Inspection on 17/01/08 for Kingsmead Lodge

This inspection was carried out on 17th January 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kingsmead Lodge 02/02/09

Kingsmead Lodge 01/05/07

Kingsmead Lodge 18/05/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Kingsmead Lodge West Town Road Shirehampton Bristol BS11 9NJ Lead Inspector Vanessa Carter Unannounced Inspection 17th and 18th January 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingsmead Lodge Address West Town Road Shirehampton Bristol BS11 9NJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0117 982 3299 0117 982 4515 fionak@mimosahealthcare.com None Mimosa Healthcare (No4) Limited ****Post Vacant**** Care Home 81 Category(ies) of Dementia - over 65 years of age (37), Old age, registration, with number not falling within any other category (44) of places Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 44 persons requiring nursing care on the first floor (Nightingale Unit) May accommodate up to 37 persons with Dementia, requiring nursing care, on the ground floor (Kingfisher Unit) One named resident under 65 years at the time of registration may remain in the home while their needs continue to be met. Registration will revert to persons over 65 years when that person ceases to be accommodated The person responsible to the registered manager, in charge of the Kingfisher Unit, must have qualifications and experience relevant to the service user group The Registered Manager must be a RN1 or RNA on the NMC register May accommodate up to 5 persons aged between 50 to 65 years of age with a physical disability requiring nursing care, in the Nightingale Unit. May accommodate one named person aged 49 years who requires nursing care in the Nightingale Unit. 1st May 2007 4. 5. 6. 7. Date of last inspection Brief Description of the Service: Kingsmead Lodge is a purpose built home that is currently registered to provide nursing care for older people and for people with dementia. The home has 81 places, of which 67 are in single rooms. These rooms all have en suite facilities. The home also has seven shared rooms, of which two have en suite facilities. The home is a two-storey building with lift access to the upper floor. The home has 44 beds on the first floor (Nightingale Unit) for persons requiring nursing care and 37 beds for persons with dementia on the ground floor (Kingfisher Unit). To the rear of the property there are private gardens and a patio area. The home is located a short distance from Shirehampton village, where there is a range of local shops and amenities. The bus route into Bristol passes through Shirehampton, making the home accessible from the city centre. The M5 and Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 5 M4 motorways are within easy reach. The cost of placement at Kingsmead Lodge is between £359.00 – £550.00 per week, the price dependent upon assessed need. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Prospective residents can be provided with information about the home and this will detail the services and facilities available at the home. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection of this care home was unannounced and took place over two days. Since the last inspection there has been a new home manager appointed – they have yet to be confirmed as the registered manager for the service. Evidence to form this report has been gained during the inspection process and :• Talking with the Home Manager • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the residents • A tour of the home • Case Tracking the care of a number of residents • Talking with a number of people who live in the home • Talking with a number of visitors to the home • Looking at some of the homes records • Information that has been received by CSCI (Commission for Social Care Inspection) since the last inspection, from Adult Community Care Services and Healthcare professionals. What the service does well: Pre-admission assessment processes ensure that placement is offered to those whose needs can be met. The home however, needs to expand on these assessments in individual circumstances (see under things they could do better). The people who live in this home can expect to have their needs met and be treated properly, because of the care planning and reviewing processes. Medication systems are safe. The people who live in this home are given the option to participate in a range of stimulating and varied activities. They are provided with good meals. This means that they will be able to follow a lifestyle of their choosing. The people who live in this home can expect any complaints they have to be listened to and acted upon. They will be safe and safeguarded from harm. The people who live in this home are cared for in a comfortable and safe surroundings. The home is generally kept clean and tidy and odour free. There are some minor improvements that are needed. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 7 The people who live in this home have their needs met by staff who have a range of different skills and run the home is run in the best interests of the people who live there. This means that the staff will be able to meet their needs. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information made available about the home and their pre-admission assessment processes ensure that placement is offered to those whose needs can be met. However, improvements with risk assessment processes may benefit some people, so that staff can be fully prepared to meet all needs. EVIDENCE: The homes Statement of Purpose contains all the information necessary for a prospective person who wants to live at the home, and/or their representative, to make an informed decision about moving to the home. The document needs to be updated to provide details about the newly appointed home manager. Each person is given a ‘Welcome Pack’ or service users guide and this gives details of the services and facilities they can expect to receive in the home. The people who live in this home are provided with a statement of terms and conditions and/or a contract, depending upon the funding arrangements for fee’s. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 10 The organisation has set out it own admission criteria and will only admit people to the home whose needs can be met. A number of concerns have been raised with CSCI regarding pre-admission assessment processes – one person had been admitted without a robust risk assessment having been undertaken regarding their challenging behaviour. This would have ensured that any risks were highlighted and management strategies could have been put in place. A healthcare professional had raised concerns that another person was admitted to the home, when their healthcare needs could not be met however it was well documented that other relevant parties had been advised of the nonavailability of nursing equipment, at the point of admission. As part of the inspection the paperwork for this person was examined and found to be in order. The pre-admission assessment document of another recently admitted person was examined and found to be detailed and informative. Information is gathered concerning a persons personal care needs, health care needs, communication and mental health needs. Care plans and health care needs assessments are provided by Adult Community Care Teams as appropriate. The home has a number of “Safe Haven beds”. People who require extra care and support for a temporary period will be admitted by their GP, rather than be admitted into an acute hospital bed, and their care will be overseen by the Rapid Response Team (a team of nurses, occupational therapists and physiotherapists jointly funded by the health and local authority). Where possible people and/or their representatives are encouraged to visit the home and have a look around prior to making a decision to move there. One visitor said “When my relative had to move from a residential care home I came to visit Kingsmead. I knew my relative would be OK here”. All placements are generally reviewed after a four-week trial period – this timeframe can be dependent upon individual circumstances. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in this home can expect to have their needs met and be treated properly, because of the care planning and reviewing processes. Minor improvements in recording mechanisms would improve moving and handling information. Medication systems are safe. EVIDENCE: Six sets of care planning documentation, three from each unit were examined in order to determine the process the home goes through in identifying individual peoples needs and how they then organise the service delivery. Each of the plans were well put together and there was evidence that additional plans had been prepared when new needs were highlighted. They each contained guidance for care staff into how identified needs should be met. The care plans in the dementia care unit had each been prepared using the same “wordy” terminology – referring to gaining the persons trust before the identified tasks is addressed. The plans cover a wide range of specific needs for each person, and are based upon the most recent assessment of need. There were some very good examples of person centred care planning for Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 12 instance the plan for one person in respects of their communication and understanding was detailed and informative. For those people who have high dependency needs, the staff takes the appropriate actions to prevent pressure sores and monitor body weights, dietary intake and fluid intake and output, as necessary. Records are maintained of their actions. Concerns have been raised by a healthcare professional that an appropriate specialist bed and pressure relieving equipment had not been available for one person who had palliative care needs. This will be addressed further in standard 22. Wound care planning documentation is good and provides clear information about the exact actions the staff are expected to take in caring for the wound. The plans are supported with photography and wound measurements and mapping – this evidences that the home has procedures in place to monitor progress or any deterioration in the wound. Of the six care plans that were examined only five of the people had had a full moving and handling assessments. The sixth person whose mobility is severely impaired, had no assessment on file despite them having lived in the home for five months. As a result of these assessments, a safe system of work is devised. Some of these did not provide clear instructions for the staff on what equipment should be used for any particular transfer movement – for example “needs assistance from two staff” is not adequate instruction. The home must ensure that this safe system of work is visibly displayed as most were hidden behind other documents inside poly-pockets. This will ensure that neither people being moved nor staff members, are hurt or made uncomfortable, due to unsafe moving procedures. There was noted to be an improved standard of recording in the daily notes, and this evidenced the care provided and the involvement of other healthcare professionals where appropriate. The home maintains a record of GP contacts and other healthcare professionals and this evidences that the people who live in this home have access to healthcare services. On the dementia care unit they are visited by community based psychiatric nurses and consultant psychiatrists. Examples of other visitors include opticians, podiatrists and RNCC nurses. Observations were also made of good interaction between staff and residents, with respectful and appropriate communication. There is a lively atmosphere in the dementia care unit and although this is much more subdued on the nursing floor, those people who were spoken with during the inspection were complimentary about the staff who looked after them. Comments received from people included “everyone is so kind”, “they all do their very best” and “the staff are always so friendly”. One visitor said “nothing is too much trouble for the staff, my relative is well looked after”. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 13 The homes medications systems were checked on the nursing floor only. The home has safe procedures in place for the ordering, receipt, storage, administration and disposal of medications. A discussion with the lead nurse for the nursing floor evidenced their knowledge of end of life issues including the need for “thinking ahead” with relatives for example, care planning, and the need for specialist equipment. The manager has recently purchased some additional equipment for the home therefore will be better resourced to meet the needs of people who have end of life care needs. The home is committed to looking after people when they reach the end stages of their illness or have been admitted for palliative care. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in this home are given the option to participate in a range of stimulating and varied activities. They are provided with good meals. EVIDENCE: The activities organiser has been employed by the home for many years. There is a weekly plan of activities with the time being divided between each of the units. However, people are able to participate in arranged activities on ‘the other unit’ if they wish. They are also able to choose not to take part and to spend their time how they wish. One person spoken with during the inspection said “I take part in some of the activities. Depends on what it is and what I feel like”. Posters displaying the arranged activities are displayed throughout the home – the next event to be arranged is a Valentines party in February. Trips out of the home are arranged in the summer months, there are regular slide shows, entertainers and arts and crafts sessions. Parties are always arranged to celebrate all the festivals and since the home has a multi-cultural mix of staff, celebrations also include festivals from other religions. One visitor to the home said that they were able to visit at any time, were welcomed by the staff and were offered refreshments. A number of Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 15 ‘volunteers’ visit the home and assist with activities and chatting with those people who are confined to their rooms. The home has a four-week menu plan and these are reviewed regularly and are seasonally amended. Those people spoken with during the course of the inspection made the following comments “the food is very good” and, “some meals are better than others” and “ they will cook something else if I don’t like the choices on offer”. Another person said “the food is alright, I have to have a soft diet because my teeth are bad”. The home dealt with two complaints where the quality of meals was not satisfactory – this had happened when the cook was not available and alternative arrangements has been made. The home will not be using this person again. On the second day of the inspection the midday meal was fish and chips plus an alternative. The meals were well presented and well cooked. People are able to choose whether to have their meals served in the dining room or their own bedrooms. The dining rooms are laid out with smaller tables and tablecloths, drinks are provided and the tables are laid up prior to meal times. Each of the dining rooms were observed to have been cleaned promptly following each meal. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in this home can expect any complaints they have to be listened to and acted upon. They will be safe and safeguarded from harm. EVIDENCE: The homes complaints procedure is displayed in the main reception area of the home and is included in the service users guide or welcome pack. Examination of the homes complaints log evidences that the home has a system in place to log complaints and a protocol for recording outcomes. Clear records are kept to evidence what measures were taken to bring about a resolution to the complaint or concern that is raised. Visitors to the home made the following comments “if I have any concerns they have been resolved, the staff are very helpful” and “the girls do everything to make sure things are right”. Three complaints have been raised with CSCI, and subsequently resulted in safeguarding adults meetings being held in respects of each. For one case it was determined that there were no safeguarding issues and the home were asked to respond to the complainant – this has been overlooked and the new home manager will discuss how to proceed with this, with the area manager. The other two safeguarding meetings resulted in the home needing to take action. A recommendation has been made in respects of pre-admission risk assessment processes, and a requirement regarding the availability of specialist equipment available to meet the specific needs of very poorly people. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 17 The home manager, along with support by the area manager, cooperated in each of the strategy meetings and made all the necessary pre meeting preparations, for example appropriate records, assessments and other relevant paperwork were available. The home has a protection of vulnerable adults (POVA) policy and clear guidance is available for the staff to follow if abuse is suspected, alleged or witnessed. The home uses an external training agency to provide POVA training for the staff team – all staff will receive this on an annual basis. Those staff spoken with during the course of the inspection demonstrated awareness of adult protection issues and also of their responsibility in reporting any bad practice (whistleblowing policy). Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in this home are cared for in a comfortable and safe surroundings. The home is kept clean and tidy but improvements must be considered in respects of the amount of specialist equipment provided. Very poorly people will not always be nursed in appropriate specialist beds. EVIDENCE: Kingsmead Lodge is a purpose built care home, with facilities arranged over two floors. There are two lifts in between the two floors, making the home fully accessible for disabled people. The home has car parking to the front of the building and gardens to one side and to the rear. The dementia care unit (Kingfisher unit) is on the ground floor. The main door into the unit, the lift and all the staircases up to the first floor, are secured with keypad systems – this makes the environment safe for those people who may wander. A number of people use the space in the long corridors to move around in. Care has been taken in decorating the dementia care unit, with Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 19 toilet and bathroom doors being ‘visible’ and ‘staff only’ doors being coloured the same as the walls. The nursing unit is on the second floor and is a tshaped unit, with a central nursing station. The unit can be reached via the stairway from the main reception area of via the lifts, accessed from the dementia care unit. Carpets have been replaced in the corridors and lounges in the dementia care unit, others will be replaced as necessary. The home is well maintained throughout. The home has a part-time maintenance person who will either complete repairs or arrange for external contractors to carry out the work. Both floors have communal facilities consisting of two lounge areas and two dining rooms. Each of the rooms is well furnished with domestic style furnishings. The dementia care unit has one activity/resource rooms, whereas the nursing floor has a training room and a activity/meeting room. There are toilets and bathrooms located throughout the home, all of which are supplied with liquid soap, hand towels and toilet paper. The home has a sufficient number of bathrooms that are fitted with either mechanical bath aids or can be used with hoisting equipment. One room is currently out of use whilst refurbishment is going on. Mimosa needs to undertake a review of the number of specialist nursing beds that the home has, and also the numbers of pressure sore prevention equipment. At present there are only six hospital type beds or electric profiling beds plus the two “safe haven” hospital type beds. All the remaining beds are ordinary divan type beds and these are likely to be unsuitable for people who are very poorly and highly dependent upon the care staff to meet all their needs. A complaint was made by a healthcare professional that one person who had palliative care needs could not be provided with an appropriate bed or mattress because one was not available. This is not good enough – they must ensure that there is the appropriate levels of equipment and that they are able to accommodate changing needs. The staff must be able to pre-empt the need for equipment, so that this can be made available for use as required. Kingsmead Lodge has 81 registered beds but at the moment not all of them are being used. Most rooms are for single occupancy and each room has ensuite facilities. There are six shared rooms with no en-suites – some of these are not being used and there are plans that these will in the future be refurbished to be premier rooms with an en-suite. Most of the rooms were viewed during the inspection. One person said “This is my room and I like to have my special things around me”. One room in the dementia care unit was odorous and another, needs to have the floor covering replaced. All other parts of the home were clean, tidy and odour free. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live in this home have their needs met by staff who have a range of different skills but improvements must be made in the recruitment procedures. EVIDENCE: A team of staff are employed consisting of registered nurses, care staff and ancillary staff, to meet the daily living needs of the people who live in the home. Staffing numbers are arranged according to the dependency levels of the people. There have been some staff changes since the last inspection and agency workers are only arranged if staff cannot cover extra shifts. There are a number of staff vacancies at the moment and recruitment is ongoing Staff rotas evidenced that all shifts are covered with sufficient numbers of staff. On the nursing floor there are always two registered nurses for the daytime shifts and one over night along with five and three care staff respectfully. In addition to the care staff and registered nurses there are catering, housekeeping and laundry personnel. Staff spoken to during the course of the inspection, were helpful and friendly, and the care staff were knowledgeable about the residents needs. Each unit should have a lead nurse, but the position is vacant on the dementia care unit after the promotion of the lead nurse to home manager. Recruitment is currently underway to fill this position. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 21 Of the 28 care staff, four who have already obtained NVQ Level 2 qualification are now completing the NVQ Level 3, and a further seven staff are working towards NVQ Level 2. Once these staff members are trained, the home will be above the 50 minimum ratio of trained members of care staff. Six staff recruitment files were looked at to determine what processes the home follows to ensure that the right people are employed to work at the home, and the people who live in the home are safeguarded from being cared for by unsuitable workers. The procedures the home follows may not be robust enough. For two people, only one reference had been obtained. Each of the six people had a CRB disclosure but only one had been received by the home after their employment had started. The home had no evidence that the other five workers had cleared POVAfirst checks prior to starting work. Although assurances were given that these checks had been received prior to the worker starting, this information could not be verified. The induction-training programme for new staff members now ensures that staff are properly inducted into their role and enables them to have the necessary skills to care for the people they are caring for, however the manager must retain an overall view of how new recruits are performing and their progress in achieving their competencies. One care assistant spoke about how the staff team supported them and how they had to complete a workbook to evidence how their competency was achieved. No workbooks were available for evidence. This same worker also explained that they were now doing the ‘apprenticeship’ prior to starting work on the NVQ. An examination of the staff training matrix evidenced that most of the staff have received mandatory training only. The new manager will be completing a training review with all staff during annual appraisals. The home has an external training provider and the training that is being provided for the next couple of months includes dementia awareness, adult abuse, health & safety, people handling, fire safety, basic life support and infection control. Two staff said they were currently working on a dementia care module. Staff training files were reported not to be in order and therefore not examined as part of this inspection. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is run in the best interests of the people who live at Kingsmead, with a management team who ensures that their views are listened to and acted upon. EVIDENCE: Mimosa appointed a new manager in August 2007, but application to CSCI for registration has not yet been made. This must be addressed as soon as possible. The manager is a qualified nurse and will be enrolled onto Registered Manager Award, management training within this month. The manager was previously the lead nurse on the dementia care unit and therefore knows the home and staff team well. This is the first inspection the manager has been fully involved in, and although there were some gaps in knowledge of “home management” issues, they conducted themselves well and cooperated in the inspection process. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 23 The home manager is well supported by an administrator who has worked at the home for many years, and a receptionist who will welcome visitors in to the home. The area support manager visits the home often, and the home managers from the three other Mimosa care homes provide a supporting role. A senior Mimosa person makes unannounced visits on a monthly basis and a report of the visit is sent to CSCI. The home undertakes other audits on a quarterly basis, including catering, health & safety, care planning documentation, laundry and housekeeping, maintenance and infection control. A record of corrective action is made and who needs to complete the tasks. A yearly “Customer Service Questionnaire” forms part of their quality assurance and monitoring processes and this is due to be started within a month. Resident, relative and staff surveys will be sent out, and feedback will form the basis of the homes development plan. There are good administrative systems in place to manage the personal monies for those people who like to have money held for them. All transactions in and out of the accounts are recorded and a check of a sample of accounts showed that everything tallied. The role of formally supervising the staff team is divided between the manager, the lead nurse and other senior staff, but the manager must maintain an overview of each workers performance and development needs. Staff spoken with during the course of the inspection confirmed that they have regular supervision and that they are supported on a day-to-day basis by the senior staff and their work performance is monitored. The fire records were discussed with the maintenance person. The weekly, monthly and quarterly checks had not been recorded on the relevant forms and other documentation was not made available for inspection. This was discussed with the area manager and evidence was subsequently provided that the appropriate checks had been undertaken at the required intervals, confirming that all was in order. Fire drills are held on a regular basis, with a ‘planned drill’ taking place during the inspection. The previous drill was recorded as having taken place during the night when the fire alarm system was activated. Staff spoken with during the course of the inspection confirmed that they have regular training and that they were aware of the homes procedure to follow in the case of a fire. Safe manual handling procedures were observed during the inspection, but comments have been made regarding manual handling risk assessments and safe systems of work, under standard 7. Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 3 3 2 3 2 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 3 Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4) Requirement Manual handling risk assessments must be completed for all residents so that a safe system of work be devised and followed. These must detail how many staff and what equipment is needed. Appropriate beds must be provided for all people with high dependency nursing needs, to aid their comfort and the delivery of personal care by care staff. CSCI to be provided with details regarding how this is to be achieved by 29/02/08. The flooring in one identified room in the dementia care room needs to be replaced. The malodour in one identified room in the dementia care unit needs to be addressed. Robust recruitment procedures must include two written references, POVA 1st checks and CRB disclosures. Evidence of when the POVA check is received must be retained in the home. Timescale for action 17/02/08 2. OP24 16(2)c 17/07/08 3. 4. 5. OP24 OP26 OP29 16(2)c 23(2)d 19 17/02/08 17/02/08 17/02/08 Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 26 6. OP31 9 The manager must make application to CSCI for registration. 17/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP24 Good Practice Recommendations Risk assessment processes should start before admission so that staff know what to do to reduce any risks that are high lighted. Staff must ensure that they keep a persons need for specialist equipment under review so that they are able to arrange for its provision in good time. The safe systems of work for each person in respects of manual handling procedures should be readily available for care staff to refer to. 3. OP38 Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kingsmead Lodge DS0000066342.V356890.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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