints are taken seriously and action is taken to address any shortfalls or issues that arise. We have found that where appropiate concerns have been referred through safeguarding vulnerable adults procedures and the Commission for Social Care Inspection notified. Due to their dementia the majority of people would find it difficult to raise concerns themselves, we spoke with a member of staff who had received training in safeguarding vulnerable adults and was aware of their responsibilities in relation to reporting any concerns in order safeguard the vulnerable people in their care. Information received from the manager during the inspection identified that the Care Homes for Older People Page 18 of 32 Evidence: majority of staff have received training, though there are some who are yet to receive training in safeguarding vulnerable adults. This training is important as it informs staff about the different types of abuse and the reporting procedures should they witness or suspect any abuse which helps to safeguard people. We looked at accident records to see how these are monitored and people safeguarded. We found that information on the accident records was in some case quite limited, for example it was not always clear if the accident had been witnessed and if so by who. We found that bruising or marks found by staff were recorded on a body map, however records relating to the description of the mark or injury were in some cases difficult to follow with some of the reference numbers being duplicated. We advised that a clearer system with evidence of review and monitoring against accident records would provide better safeguards for people. Care Homes for Older People Page 19 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean and tidy and plans for ongoing improvements were being developed. Evidence: We looked at a small part of the environment which included shared lounges and dining rooms and a sample of peoples bedrooms. Bedrooms were seen to include peoples personal belongings helping to create a more familiar and comfortable environment for people. We were informed that a programme of re-decoration and refurbishment and improvements to the premises is being developed as part of an action plan being developed through discussions with Northamptonshire County Council about occupancy levels. One of the considerations under discussion was the reduction of the number of shared rooms. Currently there are seven double rooms and thirteen single rooms with en-suite facilities. The premises are converted and extended domestic dwellings which retain existing lounge and dining rooms. These domestic size rooms allow people to be cared for in small groups which suit the needs of some people but have some limitations in terms Care Homes for Older People Page 20 of 32 Evidence: of space to wander. We did not identify anyone adversely affected by this during the inspection. The majority of people who needed a high level of assistance and supervision were using the lounges on the ground floor of one side of the building, while someone who was more independent was able to use a lounge in another part of the building enabling her to read quietly. We noted at our inspection in November 2007 that an outside area had been fenced off making a secure outdoor area. We were informed that part of the plans for improvement are to level some of the uneven areas in this area and put in some raised flower beds which would provide people with a safe area to wander or sit outside. All areas of the home seen were clean and tidy and there were no offensive odours.The annual quality assurance self assessment identifies that the majority of staff have received training in infection control. The manager also advised that further infection control training was being given by the Primary Care trust shortly after the inspection. Care Homes for Older People Page 21 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a consistent staff team who receive training to update their knowledge and skills. However recruitment process need to be more thorough to provide better safeguards for people using the service. Evidence: At the time of the inspection the home was not full and observations indicated that there were sufficient staff on duty to meet peoples needs. Comments received in surveys and from discussion with staff identify the need to keep staffing levels under close review to ensure that as peoples needs change there are enough staff to meet their needs throughout the twenty four hour period. We discussed a complaint that had been received by the home about staffing levels with the manager and were satisfied that the particular issue raised had been satisfactorily addressed. Several of the staff at Kingfisher have worked there for many years which provides consistency for people who use the service. Positive comments were received about the staff team during the inspection and in surveys which included Staff are always friendly and amiable to us and our relative. The meals are good and he doesnt want for anything. We spoke with a member of staff about training, they confirmed that training is provided and that they had completed an National Vocational Qualification (NVQ) level Care Homes for Older People Page 22 of 32 Evidence: 3. The staff development matrix shows that most staff hold or are working to wards this qualification in the care of older people. The staff training matrix shows that there is induction training for new staff, which staff confirmed. Other training includes movement and handling, hoist training, safeguarding vulnerable adults, dementia, food hygiene, first aid and Mental Capacity Act. Planned training includes infection control, safeguarding vulnerable adults and medication and three staff are enrolled on a distance learning course for dementia care. This ongoing training for staff is important in ensuring that their knowledge and skills are developed and kept up to date. The manager advised that he is attending training on Deprivation of Liberties and legislation due to come into force on 1st April 2009. This training will then be cascaded to staff to ensure that they are aware of the implications for care. We looked at records for two staff to check the adequacy of the recruitment process. Criminal record bureau clearances and references had been obtained for both staff prior to them working in the home. We found that the application for one member of staff did not include a full employment history. The collation of information and cross checking is an important part of the recruitment and selection process helping to inform decisions about someones suitability for working with vulnerable people and safeguarding them. Care Homes for Older People Page 23 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A period of consistent management is needed to improve and maintain the standards and protect and promote peoples health and well-being. Evidence: Standard 31 relates specifically to the role of registered manager. As there was no registered manager in post at the time of the inspection, this standard has not been assessed as such. However the management arrangements are considered critical in the quality of care and in safeguarding the health and welfare of people who use the service and are therefore reported on in that context. Kingfisher has experienced several changes of manager which from the comments received in surveys has caused some concern about the lack of consistency. Examples include There is no consistency in some areas. There have been at least three managers in a year. The homes needs to be able to retain their manager for longer periods to enable the staff to continue providing consistent care. Care Homes for Older People Page 24 of 32 Evidence: The manager in post at the time of the inspection started in September 2009 and was submitting an application for registration to the Commission for Social Care Inspection. One staff member commented Since we have had a new manager things have changed for the better, although the deputy manager did a wonderful job while we had no manager. Consistency in the leadership and management of the service is important in improving and maintaining standards of care. We requested that an annual quality assurance self assessment (AQAA) was carried out during 2008. This was completed and submitted to us by the previous manager. The AQAA indicated an understanding of the need for ongoing review of the services provided, which is important in helping to improve and maintain standards. Questionnaires are sent out annually to people involved with the service to gather peoples views. These were last sent out in April 2008 and will be due again next month. Following the comments made in the questionnaires improvements had been made to menus and meals and an activity organiser had been employed. It is important that action is taken based on peoples views. Staff confirmed that the responsible individual and his family visit Kingfisher regularly and records show that a report is made of an unanounced visit carried out by the responsible individual each month. These monthly visits and reports are required by the Care Homes Regulations 2001 and are important in helping to ensure that there are arrangements in place for overseeing the management and quality of care provided. The responsible individual was present during part of the inspection and for verbal feedback of the findings of the inspection. The responsible individual and the manager were receptive to comments and advice given during the inspection. We were informed that money is not held on behalf of people who use the service. Where additional services are purchased such as from a visiting hairdresser of chiropodist, Kingfisher settles the bill and then families are invoiced for the ammount owed. We found that those records that are required by the regulations to be in place, were, however as detailed in the report peoples care would be better supported by improvements in the way records are organised and kept. This would reduce the risk of important information not being acted on. Observations during the inspection were that staff were carrying out safe practice in relation to the movement and handling of people who needed assistance. Discussion with staff and training records identify that staff do receive training in safe working Care Homes for Older People Page 25 of 32 Evidence: practices which is important in helping to ensure that staff have the necessary knowledge and skills to reduce the risk for people who use the service. Care Homes for Older People Page 26 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 12 (1) (a) To monitor service users 31/12/2007 weight gains and losses, scales that are suitable for all service users use must be made available. Staff must sign the medication administration record for all medications given to service users. The employment of a member of staff prior to receiving the CRB clearance must be only under exceptional circumstances and must be subject to the induction and supervisory arrangements stipulated in the Care Standards Act 2000. 30/11/2007 2 9 13 (2) 3 29 19 (1) (i) paragraph 1 to 7 of schedule 2 30/11/2007 4 31 9 (1)(i)Paragrap h 1 to 5 and 7 of schedule 2 An application must be 31/12/2007 submitted to the Commission for Social Care Inspection for the manager to be considered for registration. Care Homes for Older People Page 27 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5A The service user guide must contain clear information about the range of fees and the reasons for any differences. 30/06/2009 This is to help people plan their finances and understand the charges. 2 7 15 Care plans must be updated to reflect any changes and to incorporate any advice given by health professionals. This is to help ensure that peoples needs are met. 3 8 12 The organisation of records must be improved to ensure that changes to peoples health can be effectively monitored. This is to help ensure that staff are able to track changes more easily and Care Homes for Older People Page 28 of 32 30/06/2009 30/06/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action reduce the risk of delay in referral to health professionals. 4 9 13 All controlled drugs must be stored according to the Misuse of Drugs Regulations on Safe Custody. To comply with legislative requirements and keep medicines safe. 5 9 13 All medicines that have been 30/06/2009 prescribed with the direction when required need to be fully care planed so as to ensure the carer giving the medication knows what situations would warrant an administration and when a referral back to the prescriber is needed. Records for reasons why a when required medicine is given should be completed. This helps to ensure that people are safeguarded by medication being used appropriately and effectively. 6 9 13 There must be clear, accurate and complete records of all medication received, administered and disposed of as part of the safe management of peoples medication. 30/06/2009 30/06/2009 Care Homes for Older People Page 29 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This helps to identify and reduce the risk of error. 7 29 19 A full employment history must be obtained as part of a robust recruitment and selection process. To help with decisions about the suitability of people to work with vulnerable people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 30/06/2009 1 1 The pre-admission assessment form should include prompts for gathering information about race, culture, language, religion, sexual orientation and any needs relating to these areas. Arrangements should be made to monitor care practices in relation to protecting peoples dignity. Care plans for social activity and occupation should be reviewed more thoroughly with the involvement of people who use the service and their relatives to ensure people are able to have the stimulation and occupation which meets their needs. Records of food intake should be kept for people identified as being at nutritional risk to help ensure their dietary needs are met. A clearer system for recording bruises, marks and injuries should be implemented with evidence of regular review and monitoring against accident records. This is to help identify any concerns and safeguard people. Continue to explore ways of maximising the facilities in relation to meeting peoples current and future needs needs and expectations. Page 30 of 32 2 3 9 12 4 15 5 18 6 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 31 Efforts should be made to maintain consistent management arrangements to improve and maintain standards. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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