Inspection on 19/07/07 for Kingsland House Care Home

This inspection was carried out on 19th July 2007.

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

Kingsland House Care Home 24/09/08

Kingsland House Care Home 29/01/08

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kingsland House Care Home Kingsland Close, off Middle Road Shoreham-by-Sea West Sussex BN43 6LT Lead Inspector Mrs J Aston Key Unannounced Inspection 09:30 19th July 2007 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 Kingsland House Care Home DS0000069308.V341295.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. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingsland House Care Home Address Kingsland Close, off Middle Road Shoreham-by-Sea West Sussex BN43 6LT 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) 01273 440019 01273 455625 amanda.f.davies@barchester.com Barchester Healthcare Homes Ltd Mrs Amanda Freda Davies Care Home 58 Category(ies) of Dementia (28), Physical disability (30) registration, with number of places Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only:Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Physical Disability (PD) 2. The maximum number of service users to be accommodated is 71 Date of last inspection New registration Brief Description of the Service: Kingsland House is registered as a care home with nursing to accommodate people with a physical disability and a dementia. The accommodation is divided into two units. The Downs Unit accommodates thirty people with a physical disability and the Memory Lane Unit accommodates forty-one people who may have a dementia and a physical disability. The property has been purpose built and is situated in a residential area of Shoreham by sea and is reasonably close to local amenities. An extension has been built and was completed in June 2007 to increase the number of rooms by fourteen. This gives the total number of beds of seventy-one. The operational activities of Westminster Healthcare Ltd were transferred to Barchester Healthcare Homes Ltd in February 2007. The responsible individual acting on behalf of the company is Mrs Carole Hunt. The Registered Manager responsible for the day-to-day management of the home is Mrs Amanda Davies. The fees for the home range from £642.95 to £1000. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. The Inspector however for this report has referred to those living in the home as “residents”. This inspection is called a key inspection as only the key standards determined by the Commission have been assessed. This inspection will determine the frequency of inspections hereafter. Planning for this inspection took place prior to the visit to the home. An Annual Quality Assurance Assessment form was received prior to the inspection and information from that will be referred to in this report. A number of surveys were distributed to people living in the home and to relatives. Six surveys were received in total all completed by relatives. Information and comments obtained from the surveys will also be referred to in this report. An unannounced visit to the home took place on the 19th July 2007. Just over eight hours was spent in the home. The Inspector looked around the home, spoke with people living in the home, members of staff and relatives. A sample of records relating to residents, members of staff and the safety of the premises was examined. What the service does well: The accommodation provided is of a very high standard and the Memory Lane Unit has been designed specifically to meet the needs of people with a dementia. The food provided is of a very good standard and the home has been awarded 4 stars in the Dining Experience Audit 2006 and are working towards the 5 star Dining Award. A relative who responded to the inspection through surveys said, “The food is excellent.” The Downs Unit has good links and relationships with other health professionals such as the Community Matron and is able to provide support through the ‘Step up’ programme that prevents people being admitted to hospital by providing intensive short-term care. A resident who was spoken with and was moving out of the home said that the staff had been really helpful and caring. She said she didn’t want to leave them as they had really helped her and really cheered her up and she made them laugh. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 6 A relative who responded to the inspection through surveys said, “I have nothing but the highest praise for all the members of staff at Kingsland House.” Another said, “I feel my Mother receives excellent care.” There is a comprehensive improvement plan in place to ensure continual development of the service. What has improved since the last inspection? What they could do better: The Registered Provider must ensure that improvements are made in the management of the Memory Lane Unit to address matters raised in this report and to comply with the requirements made. This is to ensure that the residents’ needs are met and a good standard of care is provided that is appropriate to the needs of a person with a dementia. Pre-admission procedures and assessments for people with dementia must demonstrate the individual needs of each person and how they must be supported with their admission to the home. Care plans should be person centred and reflect the individual needs of a person with a dementia. Regular and appropriate monitoring of the needs of service users must take place, which is recorded. The actual care and support provided must be recorded. A programme of activities that are suitable for the needs of a person with a dementia must be put in place. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 7 The Memory Lane unit is managed by a person with appropriate skills and experience to ensure the needs of people with dementia are met. Requirements have been made in this report for the above to be addressed. 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. Kingsland House Care Home DS0000069308.V341295.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 Kingsland House Care Home DS0000069308.V341295.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 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission procedures to the home where a person may have a dementia are not personalised with extra consideration of the individual needs, concerns and anxieties of the prospective resident and their families. EVIDENCE: There is a current Statement of Purpose and Service User Guide that have been updated to reflect the changes within the home. The Annual Quality Assurance Assessment form confirmed that these were made available to prospective residents and their relatives along with a Welcome Booklet and a copy of the last inspection report. There is an admission policy and procedure to be followed for any prospective resident and the Registered Manager and Deputy Manager explained this to the Inspector. They explained that a pre-admission assessment is carried out, a further assessment is undertaken on admission and then a fuller Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 10 assessment and more detailed care plan is compiled. Each admission would be planned according to the needs of the person and there may be regular visits to the home before admission. On admission a member of staff would spend time with the resident in order for them to settle in and orientate them into the home. A member of staff spoken with confirmed that this does happen on the unit she works on and is fully aware of this process. This is particularly important where a resident has a dementia. A sample of five records relating to residents was examined. Out of the five residents three had been admitted since the last inspection. There was evidence that the needs of each resident had been assessed prior to admission. One resident had been admitted on an emergency basis so the assessment was undertaken on admission. It was noted that the preadmission assessment covers all aspects of a persons needs and a further assessment had been undertaken once the resident had been admitted to the home. Where a Social worker/Care Manager had been involved with the admission a copy of their assessment was in place. However there was no evidence of written confirmation to the resident or their relative/representative that the service could meet the residents needs as required under regulation 14 (d). From speaking with residents admitted to the home since the last inspection and with their relatives, they conveyed that they were disappointed and concerned about the lack of information and orientation provided to the residents on and after admission. This left the residents feeling anxious and insecure in their new surroundings. From the records examined in relation to new residents admitted to the Memory Lane unit there was no evidence of a planned admission and how members of staff had assisted a person with settling the person into the home. The pre-admission assessments are a standard format used throughout the home. The pre-admission assessment records information about basic needs and from those examined they did not record any background information, life history or the person’s usual routines. As the Memory Lane Unit is a specialised unit catering for people with a dementia it would be expected that there would be a person centred approach with any admission. This takes account of individual needs and wishes of how they need to be supported to live in the home. Written evidence of the planning for how an individual should be supported on admission to the unit should be in place. A record of the actual support a resident received on admission with a record of regular monitoring noting how that individual is settling into the home should also be in place. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 11 Therefore improvements are required in the admission procedures for a person with dementia to ensure that the admission has been planned and undertaken according to individual needs to prevent as far as possible further anxiety or confusion and that records demonstrate this. Intermediate care in not provided in this setting. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 12 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care plans did not reflect the full needs of a person with dementia and provide only basic information about how members of staff should support an individual. The basic needs of residents on the Memory Lane Unit are not being monitored appropriately and records do not support where monitoring and care has been given. The incorrect handling of emergency situations involving residents who are unwell put residents at risk of further illness or injury. EVIDENCE: A sample of five care plans was examined; three for residents residing on the Memory Lane Unit and two for those residing on the Downs Unit. Care plans were a standard format used for all residents in the home. All care plans are divided into needs and they recorded information about the residents needs in relation to the environment, eating and drinking, nutrition, mobility, personal care, hygiene, continence, skin condition, psychological needs, religious, cultural and sexuality and activities. There was a section to record the dates each need had been reviewed. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 13 All needs recorded on the care plans in the sample had been reviewed within the last three months. However this did not reflect that the resident or relative had been consulted or took part in the review process. There was evidence of risk assessments for the use of crash mats and moving and handling. A progress and evaluation sheet recorded significant events. The Annual Quality Assurance Assessment form recorded that members of staff had received training in completing care plans using a person centred approach. Although the care plans recorded the basic needs of each resident, information about residents who have a dementia and reside on the Memory Lane Unit was lacking. Out of the three care plans examined for those residents residing on the Memory Lane Unit two out of the three Life Story sections of the care plan had not been completed and one was completed in 2004 but had not been updated. The care plans did not reflect in detail how each resident should be supported or the approach required from members of staff whilst providing support. From the records examined there was evidence of a record of Health Professional visits or advice given about specific treatment. There was evidence that a GP is called when necessary and as frequently as necessary. The Annual Quality Assurance Assessment form recorded that a GP visits the home every other day but will visit as required. A chiropodist visits regularly and the last visit was on the 9th July 2007. The Head of Unit was spoken with during the inspection who confirmed that she has a good relationship with the Community Matron who works for the Health Authority within the local area and with the Diabetic Nurse and Community Physiotherapist. The Inspector visited residents on the Memory Lane unit who are permanently in bed. During the visit there were eight residents being cared for in bed. There was no evidence of any fluids kept in their rooms, call alarm extension leads, a record of monitoring, care given or mouth care or fluids/food given. It was noted that the recording of intake of fluids were kept in the office on the Memory Lane unit and on examination there were at least two charts that had not been completed for a number of days. A member of staff who was spoken with whilst assisting a resident to eat their lunch was asked why the person had no call alarm extension lead in place. The member of staff could give no explanation and said that this resident had not been given the opportunity to try to use one. One of the residents who was being cared for in bed had very dry and crusty lips suggesting that they had not received any oral care for sometime. A relative spoken with at the time of the visit expressed concerns about the lack of attention to taking people to the toilet regularly and this means that their relative has an increased level of incontinence. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 14 A resident was found to have been left in their room, in a precarious position on the bed due to continual moving of the resident, and required urgent support with personal care as they were suffering from a diarrhoea and vomiting episode. Concerns about how this resident had been left were raised with the Registered Manager and the incident reported under safeguarding adult procedures. During lunch it was observed that a resident who became very unresponsive, due to a fainting episode discovered afterwards, was removed from the table by three members of staff and transferred into a wheelchair and taken out of the dining area. They did not consult a trained nurse before moving the person and this could have led to further illness or injury. Qualified nurses in the home administer the medication. The administration of medication was observed after lunch on the Memory Lane Unit. This was being undertaken at 3pm when usually undertaken between 1pm and 2pm. Storage and records were in good order. The member of staff administering medication confirmed that there is a good relationship with the Pharmacist who supplies medicines to the home and they undertake regular audits. Members of staff receive induction training when they start working in the home. A member of staff spoken with confirmed that the induction training had included all aspects of care, moving and handling training and respecting privacy and dignity. From the observations, examination of records and from speaking with relatives on the Memory Lane Unit it is evident that improvements are required in the care planning, monitoring of a resident’s needs, in the recording of monitoring and care given, the record of fluid given and any oral care and how any emergency due to the ill health of a resident is dealt with. Requirements have been made in this report in respect of these matters. Kingsland House Care Home DS0000069308.V341295.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): Standards 12, 13,14, and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities are varied and organised however the needs of individuals with a dementia are not reflected in the type of activities undertaken. Residents receive a varied, well-cooked and well-presented food. EVIDENCE: There is a full time and two part time members of staff employed in the home to provide activities for the residents. Activities provided range from board games, sherry & coffee mornings, baking, bingo, word games, some reminiscence, flower arranging, trips out, themed tea parties and most recently poetry that is provided by a volunteer coming into the home. Residents spoken with said they particularly enjoyed the poetry. The Annual Quality Assurance Assessment form stated that one to one sessions are provided where residents are isolated or are too frail to participate in other activities. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 16 There are very good facilities and space for activities within the home including a small kitchen, quiet lounge where activities could take place and two enclosed courtyards as well as large gardens around the property. The home has recently been involved in a vegetable garden project with a local school and a picture of a resident and the garden design has recently appeared in the local paper. Individual care plans examined recorded the activities available in the home and when and which activities residents had participated in. As the life story section of the care plans for two of the residents on the Memory Lane Unit had not been completed this gave members of staff very little information to base or design appropriate activities or interaction. During the visit to the home a coffee morning was being held in the Memory Lane Unit. This involved residents from the Downs Unit and one or two residents from the Memory Lane Unit. The coffee morning was held on the Memory Lane Unit in the small kitchen area. Residents had coffee or tea and biscuits and mini quiches that they had made the day before. The activities co-ordinator sat and chatted to residents. The Inspector also had coffee with the residents involved in this activity. Observations were made of the involvement of other residents in the Memory Lane Unit who were sitting in the lounge area. They were not involved with the activity and apart from the distribution of coffee & tea or other drinks there was very little attention given to them from members of staff and a there was a lack of any type of activity. This left one or two residents wandering around and other residents becoming upset with them. Although there is a varied programme of activities there was no evidence of any specific activities suitable for the needs of those residents with a dementia or severe dementia. With one activities co-ordinator working in the home on a shift there was insufficient staffing to provide suitable activities for those with a dementia. This could leave those residents with a dementia with a lack of stimulation, interaction and communication with members of staff and others. A programme of activities therefore must be devised that provides appropriate activities and interaction designed to individual needs and capabilities. It was observed that where people were visiting they were made welcome and there was a friendly atmosphere. There is a separate dining room called the guest dining room that can be used for residents and their relatives. During the visit residents and their relatives were served lunch in that room and had the use of that room during the day. The Annual Quality Assurance Assessment form confirmed that there are facilities for relatives to stay in the home where a resident is experiencing an illness. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 17 The Inspector ate lunch with the residents in the dining room on the Memory Lane Unit. Lunch was well cooked and presented and included three courses. There was a choice of lunch. The lunch on this unit was cooked in the main kitchen and brought into this unit in a hot trolley. Two kitchen staff assisted with serving the lunch. The starter of prawn cocktail included quite large pieces of cucumber that could be difficult for some residents to swallow it is recommended therefore that it is thinly sliced. A relative who responded to the inspection through surveys also commented on this and said, “The cucumber is cut so thickly it’s a wonder he doesn’t choke on it.” Three members of care staff assisted residents with eating where necessary. Where residents were in their room staff took lunch to them. It was observed that one resident was being assisted by a member of staff to eat their lunch in their rooms. The lunch was unhurried and respected the dignity of each resident. However it was noted by the Inspector that where a member of staff was assisting a resident with eating this was done with no communication at all from the member of staff to tell the resident that he was about to have a meal and what the meal was. This was brought to the attention of the Manager who confirmed that this would be addressed. The Registered Manager must ensure that there is a programme of activities designed specifically for residents with a dementia. A requirement has been made in respect of this. . Kingsland House Care Home DS0000069308.V341295.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives have sufficient information about how to make a complaint. Appropriate action is taken in response to any complaint or allegation of abuse. EVIDENCE: A complaints policy and procedure are in place and is displayed in the entrance to the home. The Annual Quality Assurance Assessment form confirms that the complaints procedure is made available to residents and relatives in the Service User Guide that is provided in residents’ rooms. It also confirms that two complaints have been received about the service in the last twelve months and an outcome in relation to the complaints is still awaited. The Commission for Social Care Inspection has been made aware of one concern and one complaint about this service. The home follows the West Sussex Social & Caring Multi-disciplinary Safeguarding Adults Procedures. Members of staff spoken with confirmed that they had received training in how to recognise signs of abuse and how to report any suspicion. The Commission is aware that two allegations have been made under safeguarding adult procedures and are still under investigation. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 19 One member of staff said they had received customer care training. The Annual Quality Assurance Assessment Form recorded that there is a plan to ensure that at least 80 of staff attend the customer care training course. It is the homes policy not to manage a resident’s finances. Residents are encouraged to manage their financial matters and where a resident lacks capacity relatives or representatives take responsibility. Only small amounts of money for hairdressing and chiropody and personal items maybe held and all transactions are recorded. Kingsland House Care Home DS0000069308.V341295.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. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The premises are maintained to a high standard and provide a safe and pleasant environment that suits the needs of the residents. EVIDENCE: Kinglsand House has the facilities to accommodate seventy-one residents. The accommodation is provided in two units the Downs unit that accommodates thirty people with a physical disability. The Memory Lane Unit accommodates forty-one residents who have a dementia and also may have a physical disability. The accommodation provided overall is of a high standard. The Memory Lane Unit has recently been refurbished to increase the number of rooms by fourteen to give the total of forty-one. The accommodation and environment in the Memory Lane Unit is of a high standard and has been designed specifically to meet the needs of people with a dementia. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 21 The decoration and furnishings provide a range of textures in cushions, wall hangings and bright pictures along corridors and on outside walls. Placed tastefully around the corridors are chests of drawers with pictures, jewellery and clothing placed on them and within the drawers for rummaging. Clothing and hats etc of 1940’s are also hanging in these areas. Bathroom and toilet doors have pictures on the outside displaying a toilet (with high cistern) and bath or shower. The doors are a different colour to the bedroom doors. Bedroom doors have a display case where photos or pictures or artwork can be displayed so residents have a meaningful sign on their doors for them to recognise. Rooms are of a good size and contain all the necessary items of furniture and equipment. The rooms can be personalised with belongings and personal furniture. All beds are adjustable in height and it was noted that pressure-relieving mattresses are in place. There is a kitchen in the dining area and in the lounge area on the Memory Lane Unit. This allows baking and other activities to be undertaken by residents. There were small old style jukeboxes in each kitchen area. The home was clean throughout and it was noted that there were infection control procedures in place for laundry and protective clothing for members of staff. There is a hair salon that has been upgraded that provides suitable facilities. The Annual Quality Assurance Form provided evidence that all the necessary health and safety checks for the premises and equipment are up to date. There is a current Public Liability Insurance certificate in place. The home has many outside areas for residents to use. They are well maintained and as well as providing an attractive display they also provide sensory stimulation with strong smelling plants and the growing of vegetables provides another activity for residents. A gardener has been employed to maintain the upkeep of the gardens. Kingsland House Care Home DS0000069308.V341295.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Trained members of staff support residents in numbers that currently meet their needs. Staffing levels are assessed and increased in line with the dependency levels of residents and with the occupancy levels of the home and will be increased accordingly. EVIDENCE: There are currently thirty-three full time care staff and eighteen part time staff employed in the home who provide care. There are twenty-two members of staff employed to undertake other duties within the home. The rotas examined and members of staff spoken with confirmed that the aim is to have seven members of staff in each unit on duty in the mornings and six on each unit in the afternoons and evenings. During the visit to the home the staffing levels were as stated. At night there is a trained nurse and two care assistants on each unit. A trained nurse and care assistant confirmed that an increase to eight members of staff on a shift in the morning has just been agreed. The Annual Quality Assurance Assessment form confirmed that agency members of staff have been used within the last three months where permanent members of staff have been unable to cover shifts. The number of shift covered in the last three months was not an excessive amount. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 23 A recognised tool that assesses the dependency levels of all residents is used to determine levels of staffing. The Registered Manager confirmed that the staffing levels would be continually reviewed as the occupancy levels of the Memory Lane Unit increases. Members of staff have dedicated roles and have been employed to work on a particular unit. This ensures that care staff do not get involved with cleaning and preparation of food and vice versa. As members of staff have been allocated to work in a particular unit this has meant that they can get to know the residents well and residents are supported by people who are familiar to them. From observations made during the inspection on the Memory Lane Unit although there may have been the allocated number of staff on shift in that unit there was a lack of co-ordination and clear leadership for the staff that meant they were perhaps working in an inefficient manner leaving residents alone in the lounge area and the reason for the lack of monitoring observed in that unit as previously stated. The Inspector was not able to determine easily who was in charge of that unit during the morning shift. This is a management matter and will be reflected in the management section. There are clear recruitment procedures used to employ new members of staff. The records relating to six new members of staff were examined. There was evidence that the recruitment procedures had been followed and that all the necessary recruitment checks had been undertaken and were in place. The Annual Quality Assurance Assessment form confirmed that out of thirtyone members of care staff only eleven had achieved a National Vocational Qualification (NVQ) Level 2. Two are working towards this qualification. This does not meet the target of fifty percent of care staff trained to NVQ level 2. A requirement has been made therefore for further support with this training is provided to ensure that this target is met. There was evidence of other training provided. A member of staff spoken with confirmed they had received training in palliative care, customer care approach, fire Marshall training, challenging behaviour, Dementia care, fire, moving and handling, food hygiene, POVA in May and a three day understanding dementia course. No actual formal infection control but this has been discussed in staff meetings. It is recommended that the Registered Manager obtain information about the Skills for Care Common Induction Standards guidance and logbooks to enhance the induction programme. Kingsland House Care Home DS0000069308.V341295.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some areas of the home are managed well. Improvements are required in the management of the Memory Lane Unit to ensure all residents’ needs are met well. The Health and Safety of the home and members of staff is well managed. EVIDENCE: The Registered Manager has the necessary experience and qualifications to manage the home. She has obtained the Registered Managers Award and has recently attended training with Care Aware to enable effective communication of the service to residents and their relatives/representatives. The Manager confirmed that she operates an open door policy and residents, relatives and members of staff can speak with her. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 25 From the information obtained through the inspection it was evident that the Downs Unit is being well managed. However there are many improvements required in the practice from members of staff on the Memory Lane Unit. Improvements are required in admission procedures, care planning, monitoring of residents needs, the recording of evidence of monitoring, activities that are specific to the need of people with a dementia, communication between members of staff and resident and they way in which an emergency situation is handled. This was discussed with the Registered Manager who confirmed that she is fully aware of these matters and explained some of the reasons for the poor management in this unit. Action has already been taken to transfer a trained RN to manage the Memory Lane Unit and to address all the matters outlined. It was confirmed that this would happen quickly. Meetings are held with the Head of Departments, Head of Units, Care staff and with residents and relatives. A quality assurance system involves monthly audits covering areas such as infection control, resident care, medication, catering, nutrition and dining experience, documentation, health & safety and activities. These audits are completed by the manager or her deputy, or in certain areas by heads of department. Actions and outcomes are reviewed by people external to the home and a documented action plan is produced accordingly. Records seen on the day of the inspection and information provided prior to the inspection demonstrate that annual safety inspections are undertaken on equipment and utility supplies and maintenance systems are in place to ensure the safety of residents. It was noted that accidents and incidents are recorded appropriately. There has also been the implementation of a comprehensive evacuation plan in the event of a fire or other emergency and equipment is in place to assist with evacuation. Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 26 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 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? 30 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 (c) (d) Requirement Pre-admission procedures and assessments for people with dementia must demonstrate the individual needs of each person and how they must be supported with their admission to the home. Care plans should be person centred and reflect the individual needs of a person with a dementia. Regular and appropriate monitoring of the needs of service users must take place, which is recorded. The actual care and support provided must be recorded. A programme of activities that are suitable for the needs of a person with a dementia must be put in place. The Memory Lane unit is managed by a person with appropriate skills and experience to ensure the needs of people with dementia are met. Timescale for action 30/08/07 2. OP7 15 (1) (2) (a) (b) (c) (d) 12 (1) 30/08/07 3. OP8 30/08/07 4. OP12 16 (n) 30/08/07 5 OP32 12 (1) 30/08/07 Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kingsland House Care Home DS0000069308.V341295.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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