Inspection on 04/03/08 for Kingsbury House

This inspection was carried out on 4th March 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kingsbury House 04/08/09

Kingsbury House 27/11/08

Kingsbury House 24/07/08

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 09/07/2008.

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 4th - 6th March 2008 08:30 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 Kingsbury House DS0000000371.V354511.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.V354511.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 ** 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.V354511.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2007 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.V354511.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 0 star, this means that the people who use this service experience poor quality outcomes. An unannounced visit was made on 4 March 2008, with further follow up visits on the 5 and 6 March 2008. The manager was present on each day and the proprietor was there on the last day. Before the visit we looked at: Information we have received since the last inspection that took place between the 19 December 2006, and the 22 January 2007; Annual Quality Assurance Assessment (AQAA). The AQAA gives CSCI evidence to support what the home says it does well, and gives them an opportunity to say what they feel they could do better and what their future plans are; How the service 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 most of the people who use the service, five staff, the manager and visitors; 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 sent “Have your say” questionnaires to home before the inspection so that residents could fill them in if they wanted to. The manager said that these were not received. An ‘Expert by Experience’ also took part in the inspection. Experts are an important part of the inspection team. They help inspectors get a picture of what it is like to live in or use a social care service. The `Experts’ comments and observations are included in this report in bold writing. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 6 “Expert by experience’ means a person who knows about social care services from using them. We told the manager and the proprietor what we found. What the service does well: Gets advice from health care professionals to help them support people who live in the home. This means that people get the right care when they need it. Uses professionally acknowledged assessment tools to monitor the nutritional, skin integrity and continence needs of people who live in the home. This means that the needs of people living in the home are monitored and recorded. Staff have made some nice, outcome-based recordings when evaluating care plans. This means that the benefit of receiving care and support can be seen. Provides a warm and homely environment for people to live in. This means that people can have their own bedroom and spend time surrounded by their own things when they wish. People are able to have their own telephone in their bedroom if they wish so that they can keep in touch with relatives and friends. Tasty, home cooked food is on the menu every day. People are able to choose what they want to eat and when. There are good control measures and records in place in the kitchen and areas associated with food preparation. This promotes good practice and food preparation routines keeping people who live in the home safe. People who live in the home are able to choose whether they want to give permission for people from outside the home to look at their records. Residents are helped to choose what they want to wear and have regular access to the hairdresser so that they feel well cared for and groomed. Nearly 100 of the staff team have obtained a National Vocational Qualification (NVQ) at a minimum of level 2. This continues to exceed the National Training Organisation recommended minimum of 50 . People told the Expert by Experience that they were happy but they did not think much happened in the way of activities. They said that the Priest or Vicar came in every week to hold a service and that another group came once a month to hold another type of service. One lady said `somebody used to come on a Saturday morning and play games – I’m not sure if she still does’. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 7 Another lady who had come to this home after her previous home had closed was `very delighted with her care’. The Expert by Experience joined residents for lunch and said everything looked very appetising. She said the dining room was very bright and tables were set nicely with linen napkins. She saw staff that seemed very caring towards the residents. Some of the staff spoken to had worked in the home for many years. What has improved since the last inspection? What they could do better: Get full assessments for everyone living, or who may want to live, in the home. This will mean that their individual need can be met in a way that suits them. Ensure that up to date pictures of residents are available on their files. This will mean that staff are properly able to identify people when giving them care and support. Develop comprehensive care plans outlining all areas of care. This will mean that people who live in the home receive the care and support they need. Ensure that any necessary medical interventions are followed up and recorded. This will mean that people who live in the home get the care and support they need. Staff must have access to information and guidance to help them deal with people who may be agitated, aggressive or have behavioural problems. This Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 8 will mean that care and support is provided in the right way, keeping people safe. Staff must receive training in the safe handling of medication. They must properly follow good practice and procedures when administering medication. This will mean that people who live in the home are kept safe. Notification of events affecting the health and well-being of people who live in the home must be sent to CSCI within the required timescale. This will mean that people who live in the home are kept safe. Provide safe and secure storage for medication that needs to be kept in a refrigerator. This will mean that medication is kept safe for people to use. Staff must receive training and support so that they can provide care to people in a way that respects their privacy and dignity. This will mean that people who live in the home know they are valued. Promote activities and social events within the home and the local community. This will mean that the home is enjoyable and stimulating to live in. Review the routines around serving and providing meals. This will mean that people are served quickly, given choice and can enjoy their food. Review and update the complaints procedure to give people accurate information. This will mean people who have a concern know what to expect and where they can go for support. All staff must complete training in Safeguarding Adults. This will mean that people living in the home are kept safe and free from abuse or neglect. The smoking policy within the home must be reviewed and consideration given to changing the designated smoking area. This will mean that people living in the home who wish to smoke have a comfortable area to do this in. Provide lids for clinical waste bins or replace the bins to promote good infection control within the home. Toiletries must be removed from all communal bathroom, shower and toilet areas to promote good infection control. The Arjo bath seat must be repaired or replaced as required by the servicing engineer. This will help keep people who live in the home safe. Ensure that sufficient staff are on duty at all times to meet the needs of people living in the home. This will mean that people can receive the correct care and support when they need it. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 9 The competency of staff and their training needs must be assessed and proper training provided. This means that people who live in the home know they are cared for by competent, qualified staff. Proper recruitment and selection procedures must be followed and records kept. This will mean that people can be sure staff are safe to be employed in the home. Staff must receive performance development interviews/appraisals. This will help identify poor practice and training needs keeping people in the home safe. An annual quality assurance assessment must be completed and returned to CSCI. This will mean that services, care and support provided to people in the home are kept under review. The new manager must apply for registration with CSCI. This will mean that people know she is competent and qualified to do her job. Return the old registration certificate displaying the name of the previous manager to CSCI. This will mean that people are sure who is running the home. The manager removed the certificate from display on the day of the inspection. Keep accurate records of monies held on behalf of people living in the home. This will mean that people know their money and belongings are respected and kept safe. Give staff employed in the home regular supervision that is also recorded. This will mean that they are helped and supported to do their job. Records must be up to date and accurate. This will mean that people who live in the home know their needs are being identified. Assess the accessibility of the dining area for people who need to use a wheelchair. This will mean that people are kept safe when moving between areas. Carry out and record fire checks in accordance with the requirements of the Fire Authority. This will mean people who live and work in the home are kept safe. Carry out the work required by the Fire Officer. This will mean that people who live and work in the home are kept safe. Properly record and monitor accidents to residents. This will mean that any action required to prevent further similar occurrences is identified. The Expert by Experience said that she felt residents were taken into the dining room quite some time before lunch was served and that Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 10 medication was given out after the first course and it seemed rather a long time before pudding was served 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.V354511.R01.S.doc Version 5.2 Page 11 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.V354511.R01.S.doc Version 5.2 Page 12 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 and 6. People who use the service experience adequate quality outcomes in this area. People are given good information to help them decide about moving into the home. Their needs and wishes are not always fully assessed before they are given the chance to move in. This could place people who live in the home at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a service user guide that is given to people who live in the home and anyone who may want to move to Kingsbury House. The records for three people living in the home were seen. New manager told us that she had `culled’ the old files and was conducting a review/update of all admission assessments so that service user plans could be built. This will provide a good baseline. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 13 The records we looked at were those that she had started work on. Two were for people recently admitted to the home. Original assessments and pre-admission assessments had not been dated or signed. The new manager told us that she had reviewed one of the records to update missing information. We saw that not all records included an up to date picture of the resident and not all documents had the individual residents name on them. People who move into the home are asked to sign an “Access to notes agreement”. This gives permission for General Practitioners, CSCI and Local Authority staff to look at that persons file. We saw assessment information from a Speech and Language therapist in the front of one file. This gave staff good advice about what they should be doing and how they could help a particular resident. We saw care plans that did not give sufficient information and guidance to make sure that staff were providing the right care and support. The home does not provide intermediate care. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 14 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 poor quality outcomes in this area. People living in the home are asked how they wish their personal care to be provided, and by whom. They are supported and helped to be independent with medication and can see health care professionals when they need. Routines for administering medication were poor and could place people who live in the home at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We saw that the quality and range of care plans in the files for residents were not sufficient to make sure that their care and support needs could be properly met. Some care plans we saw were not signed and dated. For one gentleman the evaluations of his care plans were outcome based and gave a good reflection of what had benefited him and how. We saw recordings that showed a person needed six weekly chiropody appointments. There was no record to show that this had happened. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 15 We saw no guidance for staff about dealing with agitation, aggression or behaviour issues. There were records to show that district nurses and GPs had visited the home. One GP visited during the inspection. We also saw input being sought from community psychiatric nurses, the anaemia specialist nurse, a consultant physician in elderly medicine and a speech and language therapist. The manager told us that she had introduced a system for recording when a GP had been asked to visit. The outcome of the visit was not always recorded and the GP was not asked to sign the form to say that they had attended. We saw a range of assessments that included nutrition, falls, skin integrity, continence, and moving and transferring. Recognised, professional formats for continence and skin integrity were being used. The risk assessment form we saw can be used to record the agreement between residents, relatives, social workers and the home about acceptable levels of risk. One resident, or a member of their family, had not signed their assessment. A random check of medication and medication administration systems within the home was carried out. Staff were seen dispensing medication into a plastic pot, giving it to another member of staff to take to the resident who may have been in the lounge, dining room or their bedroom, and returning the empty pot. This method of `secondary’ dispensing is not acceptable. On the day of the inspection we were not told about a medication error that had occurred the previous week when the member of staff `carrying the medication pot’ had given it to the wrong person. A regulation 37 notification had not been sent to CSCI to advise of this incident. We were only told about the error when the hospital brought a resident’s admission to hospital to our attention. The manager challenged this issue of `secondary dispensing’. The inspector telephoned a pharmacy inspector to confirm that this practice was unacceptable and an immediate requirement notice was issued. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 16 The manager told us that senior staff had been enrolled for Safe Handling of Medication training with the City of Sunderland. No dates were available for this training. One person had previously received training in the safe handling of medication but this was now out of date. The random check of medication held within the home revealed that medication for one resident was not labelled; medication not returned to the pharmacist the previous month had not been carried forward on the Medication Administration Record (MAR). This meant it was not possible to properly audit whether the correct number of tablets had been administered or remained in the home; we were told that medication requiring refrigeration was kept in milk fridge in kitchen. There was no separate medication refrigerator or locked facility to keep this safe; handwritten entries on the MAR had not been double signed. Controlled drugs are kept in a separate, secure cabinet within the medication storage room. These were all checked against the separate, controlled drugs register. Only one error was seen. Medication administered to a resident on the 29 February 2008, did not include the number of tablets given and had not been countersigned. During the morning of the first day of the inspection residents were seen coming down from their bedrooms at times that suited their lifestyle. After a late breakfast one lady was seen being asked where she wanted to sit. The carer supported her in a patient, unhurried way and gave her time to walk at her own pace. They were heard enjoying a nice conversation as they moved from one room to the other. At lunchtime two ladies were having their lunch in the quiet lounge. A different care worker was seen standing over a resident, trying to encourage her to eat her meal. We saw that people who wanted could have a telephone in their own bedroom. If they do not have their own telephone the manager told us they were given `private’ time in the downstairs office to talk, make or receive calls. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 17 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): Standards 12, 13, 14 and 15. People who use the service experience adequate quality outcomes in this area. People living in the home are encouraged to be as independent as they wish. There are limited social opportunities within the home and the wider community. Choice and rights are usually promoted as well as healthy living. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The Expert by Experience said: “I had been asked by the inspector to look at the areas of daily life and social activities, including meals and mealtimes. The manager took me into the lounges to introduce me to the residents. Following this I took the opportunity to chat to some of the residents. One lady said she `loved to come here for a rest when things got too difficult for her at home’. She was actually a permanent resident. Other residents said they were happy but they didn’t think much happened in the way of activities. One lady said `somebody used to come on a Saturday morning and play games – I’m not sure if she still does’. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 18 One lady resident often plays the piano to entertain others. The ladies were having their hair done during the morning and I did notice that everyone looked very smart and well cared for. Residents were taken into the dining room quite some time before lunch was served. The dining room was very bright, tables set nicely with linen napkins. Juice was at every place setting. Cups of tea were poured out for everyone before the first course was served. I was offered a choice of a lamb dinner or egg and chips but I asked if I could possibly have some soup and was offered a choice of four (tinned) soups to choose from. The soup was nicely served. I joined two ladies for lunch and they both had lamb, which was served already plated but looked very appetising. One lady had had a stroke and couldn’t use her left arm. Several members of staff frequently offered her help but she declined this as she was already managing quite well. The staff seemed very caring towards the residents. Some of the staff I spoke to had worked there for many years. Medication was given out after the first course and it did seem rather a long time before pudding was served – it was home made rice pudding which looked delicious. One lady I spoke to had come to this home after her previous home had closed. She was very delighted with her care. I discussed spiritual needs with another lady and she said that the Priest or Vicar came in every week to hold a service and that another group came once a month to hold another type of service. After lunch some of the ladies were going to a tea dance organised by the Alzheimer’s Society. Taxis had been ordered for them and they went off very happily accompanied by several staff. As there were no visitors present during my visit I did not get the opportunity to talk to them”. Residents were seen getting up and having their breakfast at a time that suited them. One lady told us she had just had a nice relaxing bath before her breakfast. Three ladies were still in the dining room at 9.30 am. They were enjoying their breakfast and chatting. Few activities were observed going on, or interactions with residents, other than for care, support and to get their meals. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 19 Seven residents were going out to a tea dance. Taxis were used for transport and a care worker went in each taxi. Unfortunately, when they arrived at their destination it was the wrong day. They came back to Tynemouth and went to a local pub for a social afternoon. One lady told us how much she enjoyed the Alzheimer’s Society tea dance. It is said to be very popular and it is not always possible to get tickets for this monthly event. A poster was displayed in the home advertising a clothing party that was going to take place later in the month. The manager told us that activities such as chair aerobics and games have been tried but people had said they didn’t want them. She said they had held their own tea dance in February and had recently had an entertainer brought in. The activity organiser’s file was seen. She works 12 hours a week – usually spread over three mornings. There was a recording sheet for each resident. These gave evidence of residents enjoying a foot spa, reading and discussing newspapers, having a manicure, and looking at old photographs. Two residents were heard talking after their lunch and saying that nothing would be happening in the afternoon. One carer told us about some residents that like to go out in small groups for a walk and coffee. This can depend very much on the weather. Staff were observed in the morning sitting together for their break. The manager said that this was their opportunity to have a “handover” and update each other on what was going on. We saw this happen three times during the day. We saw visitors coming to the home and residents told us they were able to keep in touch with their families. The cook showed us around the kitchen and storage areas and told us about the training she had done. We were told that there is no dedicated kitchen assistant but domestic staff and care workers were seen helping out at meal times and with washing dishes. A new industrial dishwasher due to be fitted in the next few days as the previous one had broken down. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 20 Dry stores and freezers were seen to be well stocked and meat and homemade produce in the freezers was dated. The cook showed us the new, printed books, where she recorded freezer temperatures. Fridges, freezers and books were numbered and labelled. The cook told us she had done a Safer Food Better Business Course. Four weekly menus are in place and the daily menu is displayed on a whiteboard in dining room. There is a full hot and cold choice available at breakfast time and teatime is a choice of sandwiches and/or a hot snack. On the day of the inspection home made products included rice pudding, iced buns and scones. All looked and smelled lovely. Care staff ask residents what their choice is for lunchtime, record their choice and take this to the cook. In the dry store we saw small tins and jars of soups, pastes and other products so that residents can have a snack of their choice or something different if they don’t, for example, like the soup of the day. Staff were seen collecting meals from the kitchen door/ready plated and taking them to residents one meal at a time even though there was a hot trolley available in the dining room. All the food served looked nice and residents said it tasted nice. The manager said no one needed help to eat. Two ladies in the quiet lounge waited half and hour for their meal. During this time they were sat in armchairs behind small tables. During lunch people were seen being given medication whilst they were eating their food. The expert by experience said that the lady on her table was asked to finish her mouth full of food and then take her tablets. The carer had two pots of tablets in her hand at this time. At lunchtime a gentleman was seen being left to negotiate stairs to dining room with his zimmer. He was calling out for assistance, and asking what he was supposed to be doing. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 21 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. The views of people who live in the home are sometimes listened to. They are protected from harm through policies, procedures and staff training but this is not always carried through in practice. Events and incidents are not always reported to CSCI as they are required to be, this could put residents at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has policies and procedures to support the acceptance, recording and investigation of complaints and concerns. A complaints register was seen but there had been no entries since November 2006. We saw a basic complaints procedure on display in the hallway that needs to be updated to include the new address for CSCI. The manager told us that all staff had been booked, through Future Strategies, to have training in Safeguarding Adults. She said they were just waiting for the workbooks to arrive. This training was supposed to have been delivered in February, but has still not taken place. All staff employed in the home do not have up to date Criminal Record Bureau (CRB) checks. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 22 We saw records that showed the previous manager had not been reporting events and incidents affecting the well-being of residents to CSCI. This is a legal requirement. The non-reporting and recording of events and incidents affecting people who live in the home places them at risk. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 23 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 adequate quality outcomes in this area. People live in a homely environment that promotes their independence and the chance to spend time privately. Some areas of the home are not easy to get around in if people need to use a wheelchair. Everywhere is clean and tidy and hygiene routines are good. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager showed us around the home. Some residents were seen having difficulty moving between the lounge and the dining room, as there are three long steps between them. One carer was seen moving a resident up and down the stairs in a wheelchair. Both lounges were seen to be bright and homely. The larger lounge has lovely views out over the sea. Chairs were set around the sides of the rooms. The Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 24 manager told us that they had tried to move them into smaller groups but residents had moved them back. After lunch one lady seen in the large lounge said that the television would soon be switched back on and that was all that would happen for the rest of the afternoon. She said “I sometimes feels like switching it off but don’t”. Whilst in the lounge we saw a carer stand on a settee, with her shoes on, to close a window. There is a small smoking area in the front entrance hall in the “second house”. This entrance is not used for any other purpose. There is only one resident who smokes in the home at the moment. We used the passenger lift to start the tour of the premises on the second floor. Above this there is a “flat” that is now used for office accommodation and staff training. Residents do not use this area. The manager told us that she had signed a contract to have the lift buttons moved so that people in a wheelchair could use them easily and to meet the requirements of the Disability Discrimination Act. Three clinical waste bins were seen around the home without lids. The manager told us that these were on order but had not yet arrived. Bathrooms were clean and fresh but pull cords were in need of replacement to promote good hygiene routines. The maintenance person started to replace these during the inspection. We saw a lot of toiletries being stored in communal bathrooms. The manager said that she had previously asked the staff to do this. An engineer who had come to service the Arjo bath seat left his report saying “As reported on previous visits chair frame in poor condition, heavily corroded, giving risk of cross infection. Recommend renewal/replacement.” We were shown a new shower/wet room facility that had been provided in an unused bathroom. This is a lovely, spacious and hygienic facility for residents to use. One lady had wedged her bedroom door open with her walking stick. The manager and maintenance person told us that she does this herself. The maintenance person immediately fitted a `doorguard’ so that the door would close safely in the event of a fire. Lockable facilities are provided in each bedroom so that residents can keep personal items, cash or medication safe and secure. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 25 We saw telephone and door bell extensions on both floors of the home so that staff can hear the telephone and doorbell where ever they are. The maintenance man told us he was carrying out painting work in readiness for new carpets to be fitted. All hallways and stairs will then have been painted and carpeted. We arrived at the home early in the morning when staff were busy with breakfast routines. There were no odours apparent apart from those of breakfast and all areas of the home were seen to be clean and tidy. The domestic assistant told us that two people are employed to keep the home clean and tidy. They are each responsible for one of the upper floors and share routines on the ground floor. The manager told us that she had completed a course at North Tyneside Hospital called Essential Steps to Safe Clean Care. She can provide staff training and issue certificates of completion for this area of work. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 26 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 poor quality outcomes in this area. Recruitment and selection policies and procedures are not being properly followed which could place people at risk. Training and supervision needs to improve to make sure that staff are able to safely care and support people in a way that meets their individual needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We saw that recruitment and selection procedures had not been properly followed. Two new members of staff had started work without references being obtained, evidence of identification being available, or CRB/POVA first checks being carried out. Interview records were not available for us to see and one of the new staff had not completed the Rehabilitation of Offenders Statement on their application form. There was no evidence that the new staff had received a thorough induction before starting work in the home. One of these people had been employed to work on night duty. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 27 Staff files do not exist in a format that it is possible to check whether all the information the home is required to keep is in place. We did see that CRB checks are not up to date for people who work in the home. The manager, whose hours should not be counted as part of the care team, one senior and three other care workers are usually on duty between the hours of 08:00 and 14:00. There is a senior and two carers on duty from 14:00 until 22:00. Two night staff, two part time domestics and a cook make up the remainder of the staff team. The weekend cook is on long-term sick leave and we were told that food is being pre-prepared so that care staff can cover this absence. The manager told us that she is going to take all staff through the Common Induction Standards so that there is a base line from which training needs can be identified. All staff need a performance development review/appraisal and there was little evidence of formal supervision taking place. The manager told us that as part of the performance review process she was going to look at job descriptions and update staff contracts. There had been a staff meeting to talk about this and to let people know how she wanted the home to move forward. We were also told that the manager had met with some resistance when trying to change custom and practice in the home. To try and resolve this she was looking at introducing competency style staff assessments to check and record individuals’ capabilities. We were told that almost 100 staff have a National Vocational Qualification (NVQ) at a minimum of level 2. This exceeds the National Training Organisation (NTO) minimum of 50 . Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 28 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 poor quality outcomes in this area. The home has been without a manager for a short period of time and poor care practice was seen. An AQAA was not returned to CSCI telling us about how the home operates. Residents are sometimes consulted about what goes on in the home through surveys and meetings. Good health and safety procedures and practice are not always followed. These failings do not promote a safe environment for people to live in. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Despite a reminder letter being sent by CSCI to the previous manager on the 5 November 2007, an AQAA has not been returned to CSCI. It is a legal requirement to return a completed AQAA. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 29 The new manager has a qualification at NVQ 4, has completed the Registered Managers Award (RMA) and holds a 7407 City and Guilds Teaching Certificate. She is also an NVQ assessor and has many years’ experience of working in and managing care services. An application to register the new manager of the home with CSCI has not been received by the CSCI Registration Team. We saw an old registration certificate displayed in the home’s entrance/reception area. The company administrator/secretary carries out regular quality assurance visits to the home. These are mainly to look at the safety of the environment. We carried out a random check of monies held on behalf of four residents living in the home. There is a separate “cash held” sheet for each resident. This details the date/details of expenditure or where monies have come from/the balance in and out/balance held and provides for two signatures. Entries were not supported by full signatures and were not double signed. We were told that one person out of the four people we had selected was able to manage their own finances but there was no care plan or risk assessment in place to support this. Two other records and the monies held on behalf of the residents were correct. The final record checked showed a deficit of £5. Hairdresser payments are recorded in a cash receipt book. She was seen signing the cash receipt book for money due from the previous week and leaving a list of who had had hair appointments on the day of the inspection. The manager told us that they have an account with a local taxi firm. The company sends a monthly account to the home, the bill is “marked off” to show which resident has used this facility and they are debited for the amount due. When the fire logbook was checked we saw that it was not being completed on a regular basis to show that the checks required by the Fire Authority were being carried out at the required intervals. The maintenance person showed us some evidence of lighting and alarm checks being carried but there was no actual date for when the check had been done and no proper record. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 30 The Tyne and Wear Fire and Rescue Service had visited the home on the 14 February 2008. Requirements had been made to ensure that all doors closed fully and automatically to their rebate; the cellar door should be replaced with a fire door with suitable self-closing device and intumescent strips and cold smoke seals; fire exists and doors on escape routes should open easily and immediately from the inside in an emergency; the buildings right hand side final exit door should have the bolts removed and an appropriately risk assessed system instigated to ensure simple egress. We were able to see confirmation that servicing and checks had been carried out on hoists, the fire alarm and nurse call system, electrical equipment and installation as well as a gas safety check. Any remedial action required had been carried out. The accident book started on the 2 January 2008, had been regularly and fully completed. There was little evidence to show that accident records are regularly reviewed and evaluated to see if any further action needs to be taken. During the inspection a carer was seen moving a resident in their wheelchair without footplates. The maintenance person said he had put footplates on all wheelchairs the previous week. The same resident was later seen being moved up and down the stairs between the lounges and dining room in their wheelchair. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 31 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 1 1 2 Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement Full assessments must be obtained for everyone living in the home. This will mean that their individual need can be met in a way that suits them. (Previous timescale of 1 April 2007 not met.) Up to date pictures of residents must be available on their files. This will mean that staff are properly able to identify people when giving them care and support. 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.) Any necessary medical interventions must be followed up and recorded. This will mean that people who live in the home get the care and support they need. DS0000000371.V354511.R01.S.doc Timescale for action 01/08/08 2. OP3 17 01/08/08 3. OP7 15 01/08/08 4. OP8 13 30/04/08 Kingsbury House Version 5.2 Page 33 5. OP8 12 6. OP9 13 Staff must have access to information and guidance to help them deal with people who may be agitated, aggressive or have behavioural problems. This will mean that care and support is provided in the right way keeping people safe. Staff must receive training in the safe handling of medication. They must properly follow good practice and procedures when administering medication. This will mean that people who live in the home are kept safe. An immediate requirement notice was issued in respect of this requirement. Notification of events affecting the health and well-being of people who live in the home must be sent to CSCI within the required timescale. This will mean that people who live in the home are kept safe. An immediate requirement notice was issued in respect of this requirement. Safe and secure storage must be provided for medication that needs to be kept in a refrigerator. This will mean that medication is kept safe for people to use. Staff must receive training and support so that they can provide care to people in a way that respects their privacy and dignity. This will mean that people who live in the home know they are valued. Activities and social events must be promoted. This will mean that the home is enjoyable and stimulating to live in. The routines around serving and DS0000000371.V354511.R01.S.doc 30/04/08 06/03/08 7. OP9 37 06/03/08 8. OP9 13 30/03/08 9. OP10 12 30/04/08 10. OP12 OP13 16 30/08/08 11. OP15 16 30/03/08 Page 34 Kingsbury House Version 5.2 12. OP16 22 13. OP18 13 14. OP19 23 providing meals must be reviewed. This will mean that people are served quickly, given choice and can enjoy their food. The complaints procedure must be updated to give people accurate information. This will mean people who have a concern know what to expect and where they can go for support. All staff must complete training in Safeguarding Adults. This will mean that people living in the home are kept safe and free from abuse or neglect. The smoking policy within the home must be reviewed and consideration given to changing the designated smoking area. This will mean that people living in the home who wish to smoke have a comfortable area to do this in. (Previous timescale of 1 April 2007 not met.) Lids for clinical waste bins must be obtained or the bins replaced. This will promote good infection control within the home. Toiletries must be removed from all communal bathroom, shower and toilet areas. This will promote good infection control. Repair or replace the Arjo bath seat as required by the servicing engineer. This will help keep people who live in the home safe. Staffing levels must be reviewed to make sure that sufficient staff are on duty to meet the needs of people living in the home. This will mean that people can receive the correct care and support when they need it. The competency of staff and DS0000000371.V354511.R01.S.doc 30/03/08 30/06/08 30/08/08 15. OP26 13 30/03/08 16. OP26 13 30/03/08 17. OP26 13 30/06/08 18. OP27 18 30/03/08 19. OP28 18 30/08/08 Page 35 Kingsbury House Version 5.2 20. OP29 18 their training needs must be assessed and proper training provided. This means that people who live in the home know they are cared for by competent, qualified staff. Proper recruitment and selection procedures must be followed and records kept. This will mean that people can be sure staff are safe to be employed in the home. An immediate requirement notice was issued in respect of this requirement. Performance development interviews/appraisals must be carried out. This will help identify poor practice and training needs keeping people in the home safe. An annual quality assurance assessment must be completed and returned to CSCI. This will mean that services, care and support provided to people in the home are kept under review. The new manager must apply for registration with CSCI. This will mean that people know she is competent and qualified to do her job. The old registration certificate displaying the name of the previous manager must be returned to CSCI. This will mean that people are sure who is running the home. The new manager immediately removed the certificate from display. Accurate records of monies held on behalf of people living in the home must be kept. This will mean that people know their money and belongings are DS0000000371.V354511.R01.S.doc 06/03/08 21. OP30 18 30/08/08 22. OP31 OP33 17 06/02/09 23. OP31 9 30/04/08 24. OP31 39 06/03/08 25. OP35 17 30/03/08 Kingsbury House Version 5.2 Page 36 26. OP36 18 27. OP37 17 respected and kept safe. Staff employed in the home 30/08/08 must receive regular, recorded supervision. This will mean that they are helped and supported to do their job. Records must be up to date and 30/08/08 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.) An assessment must be made of the accessibility of the dining area for people who need to use a wheelchair. This will mean that people are kept safe when moving between areas. (Previous timescale of 1 April 2007 not met.) An immediate requirement notice was issued in respect of this requirement. Fire checks must be carried out and recorded in accordance with the requirements of the Fire Authority. This will mean people who live and work in the home are kept safe. An immediate requirement notice was issued in respect of this requirement. The work required by the Fire Officer must be carried out. This will mean that people who live and work in the home are kept safe. Accidents to residents must be properly recorded and monitored. This will mean that any action required to prevent further similar occurrences is identified. DS0000000371.V354511.R01.S.doc 28. OP38 23 06/03/08 29. OP38 23 06/03/08 30. OP38 23 30/04/08 31. OP38 17 30/03/08 Kingsbury House Version 5.2 Page 37 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 OP8 Good Practice Recommendations The newly introduced form for recording a request for a GP visit should include the outcome of the visit, who attended, on what day and time. Where possible the GP should also be asked to sign the form. This will mean that full information is available if a further problem arises or someone has to be admitted to hospital. Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kingsbury House DS0000000371.V354511.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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