Inspection on 02/06/10 for Kingfisher Residential Care Home

This inspection was carried out on 2nd June 2010.

CQC found this care home to be providing an Poor 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingfisher Residential Care Home 01/04/10

Kingfisher Residential Care Home 07/01/10

Kingfisher Residential Care Home 10/03/09

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 08/06/2011.

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:   zero star poor 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: 0 3 0 6 2 0 1 0 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 33 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 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) 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. Single bedrooms and double rooms are provided, and there are four separate lounge/dining rooms. All of the roome are of domestic size. Care Homes for Older People Page 4 of 33 Over 65 27 0 1 4 0 1 2 0 1 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. 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 33 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: zero star poor 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, one unannounced and one announced inspection visit. Prior to the inspection we reviewed the information we had received about the service which included reports of previous inspections and correspondence and contact with the service and people associated with the service. The last key inspection was carried out in January 2010. Following the inspection in January 2010, statutory requirement notices were served as a result of breaches of regulations relating to staff recruitment. A random inspection was carried out in April 2010 to check compliance with the notices. We were unable to Care Homes for Older People Page 6 of 33 do this as no new staff had been employed, therefore compliance was checked during this inspection. This inspection took place over two days, 2nd and 3rd June 2010. The Acting Manager was not working on the first day, therefore staff files were not accessible. Arrangements were made to return the following day, when the Acting Manager and the Responsible Individual were present. The inspection was carried out by case tracking, which involves selecting samples of records for people using the service to look at their care and experiences. We spoke with people using the service, staff and relatives about the care provided. Because Kingfisher Residential Care Home 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 was 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. We also looked at the training staff receive to help them to meet peoples needs. Shared areas such as lounges and dining rooms, a sample of peoples bedrooms and the outside area, were seen during the inspection. We looked at staffing arrangements and the effectiveness of these in meeting the needs of people using the service. We took into account the findings of this inspection when considering the effectiveness of the management and quality assurance systems. In particular we were looking to see if compliance with previous requirements had been achieved. We found that compliance had not been achieved with all of the requirements and seized evidence Verbal feedback was given to the Responsible Individual and the Acting Manager during the inspection. We have made new requirements as a result of the findings of the inspection and where requirements have not been met they are recorded as outstanding. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: There is no registered manager and no application for registration has been received by the Care Quality Commission, even though the current acting manager told us in January 2010 that she was intending to submit one. The Statement Purpose was found not to be accurate at the last inspection and we made a requirement that this be updated. This requirement had not been met. Assessments and care plans need to be kept up to date and changed as peoples care needs change. They need to be sufficiently detailed to enable staff to provide appropriate and safe care. New staff need to have time to read peoples care plans and risk assessments and not be totally reliant on verbal information from other staff. Risk assessments need to take account of the specific risks for each individual based on their particular needs and preferences. The premises and some furnishings are showing signs of wear and tear and the home would benefit from refurbishment. Although some staff training has taken place, several new staff have started work recently and further training will be required to ensure they have the knowledge and skills to meet peoples needs. One example is dementia Care training. Kingfisher is registered to care for people with dementia, therefore all staff need the necessary training to meet the needs of people with dementia. The majority of staff who have Care Homes for Older People Page 8 of 33 had training in dementia care, have only had one training session. Medication was poorly managed with omissions and inaccuracies in records, which made it difficult to be reassured that people had received their medication as prescribed. More care needs to be taken regarding health and safety issues such as the storage of chemicals. Anti-freeze was found to have been left in the outside area. Information about incidents that have occurred is not always being sent to the Care Quality Commission as required by the Care Homes Regulations 2001. 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 33 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 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples assessed needs are not kept under review which means they may not get the care they need. Some of the information that they receive about the home is inaccurate which could mean that people move to the home without full knowledge of the service and facilities provided. Evidence: Kingfisher Residential Care Home has a statement of purpose and service user guide which gives people information about the home and the services it offers. These are used in the admission process, to give information to prospective people coming into the home. Following the inspection carried out in January 2010 a requirement was made that the information in the statement of purpose must be accurate and reflect the services and facilities offered. An improvement plan submitted to the Care Quality Commission stated that it would be reviewed and rewritten by the end of April 2010. During this Care Homes for Older People Page 11 of 33 Evidence: inspection the Acting Manager informed inspectors that the statement of purpose had not been updated yet. We also found in January 2010 that although people had copies of terms and conditions on their files, they had not been signed by the person receiving the service, their representative or a representative of the company. We recommended that these be signed by both parties. We looked at files for two people and found that this had not been done. During the key inspection we would usually look at how the needs of people were being assessed prior to admission. We were unable to do this as there have been no recent admissions. Kingfisher Residential Home Ltd agreed with the Local Authority in December 2009 that they would not take any new admissions until improvements had been made. The Local Authority also has a policy not to place people in 0* poor, rated services. As a result of the findings of the inspection in January 2010 a rating of 0* poor was given. In addition to assessing the needs of people before they are admitted, it is important that peoples assessed needs are kept under review to help ensure that people receive the care that they need. We looked at care records for someone who uses the service and spoke to staff about their needs. This identified that although the persons needs had changed, assessments and care plans had not been updated to reflect the changes to the persons assessed needs. Care Homes for Older People Page 12 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning systems do not adequately support peoples care and medication is poorly managed. Evidence: Relatives spoken with confirmed that they were happy with the way that staff care for people. Each person who lives at the home has an individual plan of care. This contains their care plans and other information that staff need to know, to provide them with the care they need. Care plans seen covered areas such as communication, eating and drinking, personal care, mobility, health and continence. As well as their care plans people have morning and evening routines in their individual plan of care file. Some of these contained a good level of detail and included things like what time people liked to get up and go to bed, whether they want a drink before they went to bed and how many pillows they like at night. Care Homes for Older People Page 13 of 33 Evidence: Three requirements were made following the key inspection in January 2010 relating to care planning. The requirements related to the need for improvements in care planning for people with dementia, people at risk of falls and people at risk of pressure ulcers. During this inspection we found that while care plans did contain some information about these areas, information was minimal and in some cases did not provide staff with enough information to fully meet peoples needs. For example a care plan identified that one person can kick out if staff get too close or when assisting with personal care, but did not give guidance to staff on how to overcome this. A staff member said that they had found their own ways of assisting this person. Advice was given about the need to fully meet this requirement. We also looked at the care plans and risk assessments for someone whose needs had changed. We found that the care plans had not been updated to reflect the change in the persons needs. For example there was no care plan for catheter care even though records showed that the person was having difficulties since the catheter had been fitted. A staff member said that increased monitoring of this person had been needed due to a deterioration in their health. Again the care plan had not been updated to reflect this need. New staff are informed as part of their induction that they have a responsibility to read the care plans, however time is not set aside as part of their induction to allow them to do this. Staff told us that they find out how to care for people through other staff telling them rather than being guided by information in the care plans. We found in one case that staff had not been using a hoist to transfer someone as directed in the care plan which put both staff and the person using the service at risk. Each care plan contained the name of a key worker. However there was no effective key worker system in place. A care plan dated 7th January 2010 identified the key worker as someone we were told in June 2010 had not yet started working in the home. Records showed that when people are unwell the General Practitioner (GP) or the out of hours GP service is contacted for advice or a visit. A record of this is kept, though not always used to update the care plan. We found that medication was poorly managed. Quantities of medication received in to the home were not always recorded, therefore there was no audit trail to ensure Care Homes for Older People Page 14 of 33 Evidence: that all medication was accounted for. Medication records could not be relied on to provide an accurate account of when peoples medication had been administered. The medication records contain a set of codes to be used in circumstances where medication has not been administered. Some of these codes were used incorrectly and without adequate explanation of why medication had not been administered. Advice was given to have a list of all staff trained to administer medication with a copy of their signature to assist in distinguishing between codes and signatures. Records showed that a product prescribed to be used to thicken drinks for someone with swallowing difficulties had been out of stock for a period of two days. Staff were unable to confirm how this persons drinks had been thickened during this period. Without the product this person could have been placed at risk. The product was available at the time of inspection. During the inspection in January 2010 we found that prescribed creams had not been dated when opened. We found that this remained the case. It is important to do this to ensure that they are used within the recommended time to reduce the risk of bacterial contamination. Observations and discussion with staff during the inspection identified that staff speak to and treat people with respect. Relatives spoken with confirmed that they were happy with the way that staff treated people. A staff member spoken with was aware of the need to understand and respect peoples preferences, cultural and religious views, particularly where the person is unable to communicate these. The staff member was checking someones care plan prior to them receiving nail care but unfortunately the information was not available in the plan. Care Homes for Older People Page 15 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Progress has been made towards improving peoples daily lives through increasing activities and food choices. Evidence: People told us that there had been some improvements in the activities provided since the last inspection. A part time activity person is employed but wasnt working on the first day of our inspection. One person told us that they enjoyed assisting the activity person and a relative told us that the person they visit was happier now that there were more activities. One person who is independently mobile likes to spend time outside in the garden and is able to do this. Some people received nail care and some hand massage on the day of inspection. Three people were seen to have access to either colouring, some dolls or were watching television in one of the lounges. In another lounge people were reliant on conversation with staff and visitors. The improvement plan submitted following the last inspection shows that efforts are being made to involve families in helping to identify appropriate activities. This is important for everyone but particularly for those less able to communicate their interests. Care Homes for Older People Page 16 of 33 Evidence: The Acting Manager told us that a trip to Hunstanton has been arranged for four people and a trip to Stanwick Lakes for people unable to travel so far. A trip to a museum is being arranged for two people interested in war memorabilia. People are able to have visitors and visiting arrangements are flexible. Visitors were greeted by staff and made welcome. There was evidence that efforts are being made to provide more choices for people. For example since the inspection in January a new four week menu has been developed which includes a choice of main meal. Staff told us that the menu had been based on dishes that they know people like. On the day of the inspection the menu had been revised as no beef had been purchased for the braised beef. Staff told us that the menu was relatively new and the shopping was not yet fully linked with the menu. Alternatives were available and people were offered fagots or jacket potato with cheese and a side salad. People appeared satisfied with the alternatives offered and meals were well presented. Staff were observed assisting people appropriately and sensitively with their meals. Care Homes for Older People Page 17 of 33 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. Action is taken to address any concerns raised which helps to safeguard people who use the service. Evidence: Improvements in the staff recruitment process provide better protection for people using the service. More details about this are recorded in the staffing section of this report. There is a complaints procedure which outlines what people should do if they wish to raise a concern about the home and the response that they can expect. A copy of the complaints procedure is displayed on the notice board in the hall. One complaint was received by the Care Quality Commission after the inspection in January 2010. We were satisfied that appropriate action was being taken to address the issues of concern which related to staffing. The Acting Manager said that no complaints had been received directly by the home since the last inspection. Prior to the inspection in January 2010, an alert had been made by staff at Kingfisher to the Local Authority under the locally agreed safeguarding adults procedure. This alert related to someone using the service losing a personal possession. The local authority found that there had been insufficient recording regarding the incident and also raised concerns that information had not been added to the persons file as they had requested. In a letter dated 11th May 2010 the local authority enclosed a protection plan to be added to the persons file. At the time of the inspection this still Care Homes for Older People Page 18 of 33 Evidence: had not been added to the care file. Staff spoken to were aware of how to raise any concerns that they may have. Some staff training in safeguarding vulnerable adults took place in June 2009, though there have been several staff changes since that time which means that the majority of staff havent received any training in this area. Care Homes for Older People Page 19 of 33 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. People benefit from the small lounge/dining rooms which provide a homely environment, though areas of the home are becoming shabby and worn in places. Evidence: Kingfisher consists of two former terraced properties which have been converted into one home. The downstairs of the property is divided in two by a covered driveway,with two of the lounges, a communal bathroom, the activity room, kitchen and office on one side and two bedrooms, a lounge and the laundry room on the other side. The majority of people use one of the two lounges in the main part of the building. There is a fourth lounge on the first floor. Each of the lounges has a small dining area. The lounge areas have been made homely with pictures, ornaments and plants and are domestic in size. The upstairs lounge area and the lounge away from the main part of the building have call bells so that people can call for staff if they need them. There are no call bells in the lounges in the main part of the building which mean that if staff are in another part of the building people sitting in the lounges are unable to call staff should they require assistance. The first floor of the property is accessed by a passenger lift, stair lift or stairs. The home currently has one double bedroom with the other bedrooms all being single Care Homes for Older People Page 20 of 33 Evidence: occupancy. All of the bedrooms have a hand basin and six have en suite facilities. People are able to bring in photographs, ornaments and other items to make their bedrooms feel more personal. The home is showing some signs of wear and tear with some chips in the paint work and tears in the wall paper. An improvement plan received on 5th May 2010 stated that there would be a rolling plan for decoration. The downstairs bathroom had been decorated since the inspection in January 2010 but at the time of the inspection no date had been set for further work. A bed base looked at was stained and the majority of towels were worn and thin and in some cases torn. The Responsible Individual said that he had a supply of new towels at home that he would bring in. Some of the radiators did not have covers. We made a requirement at the inspection in January 2010 that risks of people burning themselves from the uncovered radiators be formally assessed. Risk assessments were in place on peoples care files, however we were concerned about the adequacy of these. This is covered in more detail in the management section of this report. Since the inspection in January 2010 systems had been put in place to check the temperature of the water in the downstairs bathroom with a thermometer to reduce the risk of scalding for people when having a bath. Temperatures were being recorded. There is an outdoor area which one person was observed to access several times during the day. There is some seating with a courtyard area and some lawn and raised plant beds. Some areas are uneven and on different levels which may present a risk of falls for some people. The Responsible Individual advised that he intended to address this. The outside area contained some broken furniture and equipment, paint tins and chemicals which included antifreeze. Staff said that these were due to go to the refuse tip. Following discussion with the senior carer about the risks, she locked away the chemicals. Care Homes for Older People Page 21 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from having a committed and caring staff team and improved recruitment practices, but limited staff training continues to put peoples safety at risk. Evidence: Relatives and people using the service had no concerns about the staff team. Staff on duty during the inspection were observed to have a pleasant manner with people using the service. Staff spoken with were committed to meeting the needs of people using the service. On the day of the inspection there was a total of eleven people living in the home. One of these people was in hospital. There was a senior care assistant, a care assistant, a cook and a cleaner on duty. Following the inspection in January 2010 we served a statutory requirement notice as a result of continuing breaches of regulations relating to staff recruitment. The Care Homes Regulations 2001 requires that certain checks are carried out to determine the suitability of prospective staff to work with vulnerable people. During this inspection we checked to see that the requirements made about staff recruitment had been met. We looked at staff recruitment records for three recently Care Homes for Older People Page 22 of 33 Evidence: recruited staff and found that the necessary checks had been carried out for these people. This meant that the statutory requirement notice had been complied with. There has been a relatively high staff turnover, with nine new staff having commenced work since the inspection in January 2010. Another two people are due to start work when satisfactory clearances have been received. We looked at the induction and training process for new staff. Some of the new staff did not have any previous experience of care work. Staff told us that prior to working as part of the rota, they worked one or two shifts shadowing an experienced member of staff. The rota showed that for one member of staff with no previous care experience they had worked an early shift, a late shift and a night shift shadowing, before working as part of the team. There is no formal process for assessing competence following the induction and opportunities for extending the period are limited as staff do not get paid during this period. We asked to see staff induction records. Guidance is given to care homes through Skills for Care about the basic induction of staff caring for older people. This was not being followed. The was very basic and consisted of a list of subjects which had been signed by the inductee and the Acting Manager. The list contained some orientation to the home such as where to turn the water off and fire procedures, smoking policy and dress code. It also contained information about where care plans and policies and procedures are kept. Speaking to staff, they were clear that it was their responsibility to read care plans, though no time is set aside to allow them to do this. Staff told us that the way new staff find out about how to meet peoples needs is either from other staff or finding out for themselves. We found that in one case this had led to unsafe movement and handling practices being carried out. The cook told us that she had just started working towards a National Vocational Qualification. Requirements were made following the last inspection about staff training. Specific mention was made of the need for movement and handling training, dementia care, health and safety, first aid and infection control. A sample check showed that some staff have received some training since the inspection in January 2010. However we found that untrained staff were continuing to assist people with movement and handling. Further details are covered in the management section of this report. Care Homes for Older People Page 23 of 33 Evidence: New staff have been employed since some of the training took place and the Acting Manager advised that she is working with a training company to provide further training. Advice was given to look at the training needs of staff in relation to meeting peoples needs. For example as a care home for people with dementia, the expectation would be that staff had more than a basic awareness of dementia care. Care Homes for Older People Page 24 of 33 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The continued failures to comply with legislation demonstrate a lack of effective management and oversight of the service which places people at risk. Evidence: Kingfisher Residential Care Home does not have a registered manager. The current Acting Manager has been in post since November 2009. We were informed in December 2009 that she would be submitting an application for registration. In January 2010 we again reminded the Responsible Individual and the Acting Manager of the legislation that requires anyone managing a care home to apply for registration. During this inspection we were informed that the Acting Manager had been too busy working on shift, and had not yet applied for the necessary documentation to enable her to submit an application for registration. The Responsible Individual and the Acting Manager have again been reminded of the legislative requirements. Staff told us that the Acting Manager had been working hard to improve things in the Care Homes for Older People Page 25 of 33 Evidence: home. Following the inspection in January 2010 a statutory requirement notice relating to breaches of regulations about staff recruitment was served. These notices form part of our enforcement pathway and are used in instances where there are continued breaches of regulations which place people using the service at risk. Although compliance with the requirements in this notice had been achieved, we found that other requirements detailed in the inspection report had not been met. The continued failures to comply with legislation demonstrate a lack of effective management and oversight of the service which places people at risk. The Responsible Individual and Acting Manager said that they had not yet addressed the requirement about updating the statement of purpose. We found that some other requirements had been partially met and further advice has been given. These related to requirements for care planning and risk assessment. Some staff training had taken place on some of the areas detailed in a requirement, however training has not yet been arranged for new staff. As there has been a high staff turnover, advice has been given that this is particularly important. We found that a requirement for staff to have training in movement and handling prior to assisting people had not been met. Untrained staff had been continuing to carry out movement and handling, with unsafe procedures which placed them and people using the service at risk. Evidence was seized during the inspection for consideration of further enforcement action. Following the inspection we have written to the Responsible individual warning him of the potential for enforcement action if continuing breaches are found. As part of the review of evidence during the inspection we found that staff were not following the movement and handling plan for one person, which stated that the hoist should be used for all transfers. Conflicting information was given to the inspector about the reasons for this. The Responsible Individual provided assurances that staff had been spoken with during the inspection about the correct way to assist this person. As part of the quality assurance process, organisations are required to carry out monthly unannounced visits to the service to assess the quality of care. Records show that these visits are taking place and that the views of staff and people using the service are sought during these visits. There is no evidence within the reports of a Care Homes for Older People Page 26 of 33 Evidence: clear plan to address inspection requirements. At our inspection in January 2010 we found that we were not consistently receiving details of notifiable incidents as specified in the Care Homes Regulations 2001 and made a requirement about this. During this inspection staff told us about someone who had been admitted to hospital several times. The Acting Manager told us that she had not been aware it was necessary to notify us of this. Advice was given to refer to the guidance on the Care Quality Commission website. Requirements had been made about the need for risk assessments for people at risk of falls, risks relating to uncovered radiators and the risk of scalding while bathing. We found that although risk assessments had been put in place, these were general risk assessments and did not cover the risks for the individual and were therefore ineffective. A risk assessment on someones file contained the initials of someone else, it did not cover any specific risks such as the position of the radiator in the persons room or that they were at risk of falls. Kingfisher was operating on low occupancy levels at the time of our last two key inspections and continues to do so. Following the key inspection in January 2010 the Responsible Individual gave reassurances that the care home continues to be financially viable. We have reminded him of his responsibility to keep us informed of any changes to this. Care Homes for Older People Page 27 of 33 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 37 The registered person must 28/02/2010 notify the Care Quality Commission of any incidents or occurrences as specified in regulation 37 of the Care Homes Regulations 2001. To ensure that notifiable incidents are monitored. 2 1 4 The information in the 30/04/2010 homes statement of purpose must be accurate and reflect the services and facilities offered by the home. To ensure that people receive the correct information about the home. 3 30 13 Staff must receive 28/02/2010 appropriate training before being involved in moving and handling of people who live in the home. To ensure the safety of all. Care Homes for Older People Page 28 of 33 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 3 14 Peoples assessed needs must be kept under review, with assessments being revised as peoples needs change. To help ensure that assessments are reflective of peoples current needs and people receive the care they need. 06/08/2010 2 7 12 Arrangements must be made for care plans to be used as working tools to guide staff in the delivery of care. To help ensure that people receive the care that they need. 30/07/2010 3 7 15 Care plans must be 30/07/2010 reflective of peoples current needs and provide staff with sufficient guidance and instruction to enable them to meet those needs. Care Homes for Older People Page 29 of 33 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 To ensure peoples needs are met. 4 9 13 Accurate records must be kept as part of an audit trail of all medication received, administered and disposed of. As part of the safe management of medication. 5 9 13 Peoples prescribed medication must be available at all times and administered as prescribed. To ensure that people receive their prescribed medication. 6 18 13 Advice and protection plans provided by the local authority safeguarding team must be incorporated in peoples care plans. To safeguard people who use the service. 7 30 18 Staff must receive the 20/08/2010 appropriate training to ensure that they have the skills and knowledge to meet peoples needs. This must include dementia care training. 22/07/2010 05/07/2010 05/07/2010 Care Homes for Older People Page 30 of 33 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 To help ensure that staff have a full understanding of the needs of people. 8 30 18 Staff must receive the 20/08/2010 appropriate training to ensure that they have the skills and knowledge to meet peoples needs. This must include induction training. To help ensure peoples needs are fully and safely met. 9 33 24 The quality assurance 22/07/2010 system must be effective in maintaining compliance with regulations. To promote the health and well being of people using the service. 10 38 13 Risk assessments must take 22/07/2010 account of the risks for individuals using the service. To reduce unnecessary risk 11 38 13 Chemicals must be securely stored in accordance with COSHH requirements. To safeguard people using the service. 22/07/2010 Care Homes for Older People Page 31 of 33 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 1 9 Creams, lotions and ointments should be dated when they are opened to ensure that they are used within the recommended time and the risk of infection reduced. Arrangements should be made to identify further opportunities for occupation or activity appropiate to peoples interests outside designated activity sessions. Staffing levels should be kept under careful review taking account of the needs of people using the service and the layout of the building. 2 12 3 27 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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