Inspection on 24/07/08 for Kingsbury House

This inspection was carried out on 24th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kingsbury House 04/08/09

Kingsbury House 27/11/08

Kingsbury House 04/03/08

Kingsbury House 19/12/06

Kingsbury House 03/11/05

Kingsbury House 29/07/05

Kingsbury House 09/02/05

Kingsbury House 27/09/04

Kingsbury House 18/02/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Kingsbury House 61-62 Percy Park Tynemouth North Shields Tyne & Wear NE30 4JX Lead Inspector Elaine Charlton Key Unannounced Inspection 24th July 2008 08:40 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 Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingsbury House Address 61-62 Percy Park Tynemouth North Shields Tyne & Wear NE30 4JX 0191 2575121 F/P 0191 257 5121 No Email 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) Mrs Pamela Craig Dawson Manager post vacant Care Home 30 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (21) of places Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th March 2008 Brief Description of the Service: Kingsbury House was previously three terraced houses and has been adapted to provide care and support for 30 older people, nine of whom may have dementia care needs. The home is close the seafront at Tynemouth. Sea views can be enjoyed from some bedrooms and the large lounge. The home is close to local transport links and street parking is available. There are bedrooms at ground, first and second floor levels. All bedrooms are for single occupation. There are en-suite facilities in two bedrooms. A passenger lift is fitted for the comfort and convenience of residents. Nursing care is not provided. The cost of receiving care and support in the home is between £379 and £410 per week. A service user guide and copies of the Commission for Social Care Inspection (CSCI) reports, are available to help people decide whether the home can provide the kind of care support they need. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star, this means that the people who use this service experience adequate quality outcomes. An unannounced visit was made on the 24 July 2008, when a total of 6 ½ hours were spent in the home. This key inspection was as a result of the home being rated as 0 star at the last inspection, meaning that people were experiencing poor quality outcomes at that time. The manager was present throughout the day. Before the visit we looked at: Information we have received since the last visit on 4 March 2008; Arranged for a CSCI Pharmacy Inspector to carry out a full inspection of the policies, procedures and routines for the ordering, receipt, dispensing and disposing of medication; How the home has dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The provider’s view of how well they care for people; The views of people who use the service, their relatives, staff and other professionals who visit the service. During the visit we: Talked with people who live in the home, visitors, staff, and the manager; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff had the knowledge, skills and training to meet the needs of the people they care for; Looked around the building/parts of the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit; We told the manager what we found. What the service does well: The home provides a nice, comfortable environment for people to live in, and is close to local facilities they can enjoy. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 6 Co-operates with CSCI and other professional agencies to promote and improve the quality of care people living in the home receive. Staff talk to, and help, people in a sensitive and private way which promotes their privacy and dignity and makes them feel valued. Almost 100 of staff have achieved a National Vocational Qualification (NVQ) at a minimum of level 2. This is in excess of the National Training Organisation required minimum of 50 . Staff told us how much happier they are and that they are getting the training they need to do their job. What has improved since the last inspection? What they could do better: The manager should obtain full assessments for everyone who wants to move into the home. This will mean that the home and resident are sure that their individual needs can be met in a way that suits them. Continue with the introduction of comprehensive care plans covering all areas of care and support. This will mean that people who live in the home receive the individual care and support they need. Ensure that medication routines follow best practice guidance and the provider’s policy when storing, giving, recording and disposing of medicines. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 7 This will help to make sure that people’s health and welfare are protected from risk of medication errors or omissions. Keep CSCI up to date with the renewal of Criminal Records Bureau (CRB) checks and provide evidence that all CRB checks have been completed. This will help keep people who live in the home safe. Make sure that records are kept up to date and are accurate. This will mean that people who live in the home know their needs are being identified. Ensure that moving and handling plans are clear and non-contradictory so that staff know how a person needs to be supported. This will help keep people who live in the home and staff safe. A number of best practice recommendations have also been made as part of this inspection to monitor the progress being made to fulfil all areas of the home’s improvement plan. This will promote the health, safety and well-being of people who live and work in the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 4 and 6. People who use the service experience adequate quality outcomes in this area. People are given information to help them decide about moving into the home. Their diverse needs and wishes are usually fully assessed so that everyone is sure they can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People who live in the home have very different needs and some are able to live more independently than others. As well as the in-house assessment, the home usually gets a full assessment of people’s needs from a healthcare professional, so that everyone is sure they have all the information they need to decide if the right care and support can be provided. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 10 We looked at the admission process for a person recently admitted to the home. No assessment from a healthcare professional had been obtained even though the person had been admitted from an Intermediate Care Centre. The home’s own assessment document had been completed. This included details of the person’s health needs but there were some omissions. The record showed that the person had problems with their blood pressure but it did not say whether this was usually high or low. It was also recorded that they wore glasses, but not whether they needed to wear them all the time or just for reading. Staff need access to this level of information to make sure that people are properly supported. Staff also use recognised assessment tools to record a person’s need for pressure area care, dependency, nutritional and fluid intake. One pressure area assessment did not include the name of the person it referred to. The home does not provide intermediate care. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use the service experience adequate quality outcomes in this area. Individual health and care needs are delivered in a sensitive and respectful, in accordance with people’s wishes. However, record keeping is not fully up to date and may mean that the wrong care or support is given. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: A lot of work has been done since the last inspection to improve the records and care plans of people living in the home. The general manager told us that the new manager would be running ‘care plan clinics’ with staff so that they become more confident about working with, and updating them. We were told that the new manager is in the process of re-writing assessments to include up to date information, and putting care plans in place. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 12 In future these documents will need to include evidence that they have been reviewed and by whom. Each file does not always also include a copy of the original assessment obtained when the person was admitted to the home and evidence of in-house and/or local authority reviews. We looked at two records for people who had been living in the home when the last key inspection was carried out. One set of records had not been signed by the person they were about to show that they were in agreement with what had been put in place. We were later told that this person was not able to sign their name. This had not been recorded anywhere. The ‘old’ care plans were still available to staff but some valuable information and sensitive care plans that could have been used had been discarded. Social assessments had not yet been completed. We saw some differences in the spelling of peoples’ surnames. In one case this was on letters received from a Consultant who had been reviewing the person’s needs. We spoke to the manager about this and the need to make sure that other professionals have the correct information to avoid any confusion. There was a care plan in place to support one person to keep in touch with their family who live abroad. They speak to them on the telephone each Sunday, which is good. But the care plan did not say what needed to be done to ensure that this happened. It did not say whether the person had access to their own telephone or whether they needed help to be near the home’s telephone at a particular time. Care plans need to be written in a person centred way, making sure that staff have access to all the information they need to support people. A new ‘at risk report’ sheet has been introduced. This is to be used to record serious accidents/incidents/pressure damage/weight loss/infection control measures/Protection of Vulnerable Adults (POVA) incidents/changes to a person’s health status or any concerns about care provision. While a new GP request form is being used to record why the GP has been called, the outcome of visit and any changes to medication. A space for the date and signature of the person making out the record is not included. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 13 The general manager has also put a procedure and format in place to make sure that the right information is sent to the hospital when a resident needs to be admitted. A copy of the form will be kept in the home. The current medication policy is comprehensive and has been distributed and read by staff in the home who handles medicines. However, the policy does not reflect the way in which controlled drugs are disposed of and refers to qualified nurses being involved in the process. The current Medication Administration Records (MAR) had no list of signatures of staff authorised to administer medicines. This means it is difficult to identify who has initialled medicine records. There were generally few gaps in the records and entries were legible and complete. Hand written entries on the MAR charts were not always signed, witnessed and dated. Where the dose instructions on the MAR chart stated one or two tablets may be given the actual dose administered was not recorded, contrary to the policy and consequently it is sometimes difficult to reconcile medicines stocks against the administration record. There were a small number of discrepancies between the quantities of medicine supplied, the number of doses recorded as administered and the quantity of medicine left in stock. This suggests that all medicines are not being administered as prescribed. The medicines administration process observed did not always follow best practice guidance, and oral medicines were sometimes directly handled rather than using a no-touch technique or wearing disposable gloves. The instructions on supplies of Bisphosphonates labelled to be taken half an hour before food were not being followed although the manager amended the MAR charts as soon as this was pointed out. Medicine pots were in use to measure oral liquid medicines rather than 5ml spoons or oral syringes. Medicines for one patient were eventually administered by another member of staff not participating in the medicine round but the MAR chart was signed by the carer doing the medicines without having observed the administration process herself. The medicines trolley was placed in the office during the administration round but was not locked whilst the carer went to administer medication to residents. At one point the home handyman came into the room and walked passed the unlocked trolley to the rear of the room. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 14 There was no written dosage guidance attached to the MAR chart for a person receiving warfarin although the anticoagulant booklet was located in a drawer in the office area. The small room used to store the medicines trolley and additional stocks of medicines is consistently above 25 degrees centigrade, which is unsuitable for the storage of medicines. Some oral medicines were located in an unlocked metal box in this room and some ointments were located on the open shelves. The receipt and administration of controlled drugs were fully recorded and stock in the cupboard balanced with the records. However, the disposal of controlled drugs does not follow good practice and entries in the controlled drug register were incomplete for three supplies of medicines returned to the pharmacy. In addition there was a discrepancy between the quantity of MST 10mg tablets entered in the register and the entry in the medicines for disposal book. Regular checks on controlled drug stocks are not carried out. Staff have received appropriate training on the safe handling of medicines. The local pharmacist undertakes medication audits regularly and there is evidence of action taken to address issues raised. We saw some nice interventions between staff and people living in the home. Conversations were light and inclusive. Staff still need some input to help them understand why incidents might occur in the home and how to deflect and manage them. This applies, in particular, to known incidents that recur, particularly around meal times. Staff were seen knocking on doors before entering toilets, bedrooms and the office. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. Support to help people exercise choice, control and independence has greatly improved but does not fully support people in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Social assessments have not yet been completed for people who live in the home. Some care plans had been put in place to support people follow their beliefs, to stay in touch with family and the local community. These contained limited information. One about encouraging person to join in the monthly church meeting made no mention of whether they were able or might like to go out to a service or meeting instead. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 16 Another said staff should ensure a person got porridge for breakfast. There was no mention of checking whether they still wanted porridge and the care plan included no reference to ‘small portions’ as stated in the assessment. We saw evidence of people being supported to keep in touch with their family. They can have a private telephone in their bedroom if they wish and visitors to the home are made very welcome. Daily living profile records have been put in place. These aim to record a range of healthcare appointments or visits, as well as hairdresser appointments, a person’s religion or belief and outings. An activities co-ordinator works in the home for two days each week. Games like dominoes and scrabble are available and people can take part in chair exercise sessions. Residents and staff told us they had been out for walks along the sea front and to the boating lake. Plans are well on the way for the home’s Summer Fayre following which residents are going to have an outing to Alnwick Gardens. The manager told us they were also making enquiries about theatre outings. She had also ordered a ‘musical bingo’ and a large Connect4 game. Contact is maintained with the Salvation Army and the Alzheimer’s Society. Some residents enjoy going to the tea dances run by the Alzheimer’s Society but there were no dates for forthcoming dances available. One lady told us she had been asked if she wanted to go out on the morning of the inspection and another lady spent time outside, reading. Staff sat with a resident in the garden whilst they had a cigarette instead of in the smoking area making it a more pleasant experience. Residents had recently asked if they could have a budgerigar – staff had bought one. It hadn’t been named yet as there are plans to run a sweep so that everyone gets the chance to name it. People were talking about the bird and how nice it was to have it in the home. Meals are served in the home’s dining room but people can choose to sit in one of the lounges or their bedroom to eat if they wish. One lady came down for her breakfast just after 9.30 am. She was still able to choose what she wanted. Staff were seen helping people to move to the dining room in a sensitive way. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 17 Meals are still being served already plated and we did not see anyone being asked what they wanted on their plate. Cook does have a sheet that shows who likes only a small portion at mealtimes. She said that staff ask residents what they want to eat at lunchtime and then tell her. People’s choice is not recorded anywhere. Three residents came into the dining room, where the inspector was working, to get ready for lunch. They told us that lunch was always served to them last. One resident said this again whilst lunch was being served. We saw a record of a complaint ‘about waiting ‘till last to be served’. We discussed this with manager during inspection. There was no further problem after the residents had received their lunch. All three residents had been sitting in the dining room for at least 10 minutes before anyone else arrived. They kept checking how many minutes to go before 12:00 noon, obviously keen to have their lunch. People were given time to eat their meals as quickly or slowly as they wished. New records are in place to record refrigerator, freezer and food serving temperatures. Cook told us that the menus were due to be reviewed and the manager said this would involve residents being consulted through their meetings. Cook showed the inspector preparations that were underway for a buffet tea for a gentleman who was 90 on the day of the inspection. We saw relatives and friends of the gentleman being shown into the dining room so that they could spend time with him privately, whilst he opened his cards and presents. They brought a lovely birthday cake with them that took centre place on the buffet table. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People who use the service experience adequate quality outcomes in this area. Clear complaints and protection systems are in place to ensure that people are listened to and their concerns dealt with in a timely way, and protects people from risk of harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The homes complaints procedure has been updated to remove any reference to the National Care Standards Commission, and is clearly displayed in the entrance hall. The proprietor has shown a good commitment to attendance at, and participation in, safeguarding strategy meetings. Work has been undertaken with input from a range of healthcare professionals and agencies to promote a better quality of care for people living in the home. CSCI has been provided with an improvement plan to support the commitment expressed by the provider to improve service and protect people. Some staff have already attended an Adult Protection Basic Awareness training course and places have been booked for the rest of the staff team to attend between September and October this year. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 19 The general manager and new manager have completed the two day Protection of Vulnerable Adults (POVA) course for managers of care services. Criminal Record Bureau (CRB) checks are being renewed for all staff to ensure that they have no cautions or convictions that would preclude them from working with vulnerable adults. We were told that previous checks have been carried out but records were not up to date and did not provide confirmation of this. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. People who use the service experience good quality outcomes in this area. The home is comfortable, welcoming and well maintained and people are encouraged to bring items into the home to personalise their bedrooms. Hygiene routines are good and everywhere was clean and odour free. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We were told about, and saw a ‘Welcome Pack’ has been introduced and will be put in the bedroom of a new resident. It includes a welcome card, silk plant, toiletries and hand towel. This was nicely presented. The home sought advice from the Environmental Health Department about the current smoking arrangements for residents. They were told that the present arrangements are acceptable. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 21 During our walk around the premises we looked at six bedrooms selected at random. We were told of plans to replace existing sinks and vanity units with newer items. Two bedrooms have their own en-suite toilets. A bedroom on the ground floor was in the process of being re-decorated and the floor covering replaced so that a resident with mobility problems could move from their first floor bedroom. There is an on-going programme of redecoration and refurbishment. People are encouraged to bring personal items into the home with them. The bedrooms we saw were very homely and included personal items, furniture and pictures belonging to the residents. The Arjo bath chair has now been replaced as required by the Service Engineer. We were told that all the requirements made by the Fire Officer at his last visit have now been met. The laundry is located in the rear yard and was seen to be extremely clean, tidy and well organised. The boiler room next door was clear of any obstructions. Residents were seen to be coping well with the ramp fitted between the lounges and the dining room even though it is a little noisy when people walk on it. The requirements from the last inspection to provide lids for clinical waste bins or replace them and to remove toiletries from all communal bathroom and shower areas were met. Domestic routines within the home are good and domestic assistants clearly know what their duties are. Odours were noticed in two bedrooms but we were told about actions that were being taken to manage this problem. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People who use the service experience adequate quality outcomes in this area. Recruitment and selection procedures have improved and are now sufficiently robust to protect people from the risk of harm. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The new manager told us that in addition to herself there was usually one senior carer and two care workers on duty between the hours of 08:00 and 16:00 or 18:00 each day. One senior carer and one care worker are on duty between 18:00 and 22:00 with the same number of staff being on duty over night. There is a cook on duty each day of the week but no identified kitchen assistant. We were told that the morning domestic staff help in the kitchen before they start the domestic duties. A handyman, laundry assistant and domestic assistants are also employed in the home. The manager told us that they were considering employing someone to carry out the heavier, ‘deep cleaning’ duties in the home to supplement the domestic assistants and give people clear lines of accountability. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 23 The general manager provided us with a list of CRB checks that had been submitted to bring staff records up to date. Clearances had been received for eight out of 23 applications submitted. We looked at five of the new staff files. We saw application forms, copies of references, evidence of CRB checks and use of the POVA First system where people were needed to start work before a full CRB clearance could be obtained. An interview rating form and new induction template have been put in place and we saw evidence of these in use. Gaps in people’s employment history and any cautions/convictions disclosed had been followed up and the outcome of enquiries recorded. It was not clear if one reference, on a slip of paper, had been brought to the interview by the candidate or had been provided in response to a request from the home. It is good practice to always ensure that references are sent for by the employer. We were provided with a copy of the latest training plan and staff were keen to tell us about the training that they had been attending. Staff who administer medication have completed Safe Handling of Medication training. In addition, Occupational Health and Safety, Moving and Handling, Fire and Adult Protection Basic Awareness training has been taking place. Three staff are to attend Achieving Best Evidence training, and all staff will have completed Adult Protection training, by the end of the year. An NVQ assessor was observed taking one of the domestic staff/laundry assistants through her portfolio and getting oral feedback. Two more staff were signing up for NVQ training and had had their induction the previous week. When these have completed their course 100 of staff employed in the home will have achieved a qualification at a minimum of NVQ 2. This is an excellent achievement. One of the District Nursing team has agreed to provide staff with training in catheter care. Staff told us how much happier they are and that they are now getting the training they have been asking for. One person had considered leaving the home but was please she had changed her mind. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36, 37 and 38. People who use the service experience adequate quality outcomes in this area. People are now benefiting from living in a well-managed, open and inclusive environment that promotes, and is run, in their best interests. The general manager, manager and staff team are keen to improve practice in the home and have shown a huge commitment to achieving change. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The general manager has co-operated with CSCI and other professional agencies showing a huge commitment to improving standards and practice in the home. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 25 The new manager had been in post for just three weeks but had already completed her CRB application as part of the registration process. She has achieved an NVQ at level 4 and the Registered Managers Award. The manager has no working hours allocated for managerial tasks only. She is always included on the care rota. This does not promote the opportunity for supervising care practice or reviewing and updating systems. The general manager has carried out an annual appraisal interview for everyone working in the home. The manager and her deputy will be responsible for staff supervision. A schedule is being drawn up to meet the National Minimum Standard of six times a year. New systems have been put in place to get the views of people living in the home and their relatives and a new programme of Resident and Relative meetings has started. The general manager has introduced a new procedure for recording and accounting for residents’ monies. A ‘residents’ daily log’ has been started by the manager who expects the senior on duty to complete for everyone living in the home on each shift. The information we saw in the log was limited and of a poor quality. Recordings were not outcome based and mainly said ‘good diet/fluid intake’, ‘slept well’. One person’s record showed that they had been a ‘little agitated, wanting to go and see family’. There was no mention of what was done about this and the style of language being used still needs to improve. An example of this was ‘resident refused to’ which could be seen as judgemental. Other recordings we saw were: ‘complained about meals at teatime’. Again there was nothing to show what had been wrong or whether anything had been done. Two other entries said ‘X verbally aggressive to staff at lunchtime, actually hit another resident on the knee in an unprovoked attack’, ‘X, at teatime, rearranged X and X seating and then denied any wrong doing. Also was seen shaking fist at another resident’. There were no additional notes about what was done, or any causes. New policies and procedures that have been put in place were not dated. New recording systems for fire checks have been introduced. We spoke to handyman and saw his log of what work he has been carrying out. He is very keen to make sure that work is carried out and likes working in the home and for the provider. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 26 All fire checks had been carried out and recorded regularly since the last inspection. The manager was going to check that the homes latest premises risk assessment meets new Fire Authority guidance. Staff were very complimentary about the providers and the improved atmosphere since the general manager had become involved. One entry in the accident book included a speculative comment by a staff member that the person had “possibly been unable to fully stand up/weight bare”. Only the event and know facts should be recorded. The general manager is carrying out and recording Regulation 26 visits on behalf of the provider. One moving and handling assessment we saw recorded that there was no moving and handling issues, even though it also said elsewhere that the person needed a carer to support them getting in and out of the bath using a hoist. It was not clear from the evidence available how the assessment had been done, or how the judgement had been made. Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 2 2 Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Full assessments must be obtained for everyone living in the home. This will mean that their individual needs can be met in a way that suits them. (Previous timescale of 1 April 2007 not met.) 2. OP7 15 Comprehensive care plans must be developed outlining all areas of care. This will mean that people who live in the home receive the care and support they need. (Previous timescale of 1 April 2007 not met.) 3. OP9 13 Best practice guidance and the provider’s policy must be followed when storing, giving, recording and disposing of medicines. This will help to make sure that people’s health and welfare are protected from risk of medication errors or omissions. 24/08/08 01/08/08 Timescale for action 01/08/08 Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 29 4. OP9 13 All medicines must be stored 24/08/08 safely, securely and at the appropriate temperature to ensure that there is no mishandling of medicines and medicines remain fit for use. A system must be in place to check expiry dates and to add the date of opening on containers when necessary. This makes sure medication is safe to administer. Medication must be given as prescribed. This will make sure that people receive their mediation correctly and the treatment of their medical condition is not affected. CSCI must be provided with evidence that all Criminal Records Bureau checks have been completed. This will help keep people who live in the home safe. Records must be up to date and accurate. This will mean that people who live in the home know their needs are being identified. (Previous timescale of 1 April 2007 not met.) 24/08/08 5. OP9 13 6. OP29 19 24/09/08 7. OP37 17 30/08/08 8. OP38 13 Moving and handling plans must be clear and non-contradictory so that staff know how a person needs to be supported. This will help keep people who live in the home and staff safe. 30/09/08 Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 30 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. Refer to Standard OP7 Good Practice Recommendations Residents’ records should include a copy of their original assessment and reviews of their care and support. This will provide evidence that they are being properly cared for and that care is changed to meet their needs. Staff should record that a person has been involved in putting together their care plans but is unable to sign to indicate their agreement. This will provide an audit trail and show that people are consulted and involved in their care. Staff should keep healthcare professionals up to date with errors in correspondence and in particular the spelling of a persons’ name. This will help to minimise the risk of confusion about a persons care and support. The GP request form should include a space for the person completing it to date and sign the record. This will give a clear audit trail and evidence of who was involved in any interventions. There is no record of staff authorised to administer medicines. This makes it difficult to identify who was involved in the administration if a problem or error was to occur. Staff should sign and date handwritten entries they make on MAR charts. Each entry should be checked and countersigned by a second person to reduce the risk of error when copying information. The medicines policy should be updated in line with current guidance so that staff understand how to handle and administer medicines safely. Stocks of controlled drugs should be regularly checked and a record made in the controlled drugs register. 2. OP7 3. OP7 4. OP8 5. OP9 Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 31 A supply of 5ml medicine spoons and oral syringes should be made available to facilitate the accurate measurement of oral liquid medicines. The temperature of the room used to store the trolley and stock of medicines is excessive. Action should be taken to ensure that medicines are stored within the temperature range recommended by the manufacturer. The written instructions provided by the anticoagulant clinic should be kept attached to the MAR chart of persons receiving anticoagulant treatment. This makes sure that staff have accurate and up to date guidance on the does of anticoagulant to administer. Records for the disposal of medicines should be comprehensive and include a date and signatures when removed from the home. The procedure for the disposal of controlled drugs should be reviewed and the person collecting the medicines, preferably the local pharmacist, should sign the controlled drug register and medicines for disposal book to confirm receipt. Regular monthly prescriptions should be seen before sending to the pharmacy. This makes sure a check can be made that all the medicines required have been listed and prevents people from being without. 6. OP12 Social care plans should be completed for everyone who lives in the home to help decisions be made about what activities and social events people want to be involved in. This will help staff to provide and arrange events and activities of interest to residents. Staff should record the meal choice that people make so that they can be sure what they want. This will also provide an audit trail in the event of nutritional intake problems being identified. The planned programme of POVA training should be completed. This will help keep people who live in the home safe. Consider identifying a dedicated kitchen assistant to support the cook and improve the arrangements for serving meals. 7. OP15 8. OP18 9. OP27 Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 32 10. OP29 References for prospective employees should always been requested by the home. This will mean that the interviewer is sure the reference has come from the person named. Consideration should be given to identifying hours when the manager is not on the care rota so that she can carry out supervision, reviews and other tasks relevant to her role. This will help promote a professional approach to the management of the home. Policies and procedures in the home should be dated and include evidence of review dates. This will show that they are kept up to date and have been looked at to ensure that include current best practice. Staff should only record events and factual information in the accident book. This will mean that people make decision based on the actual events and not speculation. 11. OP31 12. OP37 13. OP38 Kingsbury House DS0000000371.V368940.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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