Inspection on 02/02/09 for Kingsmead Lodge

This inspection was carried out on 2nd February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingsmead Lodge 17/01/08

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 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kingsmead Lodge West Town Road Shirehampton Bristol BS11 9NJ The quality rating for this care home is: one star adequate service A quality rating is our assessment of how well a care home 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 full assessment a ‘key’ inspection. Lead inspector: Kath Houson Date: 2 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 38 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 Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Kingsmead Lodge West Town Road Shirehampton Bristol BS11 9NJ 01179823299 01179824515 kingsmead@mimosahealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration Category(ies): dementia old age, not falling within any other category Additional conditions: Mimosa Healthcare (No4) Limited care home 81 Number of places (if applicable): Under 65 37 0 Over 65 0 44 May accommodate 37 persons with Dementia, requiring nursing care on the ground floor (Kingfisher Unit) May accommodate 44 persons requiring nursing care on the first floor (Nightingale Unit) The maximum number of service users who can be accommodated is 81. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum number of places 44 Dementia (Code DE) maximum number of places 37 Brief description of the care home: Kingsmead Lodge is a two-storey purpose built home, which provides general and specialist nursing care to older people and to those with Dementia. The aims and objectives of the home are to provide the highest standard of care to all our residents at Kingsmead Lodge, which is to provide a high standard of nursing and personal care in full compliance with the Care Standards Act 2000 and to treat everybody concerned in a fair and considerable manner. The staff team consists of nurses, which are supported by care staff who provides twenty-four hour care on a daily basis. The home Care Homes for Older People Page 4 of 38 has 81 places, which are divided over the two floors. Each floor is divided into two units, which can be identified as the Nightingale unit, which can be found upstairs and Kingfisher, which can be described as the Dementia unit and can be found on the ground floor. There are rooms available for single occupancy and some rooms are offered for those who wish to share. All the rooms have en-suite toilet facilities. The property has a tidy landscaped garden with a patio, which is accessible to the people who use the service. The property can be found in the village of Shirehampton in Bristol. There are local shops and supermarket with other facilities on offer in the community. There is access to the motorway and public transport available into Bristol City and its surrounding areas. The fees charged are dependant on an individuals care package. At the time of the inspection 2nd and 3rd of February 2009 the fees charged are categorised into residential £425.00, nursing £535.00, dementia with residential £480.00, dementia with nursing £585.00, all are payable on a weekly basis. The weekly charges do not include, hairdressing, newspapers and magazines, chiropody or any personal toiletries. Mimosa is the care provider for a cluster of services including; Kingsmead Lodge, Bishopsmead Lodge, Honeymead Care Home, Sunnymead Manor and a care home in Shepton Mallet. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service How we did our inspection: The Visit: An unannounced visit was made on 2nd and 3rd February 2009 and was conducted by three inspectors. Two inspectors examined the Nightingale and the Kingfisher units and the pharmacy inspector looked at the medication procedures and practices for both units. We looked at information we have received since the last inspection visit. How the service dealt with any complaints & concerns since the last visit. Any changes to how the home is managed the providers view of how well they care for people living at the home. During the visit we: Talked with people who use the service, relatives, staff, other healthcare professionals and the temporary manager. Care Homes for Older People Page 6 of 38 Looked at information about the people who use the service and how well their needs are being met. Examined the homes records relating to documents including their policies and procedures, staff rotas, recruitment and selection practices and the medication procedure. Checked that staff had the knowledge, skills and training to meet the needs of the people who use the service and discuss ongoing clinical practices. Looked around the building to make sure it was clean, safe and comfortable to meet peoples physical needs. Checked what improvements had been made since the last visit. We let the unit manager know what we found during the inspection. The findings for this inspection are organised with each outcome area for the Nightingale units referred to in the first instance. The Nightingale unit findings are described in each outcome area and the medication input represents both units. Specific requirements will be given to areas of concern, to the designated unit. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? What they could do better: The staff team need to get into the habit of knocking on residents door prior to entering, this would ensure peoples dignity and respect is enhanced and maintained. The recording of complaints would ensure a satisfactory resolution has been achieved in a timely manner. Relatives have said management could provide a book, which is kept by the entrance so all visitors, can make comments of any concerns. At the time of this inspection the service was interviewing candidates for the managerial role. This would address the operational issues and the daily management of the service. Relatives also said we would like a manager in place as we have been without a manager for too long now. Care Homes for Older People Page 8 of 38 The communication levels between the support care team could be improved. This would ensure people who use the service have open dialogue with the care staff where language could be a barrier. During the mealtime it would be more appropriate to serve the desserts when people have finished their main course. This would ensure people are able to eat their pudding while it is hot. 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 on page 4. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Care Homes for Older People Page 9 of 38 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 38 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 the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given enough information, which helps them to decide their place of residence. Admissions are not made until a full assessment of needs has been undertaken which ensures only people whose needs can be met are admitted into the home. A specialist care package is provided and is based on individual need. People on the Kingfisher Dementia Unit benefit from an admission process that looks at and records their assessed needs, they are also offered the chance to visit the home before they move in. Evidence: Nightingale unit. Prospective residents are given enough information prior to admission into the service. All potential residents are provided with a welcome pack. The homes Annual Quality Assurance Assessment states the welcome pack is provided on admission. This was confirmed during the inspection. A welcome pack was seen and contained several pages of information, such as the residents charter. This is a document, which outlines the providers approach to residents care. The content includes for example, the provision of skilled, sensitive and sympathetic care to enable all residents to achieve the highest possible quality of care. Another Mimosa principle is the right of each resident to be consulted about daily living arrangements in the care home and to participate in discussions about any proposed changes. The homes aims and objectives inform the potential residents of the focus for their Care Homes for Older People Page 11 of 38 care. For instance, rights to choice, dignity and independence. Each potential resident is given a full assessment prior to admission. The care files looked at showed assessments had taken place and the multi-disciplinary team have been involved in the assessment of potential residents. Care plans are then devised using the Mimosa paperwork the sections are colour coded and consist of different elements of the care plan. For instance the personal details are bright pink compared to the relatives sheets, which are pale yellow in colour. The purpose of the relatives sheet are for relatives comments to be added. The service took a full personal history of the residents for instance this includes their past and current history and describes their likes, dislikes and preferred name to be called. The pre admission care assessment looks at what is needed for each person, for instance, personal care, physical well being, mental state, mobility, weight, diet and food preferences, sight and hearing communication and continence. The homes admissions process is accurate, thorough and in compliance with their admissions procedure, which is detailed. Residents are given a written contract and terms and conditions that detail the cost for their placement. Several surveys were given to relatives at the time of the inspection. Many relatives were visiting and the home was busy with admissions and visits from health professionals and relatives. One healthcare professional said they were satisfied with the admission of the resident and were given a detailed account on how the home can meet the residents needs. This was seen in care plans, which contained a comprehensive care package with an assessment. The responses from the surveys show relatives are given enough information about the care home, which assisted with their decision making prior to admission into the home. A relative commented, I was given a comprehensive information brochure, if I need to know anything I ask the nurse in charge who always has time or will make time for you. Qualified people carry out the assessments; this ensures the service can meet the needs of potential residents. The documents show the assessments provide good information, which is used to update the care planning process. Some of the beds are blocked for short-term care and are known as Safe Haven beds. This is for referrals made with the involvement of the local Primary Care Trust. These beds are used as an alternative to hospital admissions. The main objective is to have the Primary Care team manage certain aspects of their care, such as the Occupational Therapist and Physiotherapist would supervise care to a resident who has a Safe Haven bed. The rest of the care is provided by the service. The aim is to help the individual gain their independence, return home and avoid a hospital admission. The staff team from the Primary Care Trust said they were satisfied with the provision of care and would continue to use the service. Kingfisher Unit. We looked at the care records for seven people living in the Kingfisher Dementia Unit, Care Homes for Older People Page 12 of 38 we noted that they all had a very clear and concise assessment of their needs before they moved into the home. These were accompanied by either hospital or community care plans and sometimes additional input from a family member or friend. The preadmission assessment formed the basis for the care plans in place to identify the specific needs of the person. We observed working practices and the way staff interacted with people living in the Kingfisher Unit over three days. A full discussion of what we observed is covered in the relevant sections of this report. However it was evident that some people moving into the Kingfisher Unit did not benefit from the homes capacity to meet their assessed needs specific to Dementia. From our observations it was apparent that some staff were unable to demonstrate a basic understanding of the needs of a person with dementia and their right to receive care that respected their equality and dignity within the care home community. People can visit the home before they decide to move in, this is usually done by a relative, friend or advocate. One relative said they had visited and been shown around the home, they confirmed that the room they had chosen was the one their relative moved into. Care Homes for Older People Page 13 of 38 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is responsive to the varied and individual needs of the people who use the service and their care plans are developed with good recording of their needs and preferences. Peoples independence is promoted and maintained with satisfactory working relationships with other multi-agency teams. Knocking on peoples bedroom door would enhance peoples dignity and privacy. People on the Kingfisher Dementia Unit do benefit from detailed care plans but they are not person centered and do not reflect personal preferences, working practices do not support peoples rights to dignity and equality. People do benefit from open access to healthcare specialists with support from the community team available on request. People are not protected by the homes practice of obtaining end of life decisions from relatives without a multi disciplinary team decision. Procedures in place for giving medicines are satisfactory, however some improvements could be made so that residents health was further protected. Evidence: Nightingale Unit. Several of the care plans were looked at for present and past residents of the service. Good information was available in the individual care plans about peoples care needs and how these are met. For instance peoples life history was found to be detailed and comprehensive. Peoples like and dislikes were also recorded. For instance people who Care Homes for Older People Page 14 of 38 like to take part in activities are given the opportunity and are encouraged to participate in favourite pastimes of their choice. All the individual care plans had up to date recording and were in good order. There had been no omissions and were signed by qualified members of staff. Personal healthcare specialist and dietary needs are recorded in each residents care plan. Relatives said the care home always meets the needs of our relatives others said when stretched it is difficult to meet all needs but more than basic needs are met. Other relatives said usually my relatives needs are met. Residents spoken with said their needs are met and they enjoyed it at the home we are well looked after. Another relative went on to say my mother has been well looked after, she is always clean and all staff will do anything to help when asked. Another relative also said I feel my mother is in both safe and capable hands and there is a high duty of care. Regular reviews of the care plans were seen, this shows the staff team observe changes to peoples health needs and will seek additional assistance. For instance health professionals stated in their feedback the care staff always seeks advice and act upon to manage and improve individuals healthcare needs. Another example showed, changes to an individuals health and the staff team contacted the relevant agencies for help and advice. This was evident in the care plans. The staff team also said they felt they were given up to date information about the needs of people who use the service. This was also evident during a detailed handover this entails an account from the nursing staff at the end of one shift to the start of another shift. Each persons healthcare needs are discussed at length which ensures all staff are provided with up to date information about any changes to peoples healthcare needs. Members from the Primary Care Trust also said there were no problems, the nursing staff call us if theres any concerns. All visits by doctors, nurses and other healthcare professionals were recorded. The visitors books also confirmed all visits made by professionals and other multi-agency teams. Peoples privacy and dignity are maintained and respected by staff working in the home. The staff team were respectful to the residents and this was seen on a number of occasions, for instance regular conversations between the nursing staff and residents were ongoing in the corridors and in the dining room. However, all staff must remember to knock before entering the residents rooms. This would ensure people are not startled by the sudden appearance of a member of staff. Knocking on peoples door would enhance their privacy. We observed staff on several occasions entering residents rooms without knocking. This was discussed at the time of the inspection. Peoples wishes with regards to death were handled with consideration and sensitivity. For example discussion with the nursing staff showed peoples wishes were taken onboard and included the assistance of their relatives. The nursing staff said It is a Care Homes for Older People Page 15 of 38 difficult subject to approach with relatives but we do collect some information and record this in the residents care plan. This was confirmed in many of the care plans which were seen. Documented information about peoples wishes in respect of their death for example choice of funeral directors, hymns and psalms were detailed in their care plans. The staff team are often invited to attend the funeral service of residents who have passed away. This shows the relatives are satisfied with the staff team of Kingsmead Lodge. This was also evident from the number of compliments from relatives and family members sent to the staff thanking them for their attendance at funerals and their assistance. Kingfisher Unit We looked at the care records for seven people living in the Kingfisher Dementia Unit. They were very detailed and at first glance appeared person centered. On closer examination we noted that staff were making the same generic assumptions for most of the people living in the unit. We noticed frequent references to a physical condition being related to Dementia. An example being has poor mobility due to Dementia, rather than recognising the person may have poor mobility due to a physical ailment such as arthritis. Some care plans included a day in the life of, statement which was good practice and indicated the persons preferences for when they got up in the morning to how they liked to spend their day but this was inconsistent and not in everybody’s file. We looked at the care plans for people who displayed challenging behaviors. They again were generic and made passing comments about managing triggers but did not identify what triggers were specific to that person. We noted from care records that the care plans were regularly reviewed and revised when changes were noted we discussed with the acting manager the need for staff to compile care plans for temporary situations such as a chest infection or end of life care, she confirmed that she had already tackled this issue and on our second day in the home we saw a care plan for a person with a chest infection. They also showed that people were assisted to attend outpatient clinics, receive chiropody, dental and optician visits. District nurse advise was sought when required and specialist healthcare opinions put into place when needed. After breakfast and lunch most of the people were walked to the large lounge, some remained in their room. It was noted that some care staff would expect them to sit in the lounge regardless of whether that was where they wanted to be, the unit does have the choice of two lounges. A care worker who had been asked to remain in the lounge with residents to observe no one fell, was seen to lean against the wall or sit in a corner and did not communicate with anyone until they told someone who started to stand up, possibly to leave the room or walk around, to sit down. This care worker did not demonstrate any knowledge of how to communicate with people with dementia or their right to exercise choice and control over their own lives. We discussed this with the acting manager who confirmed that in the few days she had been managing the home she had noticed the trend to persuade people to sit in the one lounge and not wander around the unit. She stated that she had started to talk to staff about their approach and was changing working practices. Whilst we were in the unit however we also witnessed some very good practices and excellent interactions between staff and residents, it was evident that these good practices were from people with more experience in caring for the elderly person with Dementia. We spoke to three relatives whilst in the Kingfisher Unit, they all said they felt the care provided was good and that they had no problems with the way their relative was looked after, one person said they had been visiting the home for five years and had always found staff caring and very accommodating. We Care Homes for Older People Page 16 of 38 observed staff caring for people in a private and most often a dignified way with the exception of some staff who lacked the confidence or understanding of the correct way to deal with situations, such as wandering, thinking it best for the person to sit down as they may fall. Peoples doors were shut during personal care, staff knocked before entering and all conversations observed were respectful. Some staff had a very cheerful close rapport, whilst some were observed to be distant and not converse with people unless they were delivering care. We discussed with the responsible individual the undignified use of plastic cups and plates on the Kingfisher Dementia Unit. This practice demonstrated a total lack of understanding of the persons right to lead a dignified life in as equal a way as other people in the home. (People on the Nightingale Unit had the use of china crockery.) When this was mentioned to a qualified member of staff they were horrified that the people on Kingfisher would be allowed china crockery in future stating that they would start hitting each other or hurt themselves by breaking crockery. This again demonstrated the total lack of understanding of an up to date way to promote as normal a lifestyle as possible for people with Dementia and reflected an institutional, out moded approach to the care of people on the Kingfisher Unit. We saw very clear end of life decisions however these were made by relatives on the persons behalf. We saw do not resuscitate decisions signed by a relative with no input from the person living in the home. This leaves people open to abuse. If it is considered a person lacks the capacity to make the decision themselves the registered person needs to arrange a multi disciplinary decision involving the relative, GP and social worker or an independent advocate such as an IMCA (Independent Metal Capacity Advocate.) The pharmacist inspector looked at how medicines are looked after on both floors of the home. People living in the home are registered with a number of local doctors. This means that wherever possible people are able to stay with their own doctor. Staff order prescriptions from the doctors and the prescriptions are sent from the surgeries directly to the pharmacy. Medicines are supplied using a monthly blister pack system. Staff told us that this system worked well for them. We saw on Nightingale (first floor) that there was an excess supply of some items such as creams, ointments and inhalers. Some of these items had been dispensed several month ago. This is very wasteful and increases the risk that a medicine may be used when it is out of date or no longer suitable for the person. Action must be taken to make sure that only those medicines that are needed are ordered and supplied each month. It is good practice for prescriptions to be sent to the home for staff to check before they are sent to the pharmacy for dispensing. At the time of this inspection all the medicines were looked after and given out by nursing staff. Separate storage facilities are available on each floor of the home. During the inspection we saw medicines being given safely on each floor. Photographs of all the residents are kept with their medicine administration records. A list of the signatures of staff involved with giving medicines is also available, so it is clear who has given the medicines. We saw morning medicines being given on Kingfisher (ground floor). These were given after breakfast so that the meal was not interrupted, helping to ensure people completed their meal. We saw staff check the medicines administration sheet before giving the medicines and sign the record sheet when they had been taken. This helps Care Homes for Older People Page 17 of 38 to make sure that medicines are given safely. There was one nurse on duty so the process was interrupted by phone calls and a doctors visit. This could result in some medicines being given late in the morning and care is needed to makes sure that medicines are given at suitable time intervals. Staff told us that if a resident said they did not want their medicines they would go back and offer them again a short time later. Staff also told us that one person sometimes refuses their medicines in the evening and that their doctor had agreed that when this happened some medicines could be crushed and mixed with food. We looked in this persons care records and saw the information to support this. However the list of medicines which could be crushed was not clearly visible. This information must be available to staff at the time medicines are being given and staff should record any occasions when they have given medicines in this way. This is to make sure that only the medicines agreed with the doctor are given in this way. We saw some lunch time medicines given on Nightingale. One person told us that they were satisfied with how staff looked after their medicines and that they were able to take their pain relieving tablets at a time that suited them. This person also told us that they could see their doctor if they needed to. Staff told us that people living on this floor of the home were able to take their medicines without difficulty. The pharmacy provides printed medicines administration record sheets for staff to complete each month. These were generally completed clearly. Handwritten additions to the record sheet were signed, dated and checked by a second person. This helps to reduce the risks of mistakes being made. However on Nightingale some records for medicines which have a variable dose, for example pain relief tablets, when one or two may be given had no record of the dose that was given. This means that it is not clear how much medicine has been given during the day. Action should be taken to address this. One person on Nightingale had frequently refused a vitamin type tablet but there was nothing in the their care plan relating to this. There was no record that staff had discussed any possible effect this may have on the persons health with their doctor. Several people on Kingfisher were prescribed medicines to be given when required. These had clear dosage instructions however the reason for staff giving them was not always clear. We checked four peoples care plans and found that they did not include information about the circumstances that when required medicines should be used. It is important that this information is available to staff so that the medicines are given appropriately and consistently so that residents health is safeguarded. We looked at a sample of medicines on each floor to see if those missing from the packs agreed with the records of administration signed by staff. The monthly blister packs indicated that these medicines had been given as recorded by staff. A sample of standard packs on Kingfisher indicated that these had been given as recorded. On Nightingale it was not possible to check medicines supplied in standard packs because there was no record of when the pack had been opened or how much medicine had been carried over from the previous months administration record. The manager of this floor told us that a system for this had been in place and he would remind all the nurses of the need to follow this. Records are kept of the receipt of medicines into the home and of the disposal of unwanted medicines. Safe storage is available for medicines on each floor of the home. There is suitable Care Homes for Older People Page 18 of 38 storage for medicines called Controlled Drugs that need some additional security. Suitable records are kept of these medicines. Two medicine trolleys are used to transport medicines on Nightingale. Kingfisher has only one trolley available and at the time of the inspection this meant that not all the morning blister packs of medicine could fit inside the locked trolley. Action must be taken to make sure that medicines are kept securely at all times, including when the medicine trolley is left unattended as medicines are given. Care Homes for Older People Page 19 of 38 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have the opportunity to develop and maintain important personal and family relationships, which provides them with additional support. People take part in meaningful and regular activities of their own choice and individual interests. The menu is varied and contains balanced and nutritional diet, which caters to their needs. People on the Kingfisher Dementia Unit do benefit from access to some activities which are run when the activities organiser is there, however this is not carried out by care staff when the organiser is not present. They benefit from maintaining contact with friends and relatives however do not appear to take part in the wider community. People are not encouraged to maintain choice and control over their daily lives. People benefit from a nutritious and well balanced diet. Evidence: People on the Nightingale unit said they were able to make choices about their daily routine for instance when they get up, meal choices and how they spend their time. Individual routines were identified in the care plans and were further discussed with the staff team. However, on one occasion it was noticed that a residents wish to get up early was not recorded in the care plan. This was discussed with the unit manager who addressed this issue straight away. People who use the service are encouraged and given the opportunity to develop and maintain important personal and family relationships. They have formed good Care Homes for Older People Page 20 of 38 friendships with each other and positive interactions with the staff team in the Nightingale unit were seen. For instance the people who use the service have developed into a community, which supports each other and communicates their needs on a frequent basis. For instance, a resident commented on the use of a manual hoist, which they felt was not a comfortable piece of equipment and failed to meet their needs. This has been shared with management. The service takes steps to ensure friendships which have developed are maintained and people are given the time and space to be together. Relatives are encouraged to visit anytime and they too have become a large community within Kingsmead Lodge. A relative said, We visit mum daily. Another relative said I visit very regularly, but should anything happen I am always informed I am with my mum 5 days a week for approximately between 3 and 5 hours per day. Other family members said they are always kept up to date with issues regarding their relatives. This was observed during the inspection when a meeting took place and consisted of a large attendance of family, friends and relatives for those who use the service. A relative said when the need arises i.e. emergencies as I am at home on a daily basis Im kept well informed. Many of the residents are involved in recreational interests, which meet their needs. The activities coordinator who was spoken with said, residents enjoy many of the activities on this unit they play games like complex dominoes, mental arithmetic, scrabble, bingo, arts and crafts, film nights, sing a long and making artificial flowers. The coordinator said I have prizes for the winner of all the games to make it more interesting. Some of the prizes consist of chocolates, flannels and soaps, aftershave and costume jewellery. This was confirmed with many of the residents who had attended the activities, their comments include, We had a thoroughly good time. One resident said, I didnt win this time. The activities coordinator spends time between the Nightingale and Kingfisher units and is aware of the different needs of those residents between the two units. The coordinator plans the activities around those needs. The home has a four weekly menu; residents are asked daily for their preferences. One resident with reduced communication skills gave a thumbs up and said the food is good, another resident said the food is lovely, very good. Another said the food is excellent they give you a lot to eat. The food is well presented this was observed during the inspection. It was noted the staff team tended to bring out the desserts while the residents were eating their main course. This could be given after the main course had finished, which would ensure residents were able to eat their pudding while it was still hot. This was discussed with the unit manager who said he would talk to the kitchen and the staff team. Records show regular temperature checks, good food stocks were available and people had plenty of choice with healthy options. Care Homes for Older People Page 21 of 38 Kingfisher Unit. We looked at the records kept by the activities organiser for activities that people on the Kingfisher Dementia Unit can take part in. There was a record of activities and people were observed joining in with a sing-along and drawing pictures and a newspaper discussion. However this only happened when the activities organiser was on the unit. At other times people sat in the lounge with the radio on and no activity or conversation unless the right member of staff was in the room. We observed some very good interactions but also some very poor moments when there was absolutely no communication between residents and staff. The acting manager confirmed that she had arranged for the residents to have magazines and newspapers made available in the lounge daily. The activities organiser was also observed to spend some one to one time with a person who remains in their room. Visitors were seen to come and go throughout the day everyone spoken to said they could visit at anytime and were always made to feel welcome. It was not easy to evidence that people on the Kingfisher Dementia Unit exercised any choice or control over their lives, they sat were staff took them and it was expected that they did not wander to prevent them from falling. Although this approach was from staff who wished to protect them from harm it was also very disabling. This again shows evidence that some staff lack basic skills to encourage people to maintain choice and control over their daily activities. There was a wholesome and nutritious menu on display with choices and fresh fruit and vegetables available. People were observed to be helped in an unhurried way and the mealtime did appear to be a social occasion. However as previously discussed the use of plastic plates on the Kingfisher Unit is demeaning and lacks respect for personal dignity and equality. Care Homes for Older People Page 22 of 38 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged to make complaints, which are recorded but not always satisfactorily resolved. People are safeguarded from harm with assistance from other agencies. Evidence: A comprehensive complaints procedure exists and people who use the service are aware of when and how to make a complaint. A local GP said I am the GP for a number of patients at Kingsmead and I am aware of the concerns raised. I have been impressed by the professionalism of the staff and their supportive and caring attitude. Many relatives said they too were happy with the care at Kingsmead Lodge. There are many compliments from present and past relatives. One said I am very grateful that my dad was among people who cared for him, other relatives said, thank you to all the staff at Kingsmead Lodge, and said, we would like to thank you all so much for the exceptional way that you looked after mum during the last few years we could not ask for more caring people for her. There have been a number of concerns raised, which has caused anxiety for the relatives and the people who use the service. The agencies such as CSCI, the Bristol Safeguarding team and the police have been involved in addressing these concerns. During the inspection several individuals said how upset they were by the media coverage and were very happy with the service provision. The service has shown their understanding of the safeguarding concerns and complaints and has continued to work with the external agencies to resolve any issues. The outcome to residents concerns are managed but not always resolved to satisfaction and complaints are not always fully recorded. For example, a relative said that they had made a number of complaints on behalf of several residents. This was not recorded adequately and no details of the outcome were available at the time of Care Homes for Older People Page 23 of 38 the inspection. The service has a complaints folder. The family and relatives at Kingsmead Lodge are a large community who provide support to each other and strongly say there is no management to deal with our concerns. The service has a protection of vulnerable adults policy and staff guidance is in place for dealing with allegations of abuse. At the time of the inspection the service was dealing with a number of allegations, which are ongoing and has the assistance of other external agencies. Care Homes for Older People Page 24 of 38 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home, which physically meets their needs. The unit is a well maintained safe place. The shared areas provide a choice of communal space for people to choose. People on the Kingfisher Dementia Unit live in a well maintained environment that is kept clean and tidy but there were unpleasant odours in some areas. Most bedrooms are peronsalised and people can take their own furniture in if they wish. People have access to a call bell system, however this not consistent for everyone on the unit. Evidence: Kingsmead Lodge is a two-storey purpose built home which provides accommodation for elderly people. The home has 81 beds, which is split between the ground floor and the first floor. The first floor known as the Nightingale unit has two communal lounges two dining areas. There are bedrooms available for those who wish to share. The other bedrooms are available for single occupancy; all the rooms have ensuite toilet facilities and a call bell system, which is regularly checked and maintained. People inform the maintenance person if their bell has not been working and this attended to immediately. For instance if the bells have been pulled out an alarm is set off and the fault is seen on the panel in the corridor. During the inspection there was no evidence to show the call bells have been tampered with and this was also checked with maintenance. People are encouraged to bring their personal items with them, which individualise their rooms and reflect personal tastes and lifestyles. Peoples bedrooms were found to be clean and tidy. There is a range of specialist equipment for residents with reduced mobility. The bathroom has a number of hoists. The unit is wheelchair friendly with enough space for wheelchair users. There is private parking and a landscaped garden, which is well maintained and Care Homes for Older People Page 25 of 38 accessible to all residents. The home can be found in Shirehampton Village, which consists of local shops, libraries, supermarkets. The area has access to the M4, M5 motorway and the Portway. There is public transport into Clifton, Hotwells and Bristol City centre. At the time of the inspection there were a number of housekeepers and cleaners on shift. The home was warm, cozy, and very busy with relatives tending to their family members needs during visiting. Visiting was ongoing during the inspection and very relaxed. Relatives and residents were involved in the activity of the home. The unit manager said we are able to obtain specialist equipment for people whose health needs change this was highlighted in the previous report. During the inspection the home was found to be clean and tidy and generally odour free. Residents continually commented on their satisfaction with the service and how the staff catered to their needs. Kingfisher Unit. The Kingfisher Unit was well maintained clean and tidy, we looked in peoples rooms and saw that most of them contained personal possessions with pictures of family and ornaments, we noted that some rooms were still quite plain without things that showed the personality of the person living there. We looked at the provision of call bells in the unit and found that some rooms did not have call bell cords. They had been removed from the jack plug point in the wall. This meant that some people could not access the call bells when sat in the room or if the bed was not directly next to the call bell system. We examined the call bell system and the qualified nurse on the unit explained that people can activate the system touching the area that looks like a light display. However it was evident that not all staff knew this as we witnessed a care worker leave a persons room to get assistance rather than sound the alarm. We also asked why some of the call bell cords had been removed. We were informed that some residents was at risk if the cords were in their room as they could be confused and harm themselves or a member of staff. This decision had not been reflected in the care plans which needed to include a risk assessment identifying why a person could not have a call bell cord in their room. It was evident that although call bell cords could be removed and people may not be able to reach the bell in the wall the system could not be totally disabled as had been claimed by a person who had previously worked in the home. On two of the occasions we were in the Kingfisher Unit we noticed that some areas had a malodor. We sat in the large lounge and there was a very obvious smell of stale urine, this came from either the chair or the carpet. When we walked around the unit we noted other areas that also smelt of stale urine although this did not make the whole unit smell. We observed staff using appropriate protective clothing and the domestic staff worked hard to maintain a clean area. The staff training matrix showed that staff had attended training in Infection Control. Care Homes for Older People Page 26 of 38 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels reflect the needs of the people living in the home; the rotas are flexible to fit around individual lifestyles. Peoples needs are partially met due to the lack of effective communication skills. There was a lack of some information to evidence that recruitment fully protects service users. People on the Kingfisher Dementia Unit benefit from the staffing levels in the home but they are not supported by the staff skill mix as some staff are unable to demonstrate a basic understanding of the needs of people with Dementia. People have not benefited from staff training programmes however a full programme has now been put into place. People were not protected by safe recruitment practices as it was difficult to evidence all safety checks had been carried out. Evidence: Nightingale unit has a team of staff, which are long standing. The staff team consist of a core of Registered General Nurses (RGN) who are registered with the Nursing and Midwifery Council. The nurses are supported by a staff team of ancillary and care staff all of which provide the day-to-day care of the residents. The staff team are diverse and professional they speak to the residents and visitors respectfully. The night staff, which also consist of RGNs with care staff support, provides twentyfour hour care to the residents. Residents and relatives have consistently commented, The staff are good and hard working and always help. During the inspection the staff team were observed to be professional and spoke respectfully to the residents. There are sufficient staff numbers to meet residents needs on a daily basis and the staff rota confirms there are enough staff on duty throughout the day and night. Staff files looked at showed the service has a system of induction in which all-newcomers take part. The induction training equips the new members of staff with the skills needed to Care Homes for Older People Page 27 of 38 provide good care to the people who use the service. In some instances it was also observed communication was limited and some tasks were carried out in silence. For instance, residents were observed being assisted with the Stand Aid. There was very little verbal interaction between the care staff team and the residents. There is a diverse staff group within the home and for some staff English is not their first language. Relatives said, the nursing care is alright but a lot of the care staff are not up to the job, many still dont understand English. A relative who sometimes has to translate so staff could understand residents needs confirmed this and said, This often happens the staff dont always understand what is being said to them. Management need to observe there is a barrier with language. This would hinder the meeting of residents needs, which would result in residents needs being partially met. Although the residents are content with the provision of care the language barrier is cause for concern. Therefore a good standard of English would be needed for staff to understand residents requests. Management must consider the culture of the residents on the Nightingale unit and address the issue and cultural needs with further staff training and induction. This is compared to the communication between the nursing staff and the residents. The verbal exchange was different there was much more banter and verbal interaction between the residents and the nursing staff. The staff team has completed appropriate training; a comprehensive training matrix was seen to confirm training had taken place. Training in Dementia care and infection control 17.12.2008; Basic Life support (BLS) and Food Hygiene 18.12.2008, Protection Of Vulnerable Adults 19.12.08, Health and Safety and Fire Awareness 29.12.08, People Handling 16.12.98, level 3 safe medication 24.02.09. The recruitment and selection practices were found to be inconsistent. The applications for qualified staff were good and the forms and the transfer of staff protect people living in the home. However, selected files for care staff, showed inconsistencies particularly with applications and references. For instance, one staff file contained an inappropriate reference. This was discussed with the admin staff and the Director of Operations. Another concern is Criminal Records Bureau check (CRBs). There was very little evidence to show that the staff had CRBs carried out as the administration staff team had shredded the information. There were very few CRB numbers to check against the staff identification files. This shows a failure to understand the recruitment and selection process and practices, which would keep people safe from potential harm. This concern was also highlighted in the inspection report which, took place in January 2008; the report states, The procedures for recruitment and selection may not be robust enough. Only one reference had been obtained; staff CRB disclosures had not been received and they had started employment and other workers had no evidence of POVA first. One resident said, In two years there has been a couple of occasions when you feel that a bad choice of staff has been made but they tend not to stay. Care Homes for Older People Page 28 of 38 Robust recruitment and selection procedures and practices keep people who use the service safe from potential harm; failure to address these practices would have serious consequences for the people living at the home. Relatives are satisfied with the staff at the home and say, all the staff smile easily and always have nice things to say to residents, others went on to say most staff notice if a resident needs anything. Kingfisher Unit. We looked at the staffing rotas both past and present they showed that the people on Kingfisher Unit were supported by appropriate staffing levels, staff spoken to said thy always had enough staff on duty to ensure that peoples needs were met. Relatives spoken to also stated that they always saw plenty of staff on duty when they visited, we observed adequate staffing levels and staff were not over stretched to manage the work load they had. We looked at the staff training matrix which was displayed in the staff room, this showed that people had attended mandatory training and some staff had completed Dementia Care training, however we observed the working practices of staff in the unit over three days and we noted that some staff did not have the skills to confidently meet the needs of people with Dementia. We asked staff about the training they received answers varied but it was generally agreed that their had been less training available whilst they had been without a manager or someone to organise it. We noted that training was being provided and dates were available with staff names listed to attend. We looked at the recruitment records for four members of staff working in the Kingfisher Unit. We noted that they contained statements that the CRB (Criminal Records Bureau) checks had been requested and results received however it was impossible to evidence this as all staff CRBs had been destroyed by a member of the administration team. This is not good practice as we could not be sure that the registered person had protected residents form harm by following safe practices when employing staff to work in the home. Care Homes for Older People Page 29 of 38 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 the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a service, which has a manager in place who can monitor the service provision and address any concerns made by the residents, relatives and the stakeholders. Good health and safety practices keep people who use the service safe and well protected. People living in the Kingfisher Unit do not benefit from a clear management structure in the home, they are not supported by staff who have clear lines of leadership. Evidence: At the time of this inspection the service has been without a permanent registered manager for several months. A temporary manager was available for comment on the day of inspection and said they would be at Kingsmead for a number of days managing the operational/managerial running of the service. There are consistent comments from the residents and relatives who said there is a need to have a manager in place. Another relative said, The home seems to run better when there is a manager. Monthly visits are done by one of the Directors of Mimosa Healthcare. This was evident at the time of the inspection. Several months reports were seen only November 2008 was missing. Management should ensure monthly visits are maintained; the monthly visits show any area for improvements within the home. Care Homes for Older People Page 30 of 38 There are good recordings of the health and safety systems within the home. These are regularly reviewed and updated. For instance, the maintenance person was able to show evidence that the property is being maintained. For instance the call bells are regularly checked. Other maintenance duties include; check of all the light bulbs in rooms and inside lights, sweep and tidy the front and rear of the property and pick up any litter, check all fire exits, ensure the lift is working correctly. This ensures that the home is a safe place to live and work for people living in the service and the staff team who work in the home. The service has a number of policies and procedures, which underpin the practices within the home and are regularly reviewed. Policies and procedures include; the residents charter, confidentiality practices, protection against violence and abuse, bullying and harassment. The staff team are trained and usually consistently follow these practices. There are a number of allegations made which management are looking into with the view to resolve these amicably. Although the standard of care is good and the residents and relatives are satisfied with these standards the main concern is the lack of a registered manager in place who would be able to provide direction and leadership within the home. For instance a registered manager would be able to provide clear lines of accountability. Another usefulness of a registered manger would be to provide strategies for enabling residents, staff and other stakeholders to observe the provision of the service. It is of some importance that the issue of obtaining a manager for this service is given utmost attention. This would help the service to become a user-focused facility. Feedback from the relatives and stakeholders said, get a permanent manager, residents meetings, a more qualified and better trained carers, more stand aids and quicker repairs when they go wrong. Another said more staff better wages. Relatives said, my mother is generally content but notices things do get lax when the home has no manager and my father says that the care has had been very good. Kingfisher Unit. We spoke to staff working on the Kingfisher Unit, they generally felt that they lacked the leadership of a registered manager. They felt that the staff training had slipped as they did not have the management level to arrange training and to follow up issues raised from supervision. The qualified staff had continued to run the unit at floor level but were unable to provide the management cover needed to ensure continuity in training and support for all their staff. Care Homes for Older People Page 31 of 38 Are there any outstanding requirements from the last inspection? Yes No 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 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 4 14 The Registered person must ensure that all staff working on the Kingfisher Unit receive training relevant to the needs of people with Dementia. This refers to the lack of understanding demonstrated by some staff on the basic needs of people with dementia. 21/05/2009 2 7 12 The registered person must ensure that staff develop person centered care plans that recognise personal needs and preferences as 21/05/2009 Care Homes for Older People Page 32 of 38 well as identifying triggers for people with challenging behaviours. This refers to the inconsistent and generic way care plans are written, not identifying personal preferences and triggers that may cause challenging behaviours in individuals. 3 9 13 The registered manager 21/05/2009 must ensure that medicines are stored and administered safely. This refers to: Space in the medicine trolley on Nightingale. Clear information being available for the use of medicines prescribed to be given when required. Recording the amount given when the dose is variable. To protect residents health. 4 10 12 The registered person must 21/05/2009 ensure that people in the Kingfisher Unit are treated in a dignified way supporting their right to equality. This refers to the demeaning use of plastic cups and plates and the lack of knowledge demonstrated by some staff who either lack the confidence or understanding that they need to communicate with people other than when delivering personal care. The registered person must 21/05/2009 arrange for multi disciplinary teams to be involved when decisions are made regarding end of life decisions such as do not resuscitate. 5 11 12 Care Homes for Older People Page 33 of 38 6 16 22 This refers to protecting people from the risk of harm when they do not have the capacity to make the decision themselves. The registered person shall 21/05/2009 ensure any complaints made under the homes complaints procedure are fully investigated. This is to ensure a detailed record is kept of all complaints made and includes information of any investigation or action which has been taken. The registered person must ensure that everybody has access to a call bell unless it is considered unsafe to do so and this must be clearly identified in the care plans. This refers to the lack of call bell cords in some rooms on the Kingfisher Unit. The registered person shall not employ a person to work at the care home unless management is satisfied on reasonable grounds as to the authenticity of the references; two written references relating to that person. This would ensure people who use the service are safeguarded from potential harm. Robust recruitment and selection practices and procedures to include CRB checks which must be retained until the representative from the CQC can sign them against a list of members of staff in the home. 7 22 16 21/05/2009 8 29 19 31/05/2009 9 29 19 31/05/2009 Care Homes for Older People Page 34 of 38 10 29 18 This is to maintain peoples safety at all times. The registered person must ensure that all documentation regarding safe recruitment procedures are available for inspection. This refers to not destroying CRB checks until they have been seen by the CSCI inspector. The registered person must ensure that staff working on the Kingfisher Unit receive dementia Care training. 21/05/2009 11 30 18 31/05/2009 12 31 8 This refers to the lack of skills some staff demonstrated when caring for people with Dementia. Where the registered 30/05/2009 provider appoints a person to manage the care home shall forthwith give notice to the Care Quality Commission (CQC) (a) the name of the person to be appointed (b) the date on which the appointment is to take effect. This is to ensure people who use the service are given good standards of care, which is guided by the daily management of the service and the facilities continue to become user focused. The registered provider shall appoint an individual to manage the care home where (a) there is no registered manager in respect of the care home (biii) where an individual is not or does not intend to be in full time day to day charge of the care home. 13 31 8 30/05/2009 Care Homes for Older People Page 35 of 38 This is to ensure people who use the service are given good standards of care, which is guided by the daily management of the service and the facilities continue to become user focused. 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 9 Staff should ensure that suitable systems are in place to allow audit of medicines to show that they have been given correctly. Systems should be also be put in place to ensure that excess supplies of medicines are not received. This is to prevent overstocking and waste. People would benefit from a knock on their bedroom door prior to entering; this would enhance their dignity. The registered person needs to support staff in providing a therapeutic environment even when the activities organiser is not on the Kingfisher Unit. The registered person needs to look at ways in which staff can encourage people to have more choice and control over their life on the Kingfisher Unit. Residents would benefit from a large menu board in the dining area, which would provide them with up to date information about the days menu choices. People would benefit from being able to eat their dessert hot it would be more considerate to serve this when people have finished their main meal. All complaints and investigations are kept in a book, which details the date and time of the complaint; the nature of the complaint and any investigations and actions taken and to include realistic timescales. There should be an account of whether the issue has been satisfactorily resolved and if not reasons to why. Challenging behaviour experienced by members of staff should be recorded in an accident/incident book and in residents care plans. All safeguarding issues should continue to be alerted to The Care Quality Commission and the Bristol Safeguarding Team. 2 3 10 12 4 14 5 15 6 16 Care Homes for Older People Page 36 of 38 7 22 8 26 9 30 10 37 People benefit from specialist equipment, which meets their needs. The issue with the manual hoists based on the residents comments needs to be addressed. The registered person needs to identify areas on the Kingfisher Unit that may benefit from deep cleaning or alternative flooring to reduce the smell of stale urine. Open communication channels between the staff and the residents ensure peoples needs are completely met. Help with language would assist in the understanding of peoples culture and wishes, which would meet their diverse needs. The provider continues to conduct the monthly visits of the home to ensure any areas for improvements are addressed without delay. Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. ©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. Care Homes for Older People Page 38 of 38 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!