Inspection on 04/11/08 for Kingsmead Care Home

This inspection was carried out on 4th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingsmead Care Home 16/11/06

Kingsmead Care Home 17/01/06

Kingsmead Care Home 07/07/05

Kingsmead Care Home 06/01/05

Kingsmead Care Home 19/07/04

Kingsmead Care Home 27/01/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kingsmead Care Home 63 Prospect Place Old Town Swindon Wiltshire SN1 3LJ     The quality rating for this care home is:   two star good 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: Susie Stratton     Date: 0 7 1 1 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 36 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 36 Information about the care home Name of care home: Address: Kingsmead Care Home 63 Prospect Place Old Town Swindon Wiltshire SN1 3LJ 01793422333 01793422666 kingsmead@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Name of registered manager (if applicable) Type of registration: Number of places registered: care home 43 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: No more than 18 persons aged 45 years and over with a mental disorder or dementia may be accommodated at any one time. These service users must be accommodated on the first floor. No more than 18 service users in the category old age, not falling within any other category, may be in receipt of nursing care and must be accommodated on the ground floor The `Annex` area may not be used for service users in receipt of nursing care whether in the OP, MD, MD(E), DE or DE(E) categories Care Homes for Older People Page 4 of 36 18 1 18 0 Over 65 18 0 18 25 The only service user who may be accommodated in the category LD is the male service user in the application dated 28 June 2005. The only service user who may be in receipt of nursing care, aged under 65, is the service user named in the application dated 16th December 2005. The staffing levels set out in the Staffing Notice issued by Wiltshire Health Authority on 26 September 2000 in regard to Kingsmead Nursing Home (registration number QD7 8E577) must be met at all times in respect of the service users accommodated on the ground floor The staffing levels set out in the Staffing Notice issued by Wiltshire Health Authority under Sections 22(1) & 23(4) of the Registered Homes Act on 28 May 1999 in regard to Kingsmead Nursing Home (registration number QD7 - 8F177) must be met at all times in respect of the service users accommodated on the first floor Date of last inspection Brief description of the care home Kingsmead Nursing Home is situated in Old Town, Swindon and is close to local shops and bus routes. The home is a modern building on two floors and has accommodation for up to forty-three older people. It is split into three sections, comprising of a fivebedded residential unit, an eighteen-bedded nursing unit and an eighteen-bedded dementia/mental health unit. The accommodation comprises of a mixture of single and double rooms with some en suite facilities. Communal sitting and dining rooms are available and there is a safe, enclosed rear garden that contains a seating area. There are parking areas to the front and rear of the home. Kingsmead is part of the Four Seasons Healthcare group. The registered managers post is currently vacant. There is a minimum of two qualified nurses on duty at all times, supported by care assistants. Kitchen, domestic, administration and maintenance staff are also employed. The fee range is 322.60 pounds to 750 pounds a week. Additional charges are made for services such as hairdressing and chiropody. The service users guide is available in the front entrance hall and a copy is given to each resident or their supporter. Care Homes for Older People Page 5 of 36 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: two star good 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: As part of the inspection, 40 questionnaires were sent out and seven were returned. Comments made by the people in the questionnaires and to us during the inspection process have been included when drawing up the report. As part of this inspection, the homes file was reviewed and information provided since the previous inspection considered. We also received an annual quality assurance assessment from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We looked at the quality assurance assessment, the survey and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during the visit to the home. Care Homes for Older People Page 6 of 36 As Kingsmead is a larger registration, the site visits took place over two days. The first site visit was conducted by both a regulatory inspector and a pharmacist inspector. The first site visit took place on Tuesday 4th November 2008, between 9:55am and 4:00pm. The second site visit took place on Friday, 7th November, 2008 between 9:35m and 1:00pm. The new manager was on duty for both days of the inspection and was available for the feedback at the end of the site visits. During the site visits, we met with five residents, three visitors and observed care for eight residents for whom communication was difficult. We toured all of the home and observed care provided at different times of day in all parts of the home. We also performed a short observation of care provision on the dementia care unit, in accordance with our established procedures. We reviewed care provision and documentation in detail for seven residents and reviewed certain aspects of care and documentation for a further three residents, across all parts of the home. As well as meeting with residents, we met with three registered nurses, seven carers, both the activities coordinators, the cook, the maintenance man and the laundress. We observed a lunch-time meals. The pharmacist inspector reviewed systems for storage of medicines and observed medicines administration rounds. A range of records were reviewed, including staff training records, staff employment records, accident records and complaints records. What the care home does well: What has improved since the last inspection? What they could do better: Records relating to the provision of care for people with more complex needs need to be completed at the time care is given, as errors can occur if they are not completed contemporaneously. Care plans relating to prevention of pressure damage should be further developed, to include actions to take if the resident spends much of their time in the lounge, as risk does not reduce when a person is sitting out of bed. Some care plans would benefit from more precision, to include the actual types of aids or lotions used to intervention needed, this includes care plans relating to stomas. Some aspects relating to the environment need improvement, this includes Care Homes for Older People Page 8 of 36 management of sanitary items in the are of the home where there is no sluice room and risk assessments where free-standing radiators are needed. Older flooring should be replaced, further develop the homely atmosphere. Residents would benefit from a review of staffing levels in the kitchen, to ensure that their needs, particularly for evening meals can be met. The use of dried soup and sauce mixes with high levels of salt and sugar should be reviewed. Staff would benefit from being financially supported to attend non-mandatory training relating to resident care. Staff such as the laundress need to attend training on prevention of spread of infection. The manager needs to be supported in attending a course to support her in further developing her established management skills. 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 36 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 36 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. Prospective residents will benefit from a full assessment of their needs, so that the resident and their relative will be assured that the home can meet their nursing and care needs. Evidence: During the inspection, we met with some residents who had been admitted to the home recently. Many of them were not able to recall much about the admission process. One resident did report when I was first accepted for the home, I was very apprehensive but now Im here, I find the room itself is gorgeous and I cant fault the staff. One relative commented in their questionnaire that When I looked around for [my relative] I was pleased by the friendly welcome and the fact that the carers were interacting with the residents. A resident commented My [relative] came and had a look and was pleased. Care Homes for Older People Page 11 of 36 Evidence: We reviewed admission assessments for some of the people who had been admitted since the new manager came into post. These assessments were individualised and completed in detail, providing a good basis for the development of care plans. Records related to what residents and staff told us and what we observed. Where indicated, assessments from other relevant persons were obtained, such as the social worker or community psychiatric nurse. Discussions with a range of staff, including the chef and activities coordinator showed that staff felt fully informed about prospective residents nursing and care, so that they could prepare to meet their individual needs. Staff reported on one newly admitted resident and how they were getting to know them gradually as the person began to settle. One carer showed a detailed understanding of how difficult it must be for a person with dementia care needs to be admitted to a care home. Care Homes for Older People Page 12 of 36 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. Residents will be supported by a home which ensures that their care is planned individually and plans of care are revised when indicated. There are generally safe arrangements in place for the management of medicines but we highlight a few weaknesses where more attention to detail is needed so as to help protect people living in the home from any unnecessary risks with medication. Evidence: Kingsmead is divided into three different units, all of which have a different focus of care. There is a dementia care unit on one section of the first floor, a small residential unit on a separate section of the first floor and a general nursing unit on the ground floor. All three units are separately managed by different teams of staff. The acting manager has been in post since the summer of 2008. She reported that since she came into post, she has reviewed a wide range of matters relating to resident care, supporting staff in developing a more individualised approach to nursing and care provision. This has included developing a key worker and lead nurse system, to improve continuity of care to residents. She reported in her annual quality assessment Care Homes for Older People Page 13 of 36 Evidence: that she is now planning to meet with individual families, to discuss residents changing needs. Residents and their relatives reported that the home met their needs. One person reported they look after me as well as they can do, another If I need anything, they are always there for me and another the carers are doing a lot for [my relative]. During the inspection, we spoke to a range of different staff across the home. Carers and nursing staff nearly all knew their residents nursing and care needs in detail, reflecting an individualised approach to care provision. During the inspection, we also performed a short observation of care on the first floor, in accordance with our established procedures. We observed that residents were able to wander around the floor, if that was what they wished. Other residents were able to sit in either their own rooms, the dining room or this sitting room, depending on what they preferred. We observed low levels of confused or noisy behaviours and no incidents of aggressive behaviours between residents. Staff were consistently observed to approach residents in a calm, friendly manner. Staff spoken with knew their residents and how they could effectively be communicated with or approached. All residents have assessments of need performed. Where risk is identified such as risk of falls, pressure damage or nutritional risk, care plans are put in place to direct staff on how risk is to be reduced. Care plans were generally clear and written in nonjudgemental language, this included care plans relating to people who had dementia care needs. Care plans were regularly evaluated and the resident or their next of kin was involved as much as possible. Many of the care plans were clear and detailed, however some care plans could benefit from further development. Some people had clear care plans about how risks of pressure damage were to be reduced when they were in their rooms but needed sections on how risk was to be reduced when they spent all or most of their days in the lounge, as risks of pressure damage do not reduce when sitting out of bed. Some care plans could benefit from increased precision, for example some care plans referred to appropriate continence aids or that carers were to cream the persons skin daily or that thickening agents were to be used in drinks, without describing the actual continence aids, name of topical cream or actual thickness of drink aimed for. One person had a care plan relating to a stoma, this care plan did not state the specific care of the stoma including skin round the stoma site, which appliance was to be used and how often it needed to be changed. Records were not maintained of when the appliance needed to be changed. This is advised so that effective evaluations of interventions can take place. Where residents are at dietary risk, risk of dehydration or pressure damage, what the Care Homes for Older People Page 14 of 36 Evidence: resident has eaten, drunk and how often they had their position moved were documented on a monitoring chart. It was observed that where residents spent their time away from their room, in the sitting room, that these records were not completed contemporaneously and this is needed as unless such records are completed at the time care is given, they may be inaccurate, as staff may forget significant details. Where the person was assessed as being at high risk of pressure damage, records of changes of position were maintained for some people but for others their chart simply stated that they were in the sitting room. If people are at high risk of pressure damage that risk remains the same wherever they are, therefore charts need to be completed in full so that management can ensure that corrects steps have been taken by staff to reduce risk to the resident. Staff reported on close working relationships with residents GPs. Full records of consultation with residents GPs were maintained. The home also has close working relationships with other healthcare professionals, including the local hospice, community psychiatric nurses and tissue viability nurse. Where external healthcare professionals were consulted, records were maintained in full. During the inspection, we observed that a person needed emergency first aid treatment in the home. This was administered to the resident in a prompt and kindly manner. The persons GP was contacted and asked to visit and appropriate aids provided to ensure the residents safety. During the inspection, we observed that all care was provided behind closed doors. Where a resident with dementia care needs was unaware of their needs for privacy, for example, taking off clothing, one member of staff was observed to gently discuss with the resident how they might be helped, to ensure that the persons dignity was preserved as much as possible. Comments from residents, relatives and staff indicated that the home had had major issues in the recent past relating to loss of residents clothing and even communal use of clothing. People consistently reported that since the new manager has been in post, she had taken active steps to address the issue of individual residents laundry. The laundress reported that these steps have been effective and that, unlike previously, the amount of un-named clothing has been reduced to nearly nothing. One resident reported the laundrys a very good service since [the new manager] has been here - shes sorted it out. Observations of care and reviews of records showed that residents were called by their own preferred name, so some people were addressed using their title and surname, others by their first name and others by a name they preferred. One resident reported Oh yes theyre very good to me, they call me by my own name. As part of this key inspection one of our pharmacist inspectors looked at some of the arrangements for the management of medicines. The pharmacist looked at some Care Homes for Older People Page 15 of 36 Evidence: stocks and storage arrangements for medicines, some medication records and procedures. We saw a nurse administer some medicines and spoke to one person living in the home about his or her medication. We talked with the manager, two registered nurses and a senior carer. Registered nurses were responsible for the management of medication on behalf of people living in the nursing units and specially trained care staff for those people living in the residential unit. At the time of the inspection only one person was assessed as able to self administer some medication (creams). A risk assessment needed adding to the care plan for this person including considering if the arrangements for keeping the cream in the bedroom were safe for everyone in the home. We saw a nurse following safe practices for administering medicines to several people on one unit at lunchtime and asking people about their need for medicines such as for relief of pain. We spoke to one person during this time who told us he or she was looked after well enough and that staff always give her medicines. It is good practice that consideration has been given to the times medicines are administered so as to provide a more even spread of doses throughout the day and avoiding giving medicines during meal times. We discussed with some staff about not placing medicines into small pots to carry through the home to administer as this can lead to mistakes. In discussion the nurses said they had not identified any diversity or equality issues relating to medication or any particular choices that people had made about having their medicines administered. For each person living in the home there were arrangements for recording medication received, administered and leaving the home or disposed of (as no longer needed). Complete and accurate records about medication are important so that there is a full account of the medicines the home is responsible for on behalf of the people living here and so that people are not at risk from mistakes, such as receiving their medicines incorrectly. We looked at a sample of these records in more detail and these generally appeared to be in order. We identified a few improvements needed. We saw two gaps in records; the tablets had gone from the blister packs so the doses were probably administered. Staff must make sure that when a variable dose is prescribed (one or two tablets for example) that the records always state what was taken. Some records needed more directions as to which eye(s) the drops were to be instilled or where the cream was applied for example. It is good practice to arrange to see the repeat prescriptions each month as Care Homes for Older People Page 16 of 36 Evidence: this helps with better management of the medicines. There was an example where some medicines had not been sent by the pharmacy as there was no prescription. Staff would have identified this earlier had they checked the prescriptions before they were sent to the pharmacy to be dispensed. Some medicines were prescribed to use only when required. Staff were often able to describe how they used these medicines or said some people were able to tell them what they needed. We saw that the amount of information included in care plans about using these medicines was variable. It is important that care plans give clear written direction to all staff about how these medicines are intended to be used to meet identified needs in a consistent planned way and in accordance with the provisions of the Mental Capacity Act 2005, particularly where people are not able to express their wishes and staff are making decisions on their behalf. We saw a suitable care plan for someone with diabetes but the plan for another person needed reviewing with more detail such as the target blood glucose levels. The records for blood glucose tests did not always correspond with the frequency described in the care plan in this case. The lancing devices the nurses used to obtain capillary blood samples (to measure blood glucose levels) on a number of people living in the home were not in accordance with Medical Device Alert MDA /2006/ 066 dated 6th December 2006. This can put people living in the home at a known risk of transmission of blood borne infection. Staff are also at risk from needlestick injury and cross contamination. The correct lancets are available on NHS prescription. There were generally suitable arrangements for storing medicines safely. Temperature records for these areas showed sometimes these were close to the maximum storage temperature for medicines. We suggested this may partly be due to the heat produced by the fridges kept in a small room. Although there were proper cupboards for storing controlled medicines we explained how these needed fixing properly in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973. This would involve moving the location of one cupboard to a solid wall. This is necessary to make sure such medicines are stored safely and legally. Further information about the correct arrangements is available on our website. Checks we made of the controlled medicines in stock and in the record book were satisfactory. We strongly recommend improved storage and recording arrangements for a particular liquid medicine we found in the normal medicine cupboard in the nursing unit. When we visited some bedrooms we saw that some opened containers of creams or ointments were kept in the en suite bathrooms. It is important that this arrangement Care Homes for Older People Page 17 of 36 Evidence: is assessed in each case as being safe for everyone living in the home. Some of the containers we saw were not labelled and none had dates when first opened to use. There is a limited time for which these should be used after opening in order to reduce risks from microbial contamination. There was a new medication policy and procedures. The manager was arranging for this to be available on each unit so that all staff were aware of how the company expected medication to be handled in a safe way. There were also other reference sources about medicines on each unit. The manager has begun auditing medication each month which is a good practice to help make sure safe systems are in place and to identify any problems quickly. Writing the date on all containers of medicines when first opened for use not only allows for proper stock rotation but allows audit checks that the medicines remaining agree with the record of medicines administered. Recording the quantity of any tablet or capsule medication carried forward to the next month is also a useful check. Care Homes for Older People Page 18 of 36 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 home are working towards meeting residents diverse recreational needs and choice at mealtimes. Evidence: The new manager reported that she has worked to develop activities and recreational provision for residents, since she came in post. She appointed a part-time activities coordinator about three months before the inspection and had very recently appointed a second part-time activities person. During the inspection, we met with both these people. They reported that they were aware that activities was an area which had needed development and that they were gradually putting programmes in place, which were based upon resident need. Both people were able to work flexibly, so that where indicated, some activities provision would take place in the evenings and at weekends. Many of the questionnaires identified that the home had not had much emphasis on activities provision in the past. It was felt that this was now changing. One person reported We play Bingo, I won a bracelet, another Sometimes we do arts and crafts, another the new lady gets in musical talent which is quite good and another we went out one Sunday in wheelchairs to a garden centre and had a barbeque Care Homes for Older People Page 19 of 36 Evidence: there. During our short observation, we watched two residents singing along to a Tom Jones CD, both were encouraging and supporting each other in joining in and trying to get other residents and staff to participate. During the inspection, we observed that visitors could come and go as they wished. One resident reported that their visitor had joined in and helped on a recent outing. Two visitors were observed to assist their relative eating at mealtimes. The activities person who had been in post for a longer period showed an understanding of the importance of meeting residents diverse social and individual needs. They were both aware of how to contact local religious groups, to support residents. Staff also supported residents. An established couple remained together in the home, with staff giving them time on their own as well as being with other residents. One resident had a range of items relating to their faith in their room and one carer spoken with was aware of how important practice of their religion was to the person. Residents spoken with reported that they could choose. One person reported We say to them Im going to bed and they say [nodding towards the carers], Ill go with you another If I wanted to stay in bed for a day, nurses say alright, you stay in bed and another If I was to ring the bell and ask for a cup of tea, theyd get me one. We discussed with carers on the dementia care unit how they ensured that residents could chose. They agreed that this could be complex, but that it was an important area in care provision. One carer summed the conversation up by stating they got rights about their residents. Of the six people who responded to this section of the questionnaire, two people reported that they always, three that they usually and one that they sometimes liked the meals. Many comments related to the quality of evening meals. The acting manager reported that she had also identified issues particularly relating to the evening meals and that she had begun to work on making improvements. As would be anticipated in a larger care home, there were a range of comments made about the meals. One person reported sometimes I like the food another if I dont like it I dont eat it, another the foods alright, if I dont like it, the cook will do something else and Im a fussy so and so. We discussed meals with the staff, including the cook. Staff reported that the meals service had been reviewed since the new manager came in post. The cook showed a very individualised approach to meals provision, discussions with her and reviews of records showed that she meets with residents very regularly to review their likes and preferences. She was also aware of different residents needs for special diets, including diabetic diets. During the inspection, we observed a mealtime. We noted as good practice that very Care Homes for Older People Page 20 of 36 Evidence: few liquidised or soft meals were provided. Where residents had difficulty in swallowing, minced or finely chopped portions were provided as much as possible. Staff were observed to encourage residents to assist themselves to eat their meals, providing appropriate aids if needed. Discussions with staff indicated that one of the issues relating to meals provision, particularly in the evening was staffing of the kitchen, which appears to have fewer staff than in other kitchens services for this number of residents. This should be an area for review, so that quality of meals provision and choice can be more supported. The home uses dried soup and sauce mixes. When we looked at the ingredients in these mixes, some contained high quantities of sugar and salt. The cook confirmed that these dried mixes would be used for diabetics and people with heart conditions. The provider needs to research soup and sauce mixes which contain lower levels of sugar and salt. Care Homes for Older People Page 21 of 36 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. Actions taken by the new manager will ensure that if residents and their supporters have issues of concern, they will be investigated and acted upon and that people will be safeguarded. Evidence: The home has a complaints procedure, which is displayed in the front entrance area and is available in the service users guide. The manager reported that when she came in post, she had identified that complaints records had not been maintained in an orderly manner and that some complaints had been made, but there was no written evidence about this. The new manager has fully revised the complaints system, including a detailed documentary system for complaints. Records seen since the new manager came in post were clear, showing that any matters are now investigated in full and that the home are complying with the providers own complaints procedures. Two complaints have been raised with us since the last inspection. These were made since the new manager came in post but the matters largely referred back to before she was in charge. In accordance with our procedures, we handed the matters back to the home for investigation. In both cases the new manager investigated the matters raised in a detailed manner, producing a full report, showing that where matters were identified, she had taken action to address them. Care Homes for Older People Page 22 of 36 Evidence: Residents reported that they felt able to raise issues. One person reported on how, soon after the manager came in post she had held a meeting to air our difficulties. One resident reported that if they were not happy about anything Id talk to [the new manager] and another I do tell [the new manager] if Im not happy. Id tell her straight. How can [the new manager] put it right if she doesnt know. The new manager has experience of working within the local safeguarding adults procedures. Three allegations have been referred about residents under local safeguarding procedures. All related to a period before the new manager was in post. These had all been resolved by this inspection. Discussions with staff indicated that not all of them had received recent training in safeguarding vulnerable adults. All the people spoken with were keen to develop their skills in this area. The new manager reported that when she came in post, she identified that many areas of training, including safeguarding training, had lapsed. She reported that she was working though a programme to ensure that all staff would be fully up-dated in the near future. Care Homes for Older People Page 23 of 36 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. Developments are being made to the home environment which will mean that residents will be supported by a cleaner, more well maintained home. Evidence: We met with the maintenance man who showed a supportive approach to the staff in ensuring day-to-day matters were addressed. The new manager reported that since she came in post, she has developed an action plan to ensure that the home is well maintained and clean. This has included starting the redecoration of public areas of the home and some of the bedrooms, including re-carpeting these bedrooms. The new manager reported that new flooring for sluice areas was on order. Some of the other carpets and flooring are becoming old, with in-grained staining and would benefit from new flooring to suit resident need, to improve the homes atmosphere. The provider has been investing in a range of equipment to meet resident need, including profiling beds. One resident reported to us I AM VERY comfortable here in this bed. More beds had just been delivered and the maintenance man was assembling them during the inspection. Developments are also being made to other parts of the home. One of the residents on the residential wing reported how they appreciated that the home were putting in a disabled shower in their part of the home. The manager reported in the annual quality Care Homes for Older People Page 24 of 36 Evidence: assessment that she had created space for a quiet room in the dementia care unit for the benefit of residents and their visitors. One relative reported that they appreciated being able to put their own things up in the residents room. One resident who had brought a range of their own possessions in reported my rooms the best of the lot I think. Some parts of the home needed attention to cleanliness and some of the areas of the home exhibited odour. This may relate for a need for new flooring, as identified above, and improved attention to cleanliness. The new manager reported that she had set up cleaning schedules since she came in post and was taking action to improve standards of cleanliness. Issues relating to unclean bath hoists were dealt with during the inspection. One relative reported that cleanliness has been very poor in the past, but there is a BIG improvement. The home has two sluice rooms. These rooms were well organised and the manager reported that she had identified that the home needed new bins for clinical waste, to comply with the principals of infection control and that these were on order. One part of the home does not have a sluice room, which means that any sanitary items have to be taken to another floor for disposal or deep cleaning. A policy and procedure needs to be developed for this area, to reduce risks of cross infection from sanitary items to residents and staff. We visited the laundry, which was clean and well organised, with no dust visible behind machines. The laundress reported that staff now consistently managed infected or potentially infected items in accordance with the homes policies and procedures. On discussion with the laundress, she had not yet received training in prevention of spread of infection and this is needed as laundries are key areas of infection control risk. Care Homes for Older People Page 25 of 36 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. Residents will be supported by the systems for staffing and staff development put in by the new manager. Evidence: The new manager reported that a range of issues had needed to be addressed in relation to staffing when she came in post. She has reviewed how staff are allocated across the home and staff are now allocated to one of the three units for a period of time, rather than being allocated to an area on a day by day basis. This has improved continuity of care for residents. Staff reported that it has improved staff morale as well. The new manager has also worked to develop the roster and is planning to support staff in working more flexibly and in planning ahead so that the home is fully staffed at all times. Usage of agency staff has been much reduced. One relative reported on the good working relationships with staff, reporting they tell me all I want to know. The new manager reported in her annual quality assessment that she is planning to recruit more mental health qualified registered nurses, to enhance the dementia care team. The new manager reported that when she came into post, she found that records relating to staff employment and training had not been maintained in an organised manner. She had developed an action plan to address this, and was working her way Care Homes for Older People Page 26 of 36 Evidence: through this action plan. She has reviewed all staff records to ensure that all relevant documentation and checks are on file. She has reviewed staff training records and has identified all deficits and is in the process of developing an action plan to ensure that staff are trained in all mandatory areas and that training in other areas is encouraged. Uptake in training in areas relating to resident care would be improved if staff could be paid for attending training sessions if they were off-duty. One staff member reported since the new manager has started a lot of things are improving in relation to training. The new manager reported in her annual quality review that staff are keen to develop their skills, including National Vocational Qualifications (NVQs). We reviewed files relating to people who have been employed since the new manager came in post. The files were clear, with all including police checks, two satisfactory references, an employment history, proof of identify and health status questionnaire. Care Homes for Older People Page 27 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by the new manager who has improved management systems across a wide range of areas relating to health, safety and welfare of people. Evidence: Evidence from a range of sources, including residents, visitors, staff and from senior managers of the provider, indicate that this home has had issues relating to management for a period of time. The new manager was appointed in the summer. She was previously an experienced deputy manager at another home owned by the provider. In accordance with the providers policies and procedures, she will be put forward to us to be registered as the manger, once she has fully completed her induction period. To further support her in her role, the provider should ensure that she undertakes a NVQ in management. The new manager is also a registered nurse and was observed to perform appropriate first aid during the inspection, when needed by a resident. Since she came in post, the Care Homes for Older People Page 28 of 36 Evidence: new manager as assessed the situation in the home, drawn up an action plan to address the issues and has begun to work her way through this action plan. This inspection shows that she has made considerable progress since she has come into post. This is supported by residents, visitors and staff. One staff member commented since our new manager had started she always makes time to discuss our work problems and if we have any problems she is always there. There was evidence that where she has needed to take disciplinary action to improve performance, she has done so, in accordance with the providers policies and procedures. The home is regularly visited by a senior manager, who makes a report. The senior manager happened to be visiting the home on the first day of the inspection, to perform a review of service provision. The provider performs regular reviews of quality of service provision, including asking residents and their supporters opinions on care provision. The new manager reported that when she came in post, she identified that very few rooms had call bells. She rectified this shortly after her appointment, however she reports that she is aware that some residents do not use their call bells and staff are not used to responding when call bells are used, as it had not been their usual practice. She reported that she plans to address this by assessing staff response when call bells are used, as part of her audits of quality of care provision in the home. The home has standard systems for management of residents moneys. All residents have their own individualised computerised accounts, from which items such as hairdressing or chiropody are debited. It was discussed that some items are handed in to the home at weekends but the homes written audit trail is only commenced when items are handed in to the office by staff on a Monday. The home are advised that the written audit trail of items handed in should commence as soon as the item is handed in to staff. The provider has standard systems for ensuring that all equipment and building services are regularly maintained. The new manager has taken action to address a range of areas relating to health and safety. This includes ensuring that all staff receive mandatory training in areas such as manual handling and fire safety. The provider has ensured that the new profiling beds can go down to the floor, thus reducing the need for safety rails, which are can present a risk to residents. The manager is aware of the benefits to health and safety of such equipment and during the inspection, we observed more than one resident whose bed had been lowered to the floor, with crash mats, to reduce risk to residents. In one area of the home, we observed that free-standing radiators were being used. This was reported to be a temporary measure whilst action was taken to improve the heating systems in this Care Homes for Older People Page 29 of 36 Evidence: part of the home. The home were advised that as free standing radiators are regarded as a risk to health and safety of residents, particularly if the resident is assessed as being at risk of falls, so written risk assessments must be put in place for their use and they need to be secured. Care Homes for Older People Page 30 of 36 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 31 of 36 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 7 13 Fix the controlled drugs cupboards in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973. This is to make sure all these medicines are stored securely and in accordance with the law. 01/03/2009 2 7 17 All records relating to provision of care must be completed at the time care was given. If records are not completed at the time care is given, there is a risk that significant details may be forgotton by staff and so such records will not be an accurate reflection of care given. 31/12/2008 3 9 13 When staff take blood samples for blood glucose monitoring make sure that all lancing devices used comply with the action 01/01/2009 Care Homes for Older People Page 32 of 36 contained in MDA 2006 066 and are safe to use in care homes. This is to protect people living in the home and staff from known risks of cross infection linked with the use of the wrong sort of lancing device. 4 9 13 When medication is prescribed for use when required, as directed or with a variable dose, make sure there is always clear written direction to staff on how to make decisions about administration for each person and medicine and in accordance with the Mental Capacity Act 2005. This is to help to make sure there is some consistency for people to receive the correct levels of medication in accordance with their needs and planned actions. 5 26 13 A policy and procedure on 31/12/2008 management of sanitary items must be developed for the area of the home without a sluice room. If clear systems are not in place in relation to cleaninsg sanitary items in homes, there is a risk to cross infection. 01/01/2009 Care Homes for Older People Page 33 of 36 6 38 13 If free standing radiators are 15/12/2008 indicated, written risk assessments must be completed and radiators need to be fully secured. Free standard radiators have the potential to be a risk to fire safety, present a tripping risk to residents and if a resident is at risk of falls, presents risk to injury to the resident if they are in contact with a hot surface for a period of time. 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 7 Where a person has a stoma, the care plan should state the actual care to be provided, including the type of appliance. Records of changes of appliance should also be maintained. Care plans should use precise, measurable language and detail the actual care to be provided or intervention used. All care plans relating prevention of pressure damage should clearly state how risk of pressure damage is to be reduced, including when a resident spends much of their time in the lounge area. Arrange to see and check all prescription forms in the home before they are sent to the pharmacy for dispensing. Store and keep records for the particular liquid medication identified at the inspection as for a full controlled drug. Write the date on any containers of medicines when they are first opened to use and record the quantity of tablets or capsules that are carried forward to the next medication cycle. This is to help with good stock rotation in accordance with the manufacturers or good practice directions and to enable audit checks that medicines are being used correctly and the right quantities remain in stock. Where creams or ointments are stored in bedrooms carry out written risk assessments to make sure the 2 3 7 7 4 5 6 9 9 9 7 9 Care Homes for Older People Page 34 of 36 arrangements are safe for everyone in the home. 8 9 10 11 12 15 15 19 26 30 The home should avoid the use of dried soup and sauce mixes which contain high levels of sugar and salt. The home should perform a review of staffing levels in the kitchen to ensure that they can meet residents needs. Older carpeting and flooring should be replaced. All laundry staff should be trained in prevention of spread of infection. The provider should consider paying staff for attending study sessions relating to resident care, as well as for attending mandatory training. The manager should be supported by the provider in undertaking an NVQ IV in management. Where items are handed in for safekeeping at weekends, the written audit trail should commence when items are handed in. 13 14 31 38 Care Homes for Older People Page 35 of 36 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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