CARE HOMES FOR OLDER PEOPLE
Kings Lodge 50 North End Higham Ferrers Northants NN10 8JB Lead Inspector
Mrs Sheila Smith Unannounced Inspection 20th February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kings Lodge Address 50 North End Higham Ferrers Northants NN10 8JB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01933 315321 01992 710401 Mr Claude Fonseka Mrs Viola Fonseka Mrs Patricia Jeffs Care Home 21 Category(ies) of Dementia - over 65 years of age (21) registration, with number of places Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. No person within the category DE (E) can be admitted where there are already 21 persons of category DE (E) already in the home. 26/05/05 Date of last inspection Brief Description of the Service: Kings Lodge is situated on the outskirts of Higham Ferrers, with public transport links to the neighbouring towns of Wellingborough and Rushden. The home provides personal care and support for up to 21 older people over the age of 65 years who have a dementia related condition. The home is a conversion of a large detached residential property, with ground floor and first floor accommodation. There is a garden at the rear of the property, which contains a well-maintained Aviary. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for Residents, and upon their views of the service provided. The primary method of inspection used was ‘case tracking’ which involved selecting 2 Residents and tracking the care they receive through review of their records, discussions with them, and with the care staff, and observations of care practices. The inspection took place during a weekday over a period of 5 hours and was carried out on an unannounced basis. Communal areas, and some bedrooms were visited. A selection of care records, and essential records of the home were reviewed. A number of the residents, two relatives and several staff were spoken to as part of the inspection process. The Registered Manager Mrs Patricia Jeffs was available throughout the inspection. What the service does well:
The home is clean, well maintained and has a calm atmosphere, where the residents, some of whom have severe dementia related conditions, appeared to be well cared for. The home has a good quality detailed information pack, which makes it clear who the home is suitable for. Prospective residents are invited to spend time in the home to see if they like it before moving in. Residents spoken to during the inspection expressed their satisfaction with the care that they receive from the staff. Meals were nicely presented, and the mealtime during the inspection was a relaxed time with staff sensitively assisting those who required help to eat their meal. The garden is well maintained and has an aviary containing a large number of birds that provide enjoyment for the residents. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
A serious concern, relating to the recruitment of staff was identified during the inspection, which was the subject of an immediate requirement. A cleaning plan has been displayed in the kitchen, however there is no evidence that this is adhered to. Recommendations have been made in this report for the kitchen to be refurbished as a matter of priority, to facilitate easier cleaning. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 7 Pipe work and radiators should be guarded or have guaranteed low temperature surfaces, to prevent vulnerable older people from burning themselves. Some areas of the ground floor of the home would benefit from being redecorated. Two of the lounges do not have fitted carpets and appear rather bare. They would benefit by pictures, ornaments or plants to give a more homely appearance. Records of fridge and refrigerator temperatures were in place, although were not maintained every day. The outcome for residents will improve if staff are given the opportunities to improve their knowledge and skills. This can be achieved through regular updates in training such as fire and abuse, by undertaking National Vocational Qualification training, and through receiving supervisions on a regular basis. The daily records should be a ‘pen picture ‘ of that resident’s life in the home Currently the records do not always contain sufficient information, particularly in recording the resolution of identified problems. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. The assessment of prospective residents prior to their admission to the home ensures that residents and their families can be confident that the home can meet the needs identified. EVIDENCE: The Statement of Purpose, and Service User Guide, are documents given to prospective residents and their families, and viewed as part of the inspection process. These documents covered all of the areas required, and generally were clear, concise and informative to the reader. Slight differences in the services described in the document to the actual provision of services were noted, which were discussed with the Registered Manager, who will update the document. Evidence within the residents files examined as part of the case tracking process indicated a statement of the terms and conditions had been prepared that met the standard. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 10 All new residents have detailed assessments conducted by the Registered Manager or the Registered Provider prior to admission from which detailed individual plans of care are developed. There was evidence of Care Management assessments, and other professionals had also been contacted to contribute their assessments to the process. Residents interviewed confirmed that they felt satisfied and comfortable in the home and that the staff met their needs. There was also evidence in the form of care plans, staff training, and through observation of the residents who were unable to communicate, that the home is also able to meet their needs. Prospective residents are encouraged to visit the home prior to admission, along with their representatives where appropriate. One resident described his visit to the home which had helped him to make up his mind choose Kings Lodge as his future home. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10, Residents receive personal and healthcare support that meets their needs and are protected by medication procedures. EVIDENCE: Two residents care notes were case tracked. The documents were written to a high standard, and contained detailed and valuable information. The records demonstrated that one of the residents, who had been resident for some time, had accessed a variety of health professionals during the last year. Specific needs have been met as they arise and planning was evident for regular consultations with Community psychiatric nurses, and chiropodist as required. Generally the care plans had been reviewed timely, although none of the care plans seen had been signed by the resident or their representative, and a discussion was held with the Registered Manager regarding the best method of ensuring this is achieved. The daily records indicated that care is not always taken to record outcomes. For example the records for one resident chosen for case tracking, reported a specific problem but there was no record to indicate whether the problem had been dealt with or had improved.
Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 12 The Home has a contracted Pharmacist and a pre-packed blister system is used for medication. There is an incoming medication record with medication checked by staff. A medication disposal record is maintained and signed by the receiving pharmacist. The medication trolley is not attached to the wall. (A requirement has been made). The Registered Manager confirmed that all staff who have responsibility for the administration of medication have received appropriate training. Discussion with staff members on duty at the time of the inspection provided evidence of their ability to maintain the resident’s privacy and dignity. One of the residents said that he preferred to remain in his own room, and confirmed that the staff respected his privacy at all times. Residents are able to have their own telephone installed in their rooms if they wish and staff were observed knocking on residents doors before entering. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Dietary needs are well catered for, with a balanced and varied selection of food available that meets the resident’s tastes and choices. EVIDENCE: The home does not employ an activity organiser, and the responsibility for arranging activities has been allocated to the Deputy Manager. Evidence through a list on the notice board, through discussions with relatives and residents and through records demonstrates that group activities are carried out. There was however, little evidence of individual activities being arranged. This was discussed with the Registered Manager who agreed that further development was required in this area of care. A visitor from the local church visits the home to hold a regular service. The residents spoken with during the inspection said that they were happy with the visiting arrangements. Visitors were in the home on the day of inspection and were very happy about the standards at the home and one spoke of the ‘lovely and caring staff’ Due to the high dependency of some of the residents, staff have to make some decisions on behalf of them but it was clear that their preferences were
Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 14 respected. A visitor confirmed that staff were very considerate and cared for his relative to a high standard. The mid day meal served, looked and smelled very appetising, consisting of chicken and bacon chasseur, peas, sweet corn and rice, followed by fruit sponge and custard. There was a four-week menu displayed, however the Cook said that she was in the process of changing the menu to suit the requirements of the residents. Residents spoken to gave positive feedback as to the standard of catering, and one of the residents commented ‘that the cooks speciality was desserts which were delicious’. The Registered Manager said that fresh fruit was available every day. Residents were observed to be given sufficient time to eat their meal in an unhurried manner, and staff offered assistance in eating when necessary. This was carried out discreetly, sensitively and individually. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Lack of appropriate supervision and training of staff has the potential to place residents at an increased risk of harm and /or abuse. EVIDENCE: A complaints procedure is in place, which gives timescales for complaints to be responded to and details of the Commission for Social Care Inspection. Residents spoken to confirmed that they were aware of whom they could complain to if they were unhappy with the service provided. The complaints records were available during this inspection, which evidenced that complaints were handled in a satisfactory way. No complaints had been notified to the Commission of Social care Inspection since the last inspection. Staff spoken to during this visit were unsure of the types of abuse that could arise, although said that they would report any suspicions to the Registered Manager. Since the last inspection training in this area of care has not been provided. (A requirement has been made.) Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,24,25,26 Some limited improvements to the décor have been made; however there are still issues outstanding that mean the residents do not live in homely surroundings. EVIDENCE: Paintwork is chipped, particularly on the ground floor of the home, and in several of the bedrooms (A requirement has been made). Radiators in bedrooms remain unguarded, or have guaranteed low temperature surfaces (A requirement has been made) The kitchen has limited storage areas, and is therefore difficult to clean because of the lack of space for equipment. A cleaning rota has been implemented, but it was not clear who was responsible for the various tasks. In discussion with the cook it was not clear who was responsible for the cleaning in her absence. (A recommendation has been made)
Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 17 Two of the lounges on the ground floor, appear rather bare, and would benefit from pictures, plants, and ornaments to improve the overall homely effect, and so improve the rooms where residents spend most of their days. A selection of bedrooms was randomly visited during the inspection. Those seen met the standard, although some needed attention to the décor. The rooms seen contained a number of personal possessions and appropriate furniture and fittings. One resident was pleased that he was able to have his dog living in the home and said ‘I could not have moved in without him.’ At the time of the inspection visit the home was seen to be generally clean and hygienic. There is a large enclosed garden that is safe and accessible to residents, with a well-maintained aviary, which the residents said they enjoyed, and found the birds to be very entertaining. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The procedures for recruitment of staff are not sufficiently robust therefore may not provide the safeguards to offer the residents an environment in which they would be safely cared for. EVIDENCE: The staff files of two members of staff employed recently indicated that the home had not undertaken all the necessary recruitment checks to ensure protection of the residents. The Inspector had serious concerns because a member of staff has not been checked against the official list of people who are unable to work with vulnerable adults and for whom Criminal Records Bureau clearance had not been received. A requirement was made that she was not left to work unsupervised until the required documentation had arrived. . (An immediate requirement has been made). Two references had not been received for another member of staff, before employment. (A requirement has been made) Concerns had been raised at the last inspection regarding the failure to obtain two written references before employing staff that resulted in a requirement being made on the previous report that has not been met. The training profile was not clear and did not indicate when training had been delivered. Staff files did not provide evidence of training, as these were not up to date. (A recommendation has been made) Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 19 Only 4 out of 10 carers employed are currently taking or have achieved National Vocational Qualification training. (A recommendation has been made) Dementia training is provided on a regular basis, and the staff team appeared experienced, and knowledgeable about the resident group, and committed to improving the quality of life of the people they care for. Observations were made of staff engaging appropriately with residents who seemed comfortable and relaxed in their company. Residents and visitors commented that staff at the home were ‘kind and caring’, and one visitor said that he visited every day and was not aware of staff shortages. Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,37,38. The registered Manager is experienced and able to run the home, however record keeping and fire safety procedures are inconsistent and must be improved. EVIDENCE: Since the last inspection the acting Manager has been successful in her application for registration and has been appointed as the Registered Manager for the home. The manager has a large amount of experience in caring for older people. Staff commented that the Manager was easily accessible to them, and willing to discuss issues and guide them in practice by example. Supervision systems for staff were not in place to ensure guidance, support and to identify any training needs. (A requirement has been made)
Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 21 There was no evidence that a quality assurance and audit process has been introduced. (A recommendation has been made.) Some of the required records are in need of further development, i.e. staff training records, kitchen cleaning rotas, fridge / freezer temperature recording charts. (A recommendation has been made) All areas of the Home seen appeared safe. Records observed included the accident book, where advice was given to remove confidential information in line with data protection, and risk assessments, which were found to be satisfactory. The fire log- book indicated that manual fire alarms and emergency lighting was tested on a regular basis. Staff interviewed were hesitant regarding the fire procedure, and there was no evidence that they had received recent fire training, or that a fire drill had been carried out within the last year. This was discussed with the Registered Providers and the Registered Manager. (A requirement has been made) Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
OICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X X X 2 2 X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X 1 2 2 Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard OP9 OP18 OP19 Regulation 13(2) 13 (6) 23 (2) Requirement The medication trolley must be secured to the wall. Training for all staff must be arranged for the Protection of Vulnerable Adults A programme of routine maintenance and renewal of the fabric and decoration of the premises must be sent to the Commission for Social Care Inspection. . Pipe work and radiators must be covered or have guaranteed low temperature surfaces. Staff must not be employed without POVA first checks and Criminal Records Bureau clearance. Staff recruitment policies and practices must be consistently implemented in line with Regulation and having regard for Section 19 of the Care Standards Act. (This requirement was made on the previous report to be implemented by 8/06/05 and has not been met.) The Registered Manager must
DS0000061540.V279560.R02.S.doc Timescale for action 30/04/06 30/04/06 30/04/06 4 5 OP25 OP29 13(4) 19 30/06/06 20/02/06 28/02/06 6 OP29 19 7 OP36 18 30/04/06
Page 24 Kings Lodge Version 5.1 8 OP38 23(4) develop systems for staff supervision and staff appraisal in line with the required standards Staff fire training must be arranged for all staff and updated in line with the fire officer’s recommendations. 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP28 OP30 OP33 OP37 OP38 Accurate records should be maintained The kitchen cleaning rota should state clearly the names of staff responsible for cleaning and their responsibilities. Good Practice Recommendations The training development programme should continue to ensure that 50 of care staff are qualified in NVQ 2 A training profile indicating dates of training and the names of staff attending should be available for inspection A system of quality audit should be implemented and records of this audit be available for inspection Kings Lodge DS0000061540.V279560.R02.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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