Inspection on 24/09/08 for Kingsland House Care Home

This inspection was carried out on 24th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingsland House Care Home 29/01/08

Kingsland House Care Home 19/07/07

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kingsland House Care Home Kingsland Close, off Middle Road Shoreham-by-Sea West Sussex BN43 6LT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Annette Campbell-Currie     Date: 2 5 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Kingsland House Care Home Kingsland Close, off Middle Road Shoreham-by-Sea West Sussex BN43 6LT 01273440019 01273455625 sharon.mcnamara@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Barchester Healthcare Homes Ltd Type of registration: Number of places registered: care home 71 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia physical disability Additional conditions: The maximum number of service users to be accommodated is 71 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) Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 4 of 31 Over 65 0 0 71 71 Brief description of the care home This means that there are now seventy-one beds. 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. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The current fees are 850 pounds per week for rooms on the Downs unit and 950 pounds per week for rooms on the Memory Lane unit. Annette Campbell-Currie carried out the site visit over one day and a morning; eight hours in total. The general manager of the home and senior managers from the Barchester Healthcare assisted with the inspection. The information and documents required by us (the Commission) were available. There were seventeen people staying on the Downs unit for older frail people and twenty-seven people in the Memory Lane unit for people who have a dementia. The manager has been in post since October 2007 and has not applied for registration Care Homes for Older People Page 6 of 31 with the Commission. She will be moving on to a new post soon and an operations manager will manage the home in the interim. Senior managers in the organisation have begun the process of recruiting a new permanent manager. The current manager completed an annual quality assurance assessment form (AQAA) before the inspection. The AQAA was very detailed and provided information that was used to help plan the site visit. Improvements made since the previous inspection were outlined with further improvements that are planned. We sent surveys out to find out what people think about the home. Thirteen staff returned surveys. During the site visit three people living in the home were spoken with, four relatives, the visiting chiropodist, a physiotherapist, one of the activities coordinators, the deputy manager, the newly appointed manager for the Memory Lane Unit and three staff. The information gathered has been used to help make an assessment of the service. Time was spent in both units of the home; lunchtime on the Memory Lane unit was observed, a medication round was also observed. The communal areas and a sample of bathrooms and bedrooms were seen. The following documents were read: the case records of five people living in the home, samples of fluid, food and turning charts, quality assurance audit documents, the complaints records, records kept by the activities coordinator, activity programmes and photographs, training records and an action plan for developments for the service and a sample of medication records. The outcomes for people living in the home have been assessed in relation to twentytwo of the thirty-eight National Minimum Standards for Care Homes for Older People; including those considered to be key standards to ensure the welfare of people living in the home. A requirement was made at the two previous inspections regarding the information required to be in care plans to show that peoples needs are understood and that they are receiving the care that they need. This requirement has now been met. A requirement has been made regarding the need for the home to have a registered manager. What the care home does well: What has improved since the last inspection? What they could do better: A requirement has been made regarding the need for the home to be managed by someone fit to do so and registered with the Commission in order to ensure the service Care Homes for Older People Page 8 of 31 is run efficiently and effectively meets with the Regulations. The home has been through a period of being short staffed; fourteen staff have left in the past six months and thirteen have now been recruited. There was a high use of agency staff over several months and eight of the twelve staff who returned surveys in July said they were under pressure and felt unsupported in their work. Staff spoken with during the site visit also said that they are very busy and only have time to provide essential care. The general manager explained that the home now almost has a full compliment of staff and when newly recruited staff are in post the situation will improve. The use of agency staff has reduced in recent weeks. The management team should ensure that steps are taken to make sure that staff are well supported to ensure a stable staff group, minimal use of agency staff and continuity of care for people living in the home. While the induction and training programme in the home is comprehensive eight staff who made comments indicated that either their induction did not equip them for the job or that due to time pressures and shortage of staff they are not always able to receive the training that they need to do their job. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team ensure that people have a thorough assessment of their needs before a decision is made about them moving to the home. Intermediate care is not provided in the home. Evidence: There is a pre-assessment process for everyone who is interested in moving to Kingsland House to make sure their needs could be met by the staff team. The home has decided that only the general manager or the deputy manager should carry out these assessments using a recognised tool. Each person is visited at home or in hospital and their relatives are involved when possible. A brochure of the home is given to people at this time and any concerns would be discussed. Relatives and the person wanting to move to the home where possible are encouraged to visit the home to look around before a decision is made. Care Homes for Older People Page 11 of 31 Evidence: Information is gathered from other health and social care professionals who have been involved with the persons care. There are twenty-five rooms on the Downs unit that are used by the local Primary Care Trust and for these people information is obtained from the ward staff who have been providing nursing care prior to the persons discharge. The intention is that people admitted to the slow stream rehabilitation beds will have the opportunity to recover and regain their independence skills within three months before they return home; it is therefore important to have a thorough preassessment to make sure that people have the potential for this. Samples of case records were read and the pre-assessment process was looked at and discussed with the general manager and the deputy. For people moving to the Memory Lane unit assessments had been carried out and there was some evidence to show that the persons admission had been planned with a key member of staff designated to welcome the person and help settle them in. There were notes on one evaluation sheet seen to show that the persons welfare had been monitored closely for the first two days. The relatives of one person who had moved recently said they had been involved in providing information before the move and the staff had been very helpful on the day of the move. This had reassured them that their relatives would be supported to settle in and that she would receive the care that she needed. The case records of two people who moved in to the Downs unit were read and showed that assessments had been carried out when they were in hospital. One clearly showed that the person had been involved in this process and had details of all aspects of the persons background and medical and care needs. The deputy manager was advised to make sure that peoples involvement in the pre-assessment is documented to show that they have been involved in and understand the decisions that are made about their future. It was evident on the case records seen that a further assessment is carried out when the person moves in to the home so that any changes can be noted and that key information including medication, medical needs and any allergies, is clear to staff. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples individual needs and wishes are set out in a plan of their care. The health and personal care needs of people staying in the home are being met. People are protected by the homes medication policies and procedures. People are treated with respect and their right to privacy upheld. Evidence: Barchester Healthcare has a standard format for care plans. The general manager said in the AQAA that the care plans are drawn up from the assessments carried out and other information gathered from health and social care professionals as well as family members and the person themselves. Further information is added to the care plan as the staff team get to know the person better over time. The care plan format covers all aspects of a persons life including health and personal care needs, social interests, preferred daily routines and cultural and religious wishes. There are risk assessment forms for mobility and moving and handling, risk of falls and nutrition. The Waterlow system is used to assess skin integrity and any measures that Care Homes for Older People Page 13 of 31 Evidence: need to be taken to prevent the risk of pressure wounds. Body maps are also available for recording and monitoring any marks or bruising that are evident. The general manager said in the AQAA that the care planning system has been upgraded and all registered nurses have recently been re-trained on writing and updating care plans and supporting documents using a person centred approach. Care assistants write a synopsis of the care provided under the guidance of the registered nurse on duty. The case records of three people staying in the Memory Lane unit were read and those of two people staying on the Downs unit. Each case file had guidance notes about how staff should complete care plans. A sheet had been completed in each case regarding the persons legal status with information about the people making decisions on their behalf if they do not have the mental capacity to understand the consequence of their decisions. The care plans covered all aspects of the persons daily life and had been completed in detail. In some cases a person centred approach had been taken highlighting what people are able to do for themselves rather than focussing on what they cannot do; for example: X is able to walk for a very short distance with a zimmer frame under supervision. Religious and cultural needs had been discussed with each person and there was space to note any special needs or requirements. There was space to note the persons wishes at the end of their life. In some cases there was a note to say that the family would be getting back to the home with this information. In one case there was a letter on file that detailed the wishes of the person and their family at the end of life. The clinical development nurse who carries out audits of the care plans said that she would make sure that staff follow this up because it is very difficult for relatives and staff if peoples wishes are not known in the event of their death. The case records for people staying in the Memory Lane unit included some information about possible behaviour difficulties due to the persons mental health. In some cases there was detailed guidance for staff to help them avoid situations or circumstances that may trigger these behaviours and how to support the person safely. However not all care plans provided clear guidance to staff except notes such as X can be verbally and physically challenging. The clinical development nurse said that the organisation are planning to train staff in the use of an observational tool for people who have dementia so that staff can better understand peoples individual needs. The general manager said that it is sometimes difficult to access services from mental health professionals who would be able to provide the home with guidance about the best way to understand and support people who are displaying difficult or challenging behaviours. Care Homes for Older People Page 14 of 31 Evidence: The activities coordinator explained that she has worked on a one to one basis with a woman who was using disruptive behaviour and through a process of getting to know the person and understanding her background and previous role in life the activities coordinator had introduced some strategies that are familiar and validate the persons previous life experience. Staff reported that this person is much more settled and content. The records of the work carried out has been recorded separately from the care plan and may not be as accessible to care staff who be able to take a more holistic approach if this kind of work were to be documented in the case file with other aspects of the care plan. The care plans included information about peoples life history and hobbies and interests to help staff understand their needs and wishes, for example X has a longstanding interest in the military and history. Health care needs were clearly documented with guidance for staff, for example. Where care plans identified the need for people to have their fluid or food intake monitored there were separate charts to show that these concerns were being monitored. Nutritional risk assessments had been carried out and people had been weighed monthly and any changes monitored and action taken to address the concern. Mobility and falls assessments had been carried out and guidance given about how staff should provide support safely. To help someone regain the strength in their hand there was guidance to staff to: encourage X to join in activities that promote the use of right hand . There were detailed assessments of risk for people who need bed rails for their safety however there was no space to show that the person or their relative had given consent to the use of bed rails. The general manager said that she would address this issue. There were records to show that people have visits from GPs and healthcare professionals as required. A visiting chiropodist said that he visits the home every month and that people receive very good foot care in the home. He said that care staff are always helpful and manage the care of people on the Memory Lane unit, who can be difficult, very well. A physiotherapist visiting people on the Downs unit said that the care provided is good. It is important for her that people are ready when she visits and she said that sometimes she has to wait but that staff always do their best to help her. Relatives spoken with said that they are happy with the care that their family member is receiving; one person said : I am here every week, staff are always good and I have never seen anything concerning another said: staff are always helpful and manage well. Staff spoken with said that they understand peoples needs but Care Homes for Older People Page 15 of 31 Evidence: sometimes it is difficult to keep up with written changes in the care plans due to pressure of time. At the previous two inspections there were concerns about the gaps in recording of key information so that staff would know how to provide the care. This requirement has now been met. The policies and procedures in place for medication are robust in order to protect people. A blister pack system is being introduced to help avoid any medication errors. All qualified staff have attended updated training regarding medication. The lunchtime medication round was observed and medication was administered and recorded appropriately. There are some people who refuse to take their medication, the nurse in charge said that they will try at a later time and usually they manage to persuade people to take their medication. In one case the GP has been kept informed and a multi disciplinary meeting is due to be held to decide a way forward. Staff are given guidance about the way to provide personal care as part of their induction. During the day people were being treated with respect and where people were displaying noisy or difficult behaviour staff were approaching them in a calm and sensitive manner. People spoken with said that staff are good; one person said: they are all marvellous. Another person said she does not have to wait long for her call bell to be answered. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activity programme has been set up to meet the individual needs of people living in the home. People are supported to maintain contact with their relatives and friends. People are supported to make some choices in their daily lives. People are provided with a high standard of food in pleasing surroundings. Evidence: There are three part time staff who provide activities in the home. At the moment there are two in post. The case records seen showed that assessments had been carried out with people about their personal history, background, interests and topics of interest to them. For people on the Memory Lane unit much of this information is gathered from relatives. The activities coordinator spoken with explained that she visits everyone in the morning when she starts work to see how they are and to find out if there is anything in particular they would like to do. She said that it is important to gauge peoples mood so that the programme for the day can be changed if necessary. There is a programme of activities and a minibus for outings. The activity staff and the general manager have visited a local day centre for adults with a dementia to observe Care Homes for Older People Page 17 of 31 Evidence: social activities and gain advice and guidance about ways to provide a stimulating activity programme to meet individual needs. There is some opportunity for one to one sessions with people. As mentioned the activities coordinator has worked on a one to one basis with someone on the Memory Lane unit that has resulted in the person becoming calmer and more settled. The activities coordinator has set up memory boxes for each person to have in their room; these act as a focal point for discussion and to help people who have memory loss. It would be beneficial for more individual work to be carried out and for care staff to be given the opportunity to carry out some of this work especially for people on the Memory Lane unit. The home has theme days and has recently held a tea dance with afternoon tea, a celebration of St Georges Day, Ladies day for Ascot, and Chinese New Year with food from the Orient. Reminiscence sessions are popular, also cooking activities and art and craft sessions. There were some mugs painted by people in the home on display in the reception area and a charity fundraising event planned with the Alzheimers Society for a day at the end of the week. The home supports people to maintain contact with relatives and friends. Visitors to the home spoken with said they are always made to feel welcome and that they are kept informed about the progress and wellbeing of their family member. There is a visitors dining room on the Memory Lane unit so that people could entertain their guests for meals in a more private setting. People are supported to make simple choices in their daily lives and people spoken with said they could get up and go to bed when they wish to. The legal sheet kept on case records gives some information where people do not have the mental capacity to make major decisions in their lives. There is an advocacy service available for people who may need this service. The food at Kingsland House is of a very high standard. The menus are displayed in the main reception area and a choice of hot meal is always provided. People are encouraged to contribute ideas and suggestions for improvement to the meals and those spoken with said they like the food and one person said it is all home made. Lunch is the main meal of the day and the mealtime on the Memory Lane unit was a calm occasion. People were being sensitively assisted to prepare for lunch and some more able people took their lunch in the main dining room. People were given a choice of hot food and staff, including the chef, were aware of peoples nutritional needs including special dietary requirements. People who needed assistance with eating were not being rushed. Some people who find it difficult to use a knife and folk are provided with finger food so that they do not have to rely on staff for help with eating. Care Homes for Older People Page 18 of 31 Evidence: Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns and complaints will be listened to, taken seriously and acted upon. There are measures in place to ensure that people are protected from abuse. Evidence: A copy of the complaints policy is provided to everyone in the home and there is a copy in the reception area. There is also a sheet available next to the signing in book that is a Relatives Rapid Response Form. People can make a note of any concerns and they will be addressed quickly if possible. The general manager said that this had been very useful and people are using the forms. There is a system for investigating and recording complaints that includes the timescales of the response and the outcome of the investigation. The records showed that concerns and complaints are listened to and acted upon. The Commission has received a complaint from a relative that resulted in a safeguarding referral to the social services department. The issues raised were investigated and addressed by the home. Residents meetings are held so that people can discuss any matters or raise concerns at an early stage. Letters and cards of gratitude sent to the home are displayed on notice boards or kept on file. Care Homes for Older People Page 20 of 31 Evidence: There are policies and procedures regarding safeguarding vulnerable adults and the home follows the West Sussex multi disciplinary policy and procedures. Staff are provided with training and are clear about the need to report any concerns. There have been five safeguarding referrals that have been investigated by the Social Services department. Two concerns were raised by a member of staff who had recently attended training in preventing adult abuse. Two of the allegations of neglect by staff were upheld and two are still under investigation by the home. The home was commended at a recent case conference for their reporting and investigation of allegations and for the action plan put in place to help to ensure that such incidents do not occur again. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of 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 people living in the home. Evidence: Kingsland House continues to provide an excellent environment for people living and working in the home. The buildings and grounds are well maintained and safe. The accommodation and the 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. 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 1940s 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. These doors have been painted a different colour to the bedroom doors for easy recognition. Bedroom doors have a display case where photos or pictures or artwork can be Care Homes for Older People Page 22 of 31 Evidence: 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 quiet lounge on the Downs unit has been refurbished with new carpets and furniture. There are plans to refurbish the main lounge on the Downs unit later in the year. Special high-low beds have been purchased to minimise the risk of people falling out of bed, where bed rails are not appropriate. The bathroom and shower room on the Memory Lane unit have been refurbished to enable people to shower in more comfort. There is a team of domestic staff responsible for keeping the home clean and hygienic. 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, one person said that she likes to have her hair done regularly. The annual quality assurance form (AQAA) provided evidence that all the necessary health and safety checks for the premises and equipment are up to date. 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 contracted to improve the gardens for people to enjoy. A residents project has been initiated involving people in a designated area of the garden with a green house for all year round gardening. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of staff now meets the needs of people living in the home. People are protected by the homes recruitment policy and procedure. There is a comprehensive training programme, however feedback from staff indicates that they do not always get the training that they need. Evidence: Barchester provides a recognised tool to assess the dependency levels of all service users prior to admission so that the necessary numbers of staff are designated to provide nursing and care to meet the needs of people in the home. At the time of the site visit there were seventeen people staying on the Downs unit. The duty rotas for the week were seen and showed that there are two registered nurses on duty between 7am and 5pm with three care staff; after 5pm there is one registered nurse and three carers and at night there is one registered nurse and two carers. There were sufficient numbers of staff to meet the care needs of people on the unit. One person spoken with said the staff are marvellous but sometimes she has to wait a while for help with washing and dressing in the mornings. There were twenty-seven people staying on the Memory Lane unit with two registered nurses on duty and seven care staff with one registered nurse and four carers at night. There were sufficient numbers of staff on duty to provide the care for people staying Care Homes for Older People Page 24 of 31 Evidence: on the unit, this was evident at lunchtime when a number of people needed support with eating and they did not have to wait long for support from staff. In the AQAA the manager said that the home has had a recruitment drive recently and in the past three months there has been a high use of agency staff. She said that where possible the same people have been booked to provide some continuity for people living in the home. Twelve staff returned surveys that were completed before 1st August. Eight staff made comments about the home being short staffed and some said that they felt unsupported and under a lot of pressure. One person said sometimes there are no nurses on the unit and very few carers. Two care staff spoken with said that they are very stretched and have little time to make sure that they read key documents or attend training. One person who provided feedback said she could remember an occasion when she had been the only permanent member of staff on duty. Staff that made comments said that they did not feel that the care of people in the home had been compromised. One person said: Patients get treated well. Staff on the other hand are not treated so well. The use of agency staff has decreased and during the week of the site visit eight agency staff were covering shifts. An agency care worker was spoken with and said that she had been well supported when she began work and peoples needs were explained to her; she has been to the home on several occasions now and is clear about her duties. The management team said that the recruitment drive has been successful and they now almost have the full compliment of staff. Fifteen staff have achieved the National Vocational Qualification (NVQ) award at level two or above. The home has now met the target of 50 of care staff achieving the award and six more care staff are registered to study for the award. Barchester have a robust recruitment policy and process and an equal opportunities approach is taken to employing new staff. Samples of recruitment records were seen at the previous inspection and showed that all the required checks are carried out prior to staff beginning work. The manager confirmed that Criminal Record Bureau (CRB) or POVAfirst checks are obtained before someone begins work in order to protect people living in the home. There is a comprehensive induction and training programme at Kingsland House. The programme of learning and development includes an annual appraisal to help identify individual training needs for the coming year. Not all staff have had appraisals yet, the deputy manager said that she is in the process of making sure all staff have their Care Homes for Older People Page 25 of 31 Evidence: annual appraisal. Training records showed that a number of staff have attended training courses on mandatory topics and fire safety training sessions were in progress during the day. Five staff have attended dementia care training, however a clinical audit carried out in the home indicated that dementia care training has not been included in the induction programme for new staff. This is particularly important for staff who will be working on the Memory Lane unit. Eleven staff have attended training on supporting people who have challenging behaviour. Six staff who provided feedback said that the induction did not provide what they needed to know or only partly covered this. Six people also said that the training had not provided them with the knowledge and skills they need to do their job. Four people said that it is difficult to get cover or time to attend training. One person said: Training is very poor and another said: No time for nurses to go on courses, two cancelled recently. Someone recently employed to work on the Memory Lane unit said: Havent had dementia care training yet. It is clear from records seen and discussion with the management team that efforts are being made to make sure that staff are well trained and have the knowledge and skills they need to do their job. Arrangements should be made to make sure that all staff have an annual appraisal and that staffing cover is provided so that staff are able to attend the training sessions that they need. Care Homes for Older People Page 26 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has been managed by someone with experience to do so however in order to ensure that the business is run efficiently and effectively meets with Regulations then an application must be submitted to the Commission for registration of the manager. There is a quality monitoring system to make sure the home is being run in the best interests of people living there. Peoples financial interests are safeguarded. The health, safety and welfare of people living in the home and staff are promoted and protected. Evidence: Kingsland House has been without a registered manager for over a year. It is a legal requirement for a care home to have a manager registered with the Commission. The current manager began working in the home in October 2007 and is due to leave at the end of October 2008. She has the qualifications and experience to manage the home and has made progress in implementing an action plan to improve the quality of the service provided at Kingsland House. There have been improvements in the Care Homes for Older People Page 27 of 31 Evidence: assessment, care planning and review process to make sure that people receive the care that they need. A requirement has been made regarding the need for the registered providers to ensure that the home is run by someone fit to do so and who is registered with the Commission. Progress has also been made in developing an induction and training programme for staff and further improvement is planned. The recent recruitment drive should ensure that permanent staff feel less pressure and feel supported more effectively to do their job well. The five safeguarding allegations were appropriately reported by the manager and followed up, however it is of concern that two allegations of neglect were upheld and that there were two further allegations regarding the behaviour of staff. Action has been taken by the home to try to ensure that such incidents do not occur again. The company has a quality audit process and the views of residents, relatives and staff are sought every year. The information received is collated and published by staff at head office. Comments made by people are included in the report so that any issues can be followed up. Residents meetings are held so that people have the opportunity to express their views and opinions about the home. Senior managers carry out clinical audits and the most recent audit showed that there are areas for improvement. It was noted that not all staff had attended dementia care training as part of their induction and that some staff need to attend updated infection control training. An action plan is produced with timescales for improvements to be implemented. There are policies and procedures in place regarding protecting peoples finances with clear guidance to staff. It was clear from the AQAA that all equipment in the home is serviced as required and that appropriate measures are taken to protect the health and welfare of people living in the home and staff. Incidents are reported and measures taken to minimise risks in the home. A comprehensive evacuation plan has been set up in case of a fire or other emergency. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 8 The registered providers 31/12/2008 should ensure that the home is managed by someone who is registered with the Commission In order to ensure that the service is run efficiently and effectively meets with Regulations Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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