Inspection on 14/04/09 for Kingsley Cottage

This inspection was carried out on 14th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingsley Cottage 10/04/08

Kingsley Cottage 27/09/06

Kingsley Cottage 22/11/05

Kingsley Cottage 02/08/05

Kingsley Cottage 13/09/04

Kingsley Cottage 29/04/04

Kingsley Cottage 18/01/04

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Maple Lodge

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Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kingsley Cottage 40 Uxbridge Street Hednesford Cannock Staffordshire WS12 1DB     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: Linda Clowes     Date: 1 7 0 4 2 0 0 9 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. that people have said are important to them: They reflect the things 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 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Kingsley Cottage 40 Uxbridge Street Hednesford Cannock Staffordshire WS12 1DB 01543422763 F/P01543422763 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Gurbaksh Kaur Rai,Mr Rughbir Singh Rai care home 17 Number of places (if applicable): Under 65 Over 65 3 17 3 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Kingsley Cottage is a well-established care home situated in the Hednesford area of Cannock. It is registered to provide personal care and accommodation for seventeen older people. The home is conveniently situated within the town being close to public and community services and with access to public transport which passes the door. There is also a railway station in Hednesford. Limited vehicle parking facilities are provided on site. Accommodation is provided on two floors and consists of fifteen bedrooms - two double and thirteen single, two have en-suite facilities and the shared rooms have privacy screening. There are two assisted bathrooms, a shower room/wet room and four separate toilets. There is a shaft lift to provide easy access to both floors. Aids to Care Homes for Older People Page 4 of 37 Brief description of the care home daily living are provided throughout the home to promote independence and health and safety. Communal areas consist of two lounges and a conservatory/dining room. There is a hairdressing salon situated in the `snug off the front lounge area. Externally there are attractive gardens with secluded patio and mature borders, trees, shrubs and flowerbeds. The service has a Statement of Purpose and Service User Guide which are available on request. The reader may wish to contact the service directly for up to date information on fees. Care Homes for Older People Page 5 of 37 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: One inspector carried out this unannounced inspection and inspected against the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The objective of the inspection is to evaluate whether people who use the service and their family carers experience services of good quality that offer and promote independence. On the day of the inspection the Manager was off duty. The proprietor and Deputy Care Manager assisted with the inspection. The inspection took place over a period of nine hours. We looked at peoples assessments and care plans, personnel files, complaints Care Homes for Older People Page 6 of 37 files, medication records, health and safety records and gave a feedback session. Prior to the inspection visit the providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to undertake a self-assessment, which focuses on how well outcomes are met for people using the service. Information from this AQAA is used to plan the inspection visit and references to it have been included in this report. The AQAA was returned on time and gave us a reasonable picture of the current situation within the service. We sent surveys to people at Kingsley Cottage and received six responses. The impression gained from the surveys is positive in relation to the care staff team and their commitment. People have told us that the food is good. Meaningful activities are provided which include activities outside the home and relatives are invited. We sent surveys to the staff team and received five responses. Staff tell us that they feel happy and well supported in the home. They are confident that they provide a good service. We have made six requirements and six recommendations as a result of this visit. What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 37 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 37 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 37 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 service provides information so that people are able to make an informed choice about whether the home is suitable for them. No person moves into the home without having their needs assessed. Evidence: We made two recommendations in this outcome area in the last inspection report: 1. A copy of the Statement of Purpose must be readily available in the home. 2. Kingsley Cottage should retain a copy, on individual case files, of the letter they send confirming that, following the pre-admission assessment, the service is able to meet the persons needs. The proprietor showed us a copy of the current Statement of Purpose and Service User Guide for the home and told us that these documents are available for people who are Care Homes for Older People Page 11 of 37 Evidence: interested in moving into Kingsley Cottage, in order that they can make an informed choice as to whether the home can meet their needs. Six people responded to surveys and all told us that they have a contract and that they have received sufficient information about the home. Two commented as follows: Kingsley was recommended highly to me. All of the family were happy to get mom placed at Kingsley. She came in for lunch beforehand to meet other ladies and staff. We were made very welcome. Everything was explained to us when we visited the home. The AQAA tells us that the home carry out an initial assessment of need prior to the service user moving in. People tell us that a manager visits them to carry out an assessment prior to their admission to the home. We saw copies of letters sent by the home to people who use the service confirming that the pre-admission assessment has identified that the home can meet their individual needs. This ensures that no person is admitted to the home whose needs they cannot meet. These two recommendations have, therefore, been met. We noticed that the Statement of Purpose provided incorrect information about one of the categories for which Kingsley Cottage is registered. We have, therefore, recommended that this be changed to show that it has three places for people with dementia and not mental illness. We looked at the files of three people who use the service and found current care plans completed either by a social worker or a representative of the home. Each person has a contract (terms and conditions) covering their residency whether they are publicly or privately funded. The contract gives details of the room to be occupied, the extent and limitations of the service, information about how fees are to be paid. Information about fees is listed separately and prospective people who wish to use the service are advised to request this information directly from the home to ensure that it is up to date. The AQAA tells us that people prior to moving in are encouraged to join our other service users for lunch or tea, whichever they prefer and people who use the service confirm this. Care Homes for Older People Page 12 of 37 Care Homes for Older People Page 13 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people who use the service are set out in a plan of care to ensure that everyone receives a person centred service. There are concerns, however, regarding some medication practices and records that may put people at risk of harm. Evidence: No requirements were made in this outcome area in the last report. We made a recommendation for the home to monitor the temperature of the medicines storage cupboard which was very warm. They have removed the medication fridge from the storage cupboard which has reduced the temperature in this area. This recommendation has been met. The AQAA tells us that there are fairly high dependency levels in the home with all seventeen people who use the service needing support with dressing, undressing, washing and bathing. A high number need the support of staff when toileting. Two people have dementia and two require two staff to help with their care both day and Care Homes for Older People Page 14 of 37 Evidence: night. One person is bedfast. We looked at the homes care plans for three people who use the service. These show that people have access to healthcare services within the home, e.g. from General Practitioners and Community Nurses. There is evidence that health needs are monitored and appropriate action and intervention is taken. Details of progress and achievements is recorded. Staff are aware of the needs of people who use the service. Comprehensive and informative handover sessions take place at the end/beginning of each shift to keep staff informed of any issues affecting the health and well-being of people who use the service. We spoke with the three people being case tracked and a high number of people who use the service and everyone tells us that they are satisfied with their lives in the home and that staff are good to them. Everyone is well-groomed. We received positive feedback in the six surveys, with people telling us that staff listen and act on what they say and confirming that they receive the medical support they need. The following comments are added: I cannot praise the staff enough for the care and support my mother receives. Staff never hesitate if medical support is needed. If they are not satisfied they will keep requesting GP visits. Care manager or senior members of staff notifies my family of any problems. Staff are very supportive and give excellent care. We notice that bedguards are fitted to the beds of the three people who we are case tracking. We cannot find any risk assessments covering the use of this equipment and neither could the Deputy Care Manager when we asked her to check. It is imperative that the home includes healthcare professionals in the risk assessment process where bedguards are in place and that explicit instructions are provided for staff in their use. It is also important for bedguards to be regularly maintained/checked by a person who is qualified to do so. We have made a requirement under Standard 38 (safe working practices) regarding this issue. One person is bedfast. They are very frail but told us that they are well looked after. We observed staff monitoring the individual throughout the day and responding immediately when they called. Healthcare professionals are visiting regularly We monitored the procedures for medication. Medication is administered only by Care Homes for Older People Page 15 of 37 Evidence: senior care staff on each shift. We are told that all staff responsible for administration of medication have attended training for the safe handling of medication. However, it is not possible from the information provided to confirm when this took place or that everyone who needs to has attended. We have made a requirement under Standard 30 for the home to keep an up-to-date record of staff training in order to evidence that this has taken place and have suggested that they introduce a Training Matrix in order that the training undertaken by each care staff member can be seen at a glance. The majority of people who use the service take medication, all of which is managed by the care team. We are concerned that the Medication Administration Record (MAR) charts are not fully completed to confirm the quantities of drugs held in the home both in relation to the monitored dosage system and medication in individual bottles, packets and creams. It is not possible, therefore, to follow an audit trail for all medicines held in the home. It is not always possible to identify from the information contained in the MAR chart that sufficient time has been left between medicines that are time specific, e.g. paracetamol which needs at least four hours between doses. We asked the service to ensure that the MAR chart clearly identifies this. Some medication is prescribed pro re nata (prn - as and when) but there is no written protocol to advise staff what the circumstances are when this should be administered. Where pain relief is prescribed for one or two tablets as and when required, there are very few instances where the MAR shows whether one or two tablets are administered and why. This also situation affects the ability to follow and audit trail for the medication. On a high number of occasions the MAR chart gave instructions for administration of medication such as as required, as directed, as needed. It is apparent that this has been the case for some considerable time. The Deputy Care Manager was asked to liaise with the General Practitioner to ensure that explicit instructions for the administration of all medicines is included on the MAR sheets covering the monitored dosage system and the labels of all medicines held outside of the monitored dosage system. We left an Immediate Requirements Form with the proprietor so that these medication issues can be addressed without delay. We returned to monitor progress on 17 April 2009. We are satisfied that the manager and proprietor have introduced procedures to ensure that they progress with the Care Homes for Older People Page 16 of 37 Evidence: Immediate Requirements. We will visit again to ensure that this has been completed. The AQAA document tells us we dont feel that this (health and personal care) could be improved on as all our staff deliver excellent health and personal care to our clients. Handling of medication follows a process which is traced by the standard receipt, recording, storage, handling, administration, disposal. A clear ordering system is used by liaising effectively with GPs, pharmacists and other relevant professionals. Trained staff, i.e. senior carer on shift, have all undertaken 12 week courses on the Handling of Medications and on-going assessments are carried out by myself (care manager) or deputy care manager. People who returned surveys tell us: All the family are really pleased with (name) being at the home. She is very happy there and gets all the care that she needs. Kingsley Cottage is a warm and caring establishment. Family and friends are made welcome and offered the odd cup of tea, there is always a smile even though the staff are very busy. Care Homes for Older People Page 17 of 37 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. People are assisted to exercise choice and control over their lives. Family and community links are promoted. People are provided with a wholesome nutritious and balanced diet. Evidence: No requirements or recommendations were made in this outcome area in the last inspection report. People who use the service have the opportunity to develop and maintain important personal and family relationships. Relatives tell us that they are made welcome in the home. They also tell us that meaningful activities are organized by the home for everyones enjoyment. Everyone who responded to surveys tell us that they always or usually take part in activities provided by the service. The following comments were added: Ive always been included in the activities whether it be at the home or going on trips. Care Homes for Older People Page 18 of 37 Evidence: I always go on their outings and pub meals. (name) enjoys bingo and keep fit, church service, in-house musical entertainment. A religious service takes place once a month. An entertainer comes in regularly. Bingo is played on a weekly basis. Hairdresser visits every week. I have been on four trips in the past year - a member of the family is always invited. We had a Summer Fete, Christmas Lunch (externally) and a Christmas Trip. Family are always invited. Those people we case tracked tell us that the home endeavors to meet their individual lifestyles and routines. People choose whether to spend much of the day in the communal areas or in their own bedrooms, whether to join in the activities or just to watch. Care staff are observed encouraging people to eat meals in the pleasant dining room, although some people prefer to eat in their own rooms or in the lounge areas. Kingsley Cottage offers a four-week rotational menu. Two cooks are employed to cover each week working from 8 am - 2 pm and covering breakfast and lunch. Care staff prepare teas and other snacks. The cook on duty has been in post since May 2008 and has undertaken her Basic Food Hygiene training on 25 March 2009. She is currently undertaking relevant National Vocational Qualification. All care staff in the home undertake food preparation and should have Food Hygiene Certificates. From information provided on the day of this inspection it was not possible to confirm that all training was up to date. We have made a recommendation regarding this issue under Standard 38 (Safe Working Practices). A record should be readily available of the training completed by all staff in the home. People tell us that they enjoy the food served in the home. In surveys everyone says that they like the meals, adding: Food is enjoyable, nicely presented. Always a choice. Staff are aware of my likes and dislikes. Mother always enjoys her meals. We observed people eating the lunch and teatime meals which were well presented, wholesome and of sufficient quantity. We saw staff prompting people where appropriate. Those who need assistance are given sensitive help from staff and are not Care Homes for Older People Page 19 of 37 Evidence: rushed. Staff ensure that those people who remain in their bedrooms are regularly monitored and assisted to eat their food where necessary. Special diets are catered for. Care Homes for Older People Page 20 of 37 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 who use the service and their relatives are confident that their complaints are listened to and appropriately handled. The service has policies and procedures in place to ensure that people are protected from abuse. Evidence: No requirements were made in this outcome area in the last inspection report. We recommended that the service obtains a copy of the Local Authority Safeguarding Procedures (Protection of Vulnerable Adults from Abuse) to ensure that appropriate referrals are made to the Safeguarding Team and they have done so. Details of Kingsley Cottages complaints procedure are contained in the Service User Guide. A copy of the Complaints procedure is displayed in the home. The AQAA tells us that the home has received no complaints since the last inspection. We, the Commission, have received no complaints about the home since the last inspection. The manager is aware of the protocols and procedures in respect of Safeguarding Adults from Abuse and has a current copy of the Local Authority Safeguarding Procedures. There have been no safeguarding referrals/investigations since the last inspection. We have received no safeguarding alerts about the home since the last Care Homes for Older People Page 21 of 37 Evidence: inspection. The AQAA tells us that the homes Safeguarding Adults and the Prevention of Abuse policy was last reviewed in February 2009. The AQAA also tells us that staff have received training in Protection of Vulnerable Adults but does not specify numbers of staff or dates. Unfortunately, we were unable to clarify this from the information available on the day of our inspection visit. The AQAA tells us All complaints are taken seriously and in confidence and are acted on immediately to resolve or improve the situation to an agreeable solution. The home has an open culture that allows people using the service and their advocates to express their views and concerns in a safe and understanding environment. People tell us that they are happy with the service provided and feel safe and well supported. There is a clear system for staff to report concerns about colleagues and managers. Staff have access to whistle blowing policies and procedures at the start of their employment. The home has a policy on Disclosure of Abuse and Bad Practice (whistle blowing) that was last reviewed in February 2009. Care Homes for Older People Page 22 of 37 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recent alterations have improved facilities and the health and safety of people who use the service and staff. The home is generally clean and fresh. Evidence: No requirements were made in this outcome area in the last inspection report. A recommendation was made for debris and dust to be removed from behind the legs of the base units and extractor fan in the kitchen and this has been done. Kingsley Cottage Care Home provides services in a converted large, traditional property. As a consequence, bedrooms and corridors are irregularly shaped and sized with few that are alike. This adds to the character of the premises but does cause some difficulty in accommodating any pieces of furniture brought from home. However, no person who used the service complained about the lack of space, commenting about the homely feel of the building. The last report highlighted that communal areas would benefit from an audit to reduce clutter. It is noted that this has improved on this visit. There is a selection of communal spaces both inside and outside the home which means that people using the service have a choice of place to sit quietly, meet with Care Homes for Older People Page 23 of 37 Evidence: family and friends or be actively engaged with other people who use the service. There are bathrooms on the ground floor and first floor. Both have specialist bathing facilities to promote health and safety for both people who use the service and staff. The majority of the home is clean and fresh, although one bedroom had a malodour which the proprietor agreed would be addressed without delay. Since the last inspection the AQAA states the home has purchased a rotawash cleaner so that carpets can be cleaned regularly. All the surveys tell us that the home is always clean and fresh. The ground floor shower room is not being used by people who use the service and is used as a staff room. The proprietor is in the process of refitting specialist locks to bedrooms (following consultation with the Fire Authority) to promote privacy and to provide people with choice as to whether to hold a key themselves or not. The AQAA tells us that the home allow personal space in the lounges - making it clutter free. (We have) certificates for all staff in achieving Infection Control. Kingsley Cottage has maintained a four star certificate from Environmental Health for stock rotation, cleanliness and food quality. The AQAA also tells us that since the last inspection the following work/purchases have been carried out: New commodes, redecoration to hall, stairs and landing, redecoration to bedrooms before new clients move in, resurfaced driveway, totally refurbished upstairs bathroom, installed external Emergency Lighting, fitted Smoke Sensors. There are on-going plans for redecoration and refurbishment. The AQAA tells us of plans to: Landscape a small area of garden, on-going decoration, upgrading fire doors. We also notice that flat screen, wall mounted televisions have been purchased. Care Homes for Older People Page 24 of 37 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. People have confidence in the staff who care for them. There are sufficient staff to meet the needs of people who use the service. Staff records are not sufficiently detailed to provide evidence about training undertaken which means that it is difficult to confirm that the staff team is fully trained. Evidence: We made one requirement in this outcome area in the last inspection report for full recruitment procedures to be carried out that includes taking up of references, police checks and confirming identity. We looked at the personnel files of the two latest recruits and find that appropriate recruitment checks have been taken up. We notice that the file did not contain a photograph of the employee or records of the documentation used to confirm identity of the new recruit. We have, therefore, made a recommendation in respect of this. We are not, however, able to confirm from information provided on the day that Induction Training has always taken place. It is also identified that moving and handling training is provided for the new employees by a person who is not trained to Care Homes for Older People Page 25 of 37 Evidence: do such training. We find that they have subsequently received formal training for moving and handling but the home are unaware that the training given at induction stage needs to be given by a trained trainer. The home must ensure that information held in personnel files is sufficient and explicit enough to confirm that new staff have received sufficient training to enable them to satisfactorily carry out the work they are asked to perform. We have been unable to confirm other staff training, e.g. medication, food hygiene, adult protection, dementia and have made a requirement in the management and administration section of this report regarding this issue. The AQAA tells us staff training is promoted, they have at least three paid sessions per year i.e. fire training, manual handling. Unfortunately, from the information provided on the day we are not able to readily confirm training throughout the staff team. We have, therefore, made a requirement regarding this as part of this report. Staff spoken with on the day confirmed that they are well supported in the home and receive training. We received five responses to surveys in which all staff confirm that they receive training relevant to their job. They have added the following comments: The home provides a very good homely environment in which the service users are well cared for. As a member of staff who enjoys the job and am very happy to work here, there is nothing that the service could do better. Consider our clients needs and apply empathy when dealing with clients. The service we provide works well. I am very happy with my job role at this home and consider it to be a very high standard of care.. At the moment I cant think of anything that would improve our home. I am proud and happy to work at this residential home. (we) provide, friendly homely environment but at a professional level. I feel there isnt anything they can do much better. I feel everything is done in a high standard and management are very approachable. The AQAA tells us that there are sixteen permanent care workers, twelve of whom have attained a minimum of NVQ level 2 in Care and two of whom are working towards this award. We are also informed that all staff are undertaking at present a 12 week distance learning course on health and safety - this is the second one undertaken for some staff. Care Homes for Older People Page 26 of 37 Evidence: It is understood that Kingsley Cottage has low staff turnover and there has been no use of agency staff. This provides consistency for the people who use the service. Care Homes for Older People Page 27 of 37 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. People benefit from the home being managed by a person who is of good character and fit to be in charge. Some areas need to be managed more effectively in order that the health and welfare of people who use the service are better promoted and protected. Evidence: The proprietor is present in the home from Monday to Friday and every other Saturday morning. People who use the service and staff confirm that he is popular and approachable and it is apparent he has friendly and appropriate relationships at all levels. The Registered Manager has a long history of working in social care. She is appropriately trained and experienced to manage the home. She has the best interests of people who use the service at heart. It is apparent that her leadership style promotes caring relationships in the home. Care Homes for Older People Page 28 of 37 Evidence: This is a popular home and is fully occupied on the day of this inspection visit. It is understood that there is a waiting list of people wishing to live at Kingsley Cottage. Four requirements and four recommendations were made in this outcome area in the last inspection report: Requirements: 1. Work must be carried out on the front driveway to provide safe access 2. The first floor bathroom must be upgraded. 3. All COSHH materials to be appropriately stored. 4. Replacement of carpet on steps on the first floor landing. All these requirements have been satisfactorily met. Recommendations: 1. Reduction of clutter in communal areas. 2. Three-monthly fire training for night staff. 3. All surfaces in the kitchen must be kept clean. 4. Fire risk assessments to be carried out for all people who use the service. All these recommendations have been satisfactorily met. The manager completed the AQAA, which is a legal document, and returned it to us within the specified timescale. We checked the staff files of two new recruits but could not find a record of any formal supervision sessions. We could not find records to confirm that induction training has taken place at the start of their employment. We looked at the personnel file of a person who had been employed for a number of years and found the record of the last supervision session dated 13/03/07. We asked the Deputy Care Manager if supervision records may be stored elsewhere but she confirmed that they should be in the personnel file. We have made a recommendation that care staff should have regular formal supervision sessions that are recorded. Regular supervison, that includes observation of practice, enables a manager to monitor the workers on-going competence and identify any training needs in a constructive and formal manner which should be recorded. This important function allows the manager to determine that her care team is fit to provide the service. As part of this inspection we have made immediate requirements in respect of medication issues and have returned to the home to monitor progress. We will visit Care Homes for Older People Page 29 of 37 Evidence: again to ensure that medication procedures have improved and present no risk to people who use the service. We have also made health and safety requirements as part of this report as follows: 1. Risk assessment procedures that include input from appropriate healthcare professionals, must be carried out in all instances where bedguards are fixed. Records of the maintenance arrangements for bedguards must also be in place. Risk assessments should be carried out prior to the fixing of bedguards. These procedures will protect the health, safety and well-being of people who use the service. 2. All care staff must receive moving and handling training from a moving and handling trained trainer before they are deployed in the home to assist people who use the service. We have made the following health and safety recommendations: 1. The service must ensure that staff responsible for recording food storage temperatures know how to use the temperature probes/thermometers. Equipment used for testing fridges, freezers and food must be in good working order in order to give accurate and reliable readings. 2. The kitchen cleaning programme must be recorded to ensure regular cleaning of surfaces and appliances in the food preparation area. We have given an adequate rating in this outcome area because there is a lack of written evidence to confirm that there is a strong management overview in areas where we have made requirements and recommendations as part of this report. Those areas - medication, manual handling, lack of risk assessments for bedguards, supervision - are high risk areas which could have serious consequences for the people who use the service. The views of people who use the service and their advocates are actively sought. This is undertaken on an informal basis rather than using a formal quality assurance system. People we spoke with and those who responded to surveys tell us that their views are listened to and acted upon. The home is only responsible for small amounts of peoples personal allowance monies. We checked the records and monies of two people who use the service and found these to be satisfactory. Care Homes for Older People Page 30 of 37 Evidence: The Certificate of Registration is displayed in the home as required by our regulations. There is current insurance in place. Care Homes for Older People Page 31 of 37 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 32 of 37 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 1 9 12 Reg. 12(1)(a) & 13(2). 24/04/2009 The home must promote and make proper provision for the health and welfare of people who use the service and make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Explicit instructions for the administration of all medicines must be given by the prescriber. as required, as directed is not acceptable. This will ensure that people receive medication as prescribed by their general practitioner. 2 9 12 Reg. 12(1)(a) & 13(2). 24/04/2009 The home must promote and make proper provision for the health and welfare of people who use the service and make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. All records for pro re nata prn medicines should have a protocol and where there is an option on quantities that may be administered the record should show the reasons why the quantity has been administered. This will Care Homes for Older People Page 33 of 37 identify why and in what quantities medicines have been administered. 3 9 12 Reg 12(1)(a) & 13(2). 24/04/2009 The home must promote and make proper provision for the health and welfare of people who use the service and make arrangements for the recording, handling, safekeeping safe administration and disposal of medicines received into the care home. A record of the quantities of all medicines held in the home must be maintained. This will provide an audit trail for each medicine held. 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 9 12 Reg. 12(a)(a) & 13(2). 22/05/2009 The home must promote and make proper provision for the health and welfare of people who use the service and make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The administration times of medication that is time critical and in this instance paracetamol, should be recorded so that the Care Homes for Older People Page 34 of 37 Medication Administration Record clearly identifies that there is an appropriate interval between administration of each dose. 2 38 12 12(1)(a) & 13(5) 22/05/2009 Moving and handling training must be provided by a suitably trained person to all care staff deployed in the home who assist people who use the service. This will ensure that the health and welfare of people who use the service and staff are promoted and protected. 3 38 12 12(1)(a) 29/05/2009 Risk assessment procedures that include input from appropriate healthcare professionals, must be carried out in all instances where bedguards are fixed. Records of the maintenance arrangements for bedguards must also be in place. This will ensure that the health and welfare of people who use the service are promoted. 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 1 1 The homes Statement of Purpose and Service User Guide should be amended to show the correct categories for which the home is registered. The home is registered for Care Homes for Older People Page 35 of 37 Old age, not falling within any other category (17). Dementia - over 65 years of age (3). Physical disability over 65 years of age (3). The home is not registered to provide services to people with mental health needs. This will ensure that only people from categories for which the home is registered are admitted to the home. 2 29 Reg 19(1)(b)(c) A photograph, together with copies of documents seen to confirm the identity of the employee should be held on file as required by regulation. This will demonstrate that the person is fit to work at the care home. An up-to-date and accurate record of all staff training, and particularly care staff, must be maintained in order to provide evidence that training has been carried out and is current. Formal induction and supervision sessions should take place for all care staff. New staff need training to ensure that they adopt the homes employment policies and procedures. Formal supervision that covers all aspects of practice, the philosophy of care and career development needs will improve the service. This wil ensure that people who use the service receive a consistent and focussed level on care. The kitchen cleaning programme must be recorded to ensure regular cleaning of surfaces and appliances in the food preparation area. This will ensure the regular cleaning of all kitchen areas and equipment. Staff responsible for recording food storage temperatures must know how to use the temperature probes/thermometers. Equipment used for testing fridges, freezers and food must be in good working order so that they give accurate and reliable readings. 3 30 4 36 5 38 6 38 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) 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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