Inspection on 24/07/08 for Kingston Court Care Home

This inspection was carried out on 24th July 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

Kingston Court Care Home 01/09/09

Kingston Court Care Home 23/08/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Kingston Court Care Home Newtown Road Carlisle Cumbria CA2 7HY Lead Inspector Marian Whittam Unannounced Inspection 24th July 2008 09:45: 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 Kingston Court Care Home DS0000068983.V368237.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. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingston Court Care Home Address Newtown Road Carlisle Cumbria CA2 7HY 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) 01228 528 542 01228 528638 Express Care (Guest Services) Ltd Mrs Jean Walker Care Home 80 Category(ies) of Dementia (27), Old age, not falling within any registration, with number other category (53) of places Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing code N, to people of the following gender:Either. 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: 53) Dementia - Code DE (maximum number of places: 27) The maximum number of people who can be accommodated is: 80 Date of last inspection 23rd August 2007 Brief Description of the Service: Kingston Court is a modern purpose built home that provides nursing care for older people and for up to 27 people with dementia. The home is arranged over three floors with the top floor accommodating people with dementia. Express Care owns the home. They have other homes in England - including one other home in Cumbria. Mrs Jean Walker manages the home on their behalf. The home has been registered since spring of 2007. The home is situated in central Carlisle near to the Cumberland Infirmary. It is within easy travelling distance of the centre of town and its amenities. It is also within walking distance of local shops and amenities. There is a car park to the front of the home and a small garden area for residents at the front of the home. The home has its own grounds and accommodation is in single occupancy rooms. Information about the service is available in the Statement of Purpose that includes a copy of the last report. There is also a colour brochure. The cost of care ranges from £389.00 to £525.00 per week depending on need. Further information about the costs can be obtained from the manager or the company. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This site visit to Kingston Court Care Home forms part of a key inspection. It took place on 24.07.08 and we (The Commission for Social Care Inspection, CSCI) were in the home for seven and three quarter hours. The CSCI pharmacist inspector also visited on the same day and assessed the handling of medicines through inspection of relevant documents, storage and meeting with the nursing staff and residents. The pharmacy inspection took five hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager identifying what the service does well and what could be improved. This was returned to CSCI before the visit. The service history. Interviews with residents and staff on the day of the visit and discussions with the management. Observations made by us in the home during the visit. Also a ‘short observation framework for inspectors’ (SOFI) was carried out. This observational tool is used to observe interaction between residents and staff and gain information and insight into how well people’s needs are being met. Completed questionnaire survey forms from people living in the home and staff working there. • • • • During the visit we spent time with people living in the home and talking to them about their experiences. We looked at care planning documentation and assessments to ensure the level of care provided met the individual needs of those living in the home. We made a tour of the building to inspect the environmental standards. Staff personnel and training files were examined and a selection of the service’s records required by regulation. What the service does well: The environment is homely, tidy, and comfortable and people living there are able to bring in their own things from home such as pictures, ornaments and suitable items of furniture to make their rooms more homely and personal. The home is well lit and well furnished in both communal areas and personal bedrooms. Admissions only take place after an assessment to try to make sure the home can meet the assessed needs of the prospective resident. People’s health is Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 6 protected by safe systems for managing medication and through referral to appropriate professionals. There are good recruitment systems in place and procedures are being followed in this and in safeguarding to promote the welfare and safety of people living there. Regular audits of medication are done to monitor the management of medicines and to keep people safe and the service has audit and monitoring systems across the home to monitor their performance against the National Minimum Standards. The manager is being supported to develop services by the organisation and the operations manager who visits regularly and spot checks aspects of the service for quality. From rotas, resident’s surveys and observation there are sufficient staff available to meet people’s personal care needs. Over two thirds of people said in their surveys that there were ‘always’ staff available when they needed them. People we spoke to living there said that staff treated them well and were “polite, “responsive” and “very good”. From our observations we saw some staff were very good with people and there was very good interaction between some staff and some residents. Staff were seen to be polite and respect people’s privacy. One relative commented, “ The staff at Kingston court are pleasant, helpful, considerate and seem to take care and pride in what they do”. The catering in the home is well organised and comments on the food were positive. People told us that the food was “good” and one person commented in their survey that the home had an “excellent chef”. What has improved since the last inspection? Care plans are more detailed and plans and strategies are in place to meet particular identified needs and behaviours. The care plans are now being audited to identify areas of weakness that are being addressed promptly by staff. Medication records have improved and show more accurately the treatment received by people. There are safe systems in place for managing medicines, including “when required” medicines and those associated with high risk, so that peoples’ health is better protected. The EMI unit is fully occupied and staff levels have been increased on night duty to meet the needs of people living on that unit. Extra staff also means there are staff available in the early morning to supervise people who get up early and provide them with drinks and a light breakfast if they want this. The home has developed the range of activities and social events it offers and how residents comment on these. Some work is being done on life histories and Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 7 these improvements need to continue to be extended in this important area of social life. The registered manager has made improvements in the way they apply and follow procedures to safeguard people and report any suspicion of abuse. Referrals are made promptly to social services and local procedures followed to promote the safety and welfare of people living in the home. CSCI is now being informed of any referrals and accidents and incidents occurring in the home that affect the people living there. The service has undertaken a full audit of systems in use and against the National Minimum Standards since the last inspection. Identified areas for improvement are being addressed. Satisfaction surveys are being used to gather opinions and residents meetings are being held so people have a chance to comment on life in the home. The service now has its own health and safety meetings to discuss this area of practice. Since the home’s first inspection last year the management team and staff have been improving and developing the services they provide and they need to keep up this effort to take the service forward. What they could do better: Information provided to prospective residents is generally accessible but this information should make it clear that there are no designated smoking facilities for people coming to live there. The service should also provide more detailed information in its statement of purpose on what specialist services and facilities they provide for the care of people with dementia. This would help make sure people were clear about what facilities were available to them. Although there have been great improvements in the management of medication since the first inspection the manager should make sure that staff are signing for medicine administration at the time that they are given to reduce the risk of errors. Where medicines are given disguised in food care plans should clearly record reasons for this and discussions with all people involved in the person’s care. The service has been developing the activities provision and should continue this by making improvements to its activities programme in relation to the more specialised needs of people with dementia. People living in the home on the EMI unit should always be offered a choice of meals with hot and cold drinks offered at mealtimes so they can express their preferences. The management needs to improve the organisation of training offered to staff so no one is missed. Staff working in the home with people who have dementia must have appropriate training in dementia care and awareness to ensure they Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 8 are competent to fulfil their roles and support the specialist needs of people with dementia. All nursing and care staff should have up to date and recent Protection of Vulnerable Adults (POVA) training and this should be recorded. This will help make sure that all staff are aware of their responsibilities and what to look for to safeguard people. The service should also record the paid days training staff receive, including their in house training, to make sure they receive a minimum 3 days paid training per year to obtain training relevant to their work with people living there. Because of high staff turnover in the last 12 months the manager should consider doing exit interviews with staff that leave to see if there is anything that could be done by the organisation that would improve retention. Care staff are employed in accordance with GSCC codes of conduct and practice and so should be given copies of the code to support their practice. We saw that call systems were not always easily accessible to summon assistance in toilets and en suite bathrooms and they must be at all times so that people living in the home can get the help and assistance they need quickly and safely. The manager must also ensure that there are easily accessible clinical waste bins in toilets and bathrooms and protective clothing for staff to use and so follow infection control procedures to prevent the spread of infection. Action must be taken promptly to assess and minimise the trip hazard posed by the patio doors having a frame to step over for people going out into the garden. This will promote people’s safety when using the outdoor space. 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. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 9 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 Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 10 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): NMS 1, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information about the home and facilities is available before and following admission so people can have information to help them make an informed choice. Pre admission assessments help ensure that people’s different needs can be met when they come in. EVIDENCE: General information is available about the service for prospective residents and their families in the combined statement of purpose and service users guide to help them make an informed choice about the service. There is also a copy of the last inspection report available and colour brochures and ‘introduction notes’ about the home that can be given out to prospective residents and families to help them settle in and know the routines and what to expect. We looked at the statement of purpose and it contained relevant and the required information. We discussed the information with the manager and recommended that the service made it clear in their Statement of Purpose and supporting information that the home does not have separate, designated Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 11 facilities for people who want to smoke. We also recommended that more detail be provided for prospective residents and families on what specialist services and facilities they provide for the care of people with dementia. Some minor updating was needed and wording altering where it did not make it clear that the service was not residential but nursing and the category of dementia care was not clear. This was altered during the visit so that ambiguous wording could mislead no one and prospective users of the service were clear what services were available to them. The manager began attending to this during the visit. All the eleven residents surveys we got back said that they felt they had enough information before they came in. People we spoke to also said they had been given information about the home. There are also useful information leaflets available in the foyer and useful contacts for organisations and advocates. The notice boards in the home give information of what is going on in the home, the weather, what was in the news and the day’s menu. The manager or deputy manager does the pre admission assessments. The pre admission assessments we looked at were clear and contained relevant information from which to develop an individual care plan. The service gathered information from agencies and services involved in people’s care before and at admission and if any particular equipment was needed such as profiling beds. Those people who had care management assessments from social services had these on file and also discharge information for the people who came there from a hospital. There was evidence in care plan records of specialist services being involved in people’s care when they came to live there. Prospective residents are able to visit the home before they come in to help assess its suitability if they want to. This was evident for one person who also had their pre admission assessment done during a visit. The service does not provide intermediate care. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 12 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): NMS 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 health and personal care which people using this service receive is based on their individual needs. People’s health is protected by safe systems for managing medication. EVIDENCE: All residents have an individual plan of care that is well set out and easy to follow and does present their preferences about what they want from their care. It is based on initial assessments and the individual plans set out health, personal and social care needs and personal and clinical risk assessments. Risk assessments in place were up to date and plans were in place to support particular physical needs or identified behaviours. We saw that these had been updated as the needs or behaviours had changed and other agencies and professionals were being involved in meeting specialist needs. Care plans and assessments are being reviewed regularly and generally had been updated. Care plan audits have been carried out to monitor if procedures are being followed in care planning and necessary information recorded. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 13 We examined eight people’s care plans in more detail and found that the homes own random care plan audits had shown some areas that had not been assessed and fully completed and generally these had been attended to by staff. Records for receipt, administration and disposal of medication were good with only occasional missing records and showed that people received the correct treatment. However, we saw records for administration of medicines to several people being signed all at once. This practice could lead to errors if staff rely on memory when completing records. We checked a sample of medicines against records and these were mostly in order. The handling of high-risk medication that required regular blood tests was well managed to keep people safe. A sample of care plans was checked for “when required” medication such as sedatives and painkillers and these were in order, describing the appropriate use of these medications so that people received the best treatment. We noted a person who received medication disguised in jam. There was no care plan in place to show that this was done or why and who had been involved in that decision in the best interests of the person. There were records for communications with peoples’ doctors and medication changes were implemented accurately and promptly so that people received the correct treatment. Regular checks, or audits, of medication were being done to look for discrepancies to keep people safe. Residents spoken with said their privacy was being respected. The observation exercise (SOFI) done during the inspection saw good handling techniques when staff helped residents to and from the dining room and staff appeared supportive and gentle to residents. They took their hands and guided them around furniture. We observed that the staff addressed the residents in an informal but respectful manner. Some staff demonstrated very good interaction and communication with residents, others less so. The residents that were more vocal or that could participate in conversations received the most attention. Some people were just left to sit quietly without any stimulation or attention. The service has policies and procedures in place regarding the care and comfort to be given to people at the end of their lives and procedural information for staff on different cultural and religious needs to be aware of at that time. Any specific wishes and arrangements a person wants are recorded in the care plan. There are procedures on the relief on common symptoms and upon the principles of palliative care and the use of equipment such as syringe drivers. There was no one receiving palliative care at the time of the visit. Kingston Court Care Home DS0000068983.V368237.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): NMS 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. People who use this service have access to organised activities, are able to make choices about daily life and are supported to maintain their independence. EVIDENCE: Activities and recreational preferences are included in the individual care plans and records of what people enjoy and what they like to do. Social assessments have been developed and now contain more detail about people’s interests, communication needs, abilities and past life. We spoke with people and looked at their activities plans and expectations to see if they did give a picture of their life story and interests. Individual records are kept of what people have chosen to take part in and activities are discussed at residents meetings and recorded in the minutes. Action had been taken to implement activities asked for at the meetings such as church visits and getting books from the county library. The home’s activities co-ordinator has recently left so reducing the service offered, but recruitment is well advanced for a replacement to start work shortly covering 30 hours a week. People we spoke to enjoyed the activities they had been able to take part in including Seasonal events, bingo, floor puzzles and games, attending religious services, singing, Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 15 going out to see friends and relatives, monthly musical entertainment and social events, some crafts and trips out in the organisation’s minibus. From time to time the local museum comes in with items to do reminiscence sessions and also a flower arranging demonstration with a raffle for the completed work. Some residents we spoke with said they preferred not to take part in organised activities and they were not made to feel they had to. Survey responses indicated that usually there are activities to take part in. The service has generally improved its activities provision overall but needs to continue this work to develop the activities it offers in relation to the more specialised needs of people with dementia. The social and cultural life of the home is still in the process of developing as occupancy increases and the service needs to continue to develop this and its community links. Some work was on display relating to life story work on the EMI unit and this useful work also needs to continue. In the lounge after lunch there was nothing going on. Residents sat quietly or dozed in the chair. There was little or no interaction from staff. Especially with one or two of the residents. We discussed this with the manager who plans to address this with staff. Peoples wishes are recorded in respect of their wishes regarding their finances and if they want someone else to oversee or support them with this, usually a family member. There is information available and leaflets on obtaining advocacy services if people want them and the service is a member of an advocacy service. The SOFI observation took place in the dining room and then in the lounge area on the EMI unit. We noted all residents were given the same meal, even though there was a choice. One person decided that it was too hot for a hot meal and requested a salad. The chef prepared one specially and brought it up for her. Everyone got a cup of tea but were not offered a choice of drinks at lunch. We discussed this with the manager and recommended that people were always given a choice of meals and drinks both hot and cold at mealtimes. Staff were available to help people at mealtimes if they needed it and assist them sensitively with meals. One person was helped from the dining room after their meal they thanked staff for lunch and said ‘it was lovely’. Generally staff encouraged and supported people with their meal. However one person needed to be closer to the table to eat. They were independent and struggled to eat the meal, first with a fork and then with a spoon. There was no adapted cutlery or crockery and plate guards and no intervention from staff. We recommended that such cutlery should be provided for use if needed. Survey responses from eleven residents about meals in the home were positive and people we spoke to said they liked the meals One person told us, “ The food is very good, but I like the steak pies best”. The menus we looked at offered nutritious meals with choice and variety. We visited the kitchen and spoke with the cook who was aware of the different dietary needs of residents and could cater for special diets. The service has a 5 star rating following a visit from the environmental health department. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 16 The dining rooms were attractively furnished but we observed on the ground floor unit that the teacups put out for lunch were heavily stained and we drew the manager’s attention to this. New crockery had been purchased and staff changed the cups for the new ones before lunch. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 17 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): NMS 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 service has complaint and adult protection procedures in place and in use to protect people using the service. EVIDENCE: There are suitable policies and procedures in place for dealing with complaints and concerns. The complaints policy and procedure is part of the guide and ‘introduction notes’ for the people using this service. There was also a copy on display. Information on advocacy is also displayed in the foyer. The home is a member of an advocacy service. The service received and logged 3 complaints made since the last inspection and we saw that there is system in place for recording and investigating any complaints that are made about the service. Those resolved were responded to in 28 days and one was still ongoing. Details are kept of the investigation, correspondence the outcome and actions taken to rectify and/or prevent reoccurrence. The services operations Manager checks complaints as part of their regular visits. The Commission for Social Care inspection (CSCI) received 2 complaints about the service that were looked at through regulatory visits. The residents we spoke with during the visit were all aware of the procedure and what they would do should they need to use it. The survey results supported this. Most people said they would speak to staff first if they were unhappy. Staff we spoke with were aware of how a complaint should be Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 18 handled and also any allegations of abuse and who needed to be informed. Nine surveys were received back from staff and these also indicated that staff are aware what to do if concerns are raised with them. The service had clear and detailed procedures for safeguarding vulnerable adults and has internal policies and procedures for the Protection of Vulnerable Adults (POVA). This included how to make referrals to the POVA register. Multi agency guidance on safeguarding adults is also available for staff in the home. Since the last inspection the service has referred 2 incidents promptly to social services for investigation under safeguarding procedures and has followed procedures and worked with relevant agencies to safeguard residents and their best interests. Training records show that staff have been offered, and some nursing and care staff have had, training on recognising abuse and the adult protection procedures. We recommended that the manager make sure all staff are given this to promote residents welfare and interests. Care staff doing their NVQ Level 2 in care also cover this area of practice during their course. The service has whistle blowing procedures to allow staff to report bad practice and the operations manager was providing a copy of the Department of Health guidance ’No Secrets’, for staff reference. There are procedures in place on restraint such as bedrails and these are being used within a risk assessment framework and with consent obtained. There are also procedures on handling finances, staff involvement in wills, data protection and advocacy to support practices. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 19 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): NMS 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This new building provides people living there with a well maintained and well furnished home but inconsistent clinical waste handling can increase the risk of infection. Access to the garden may pose a hazard. EVIDENCE: The home is being well maintained with an overall good standard of decoration and provides a clean, tidy and homely environment for residents. The home was clean and tidy and well lit. The furnishings in communal areas and bedrooms were of a good standard. There are dining and lounge areas for people in the home on each unit and these were clean and homely with domestic style lighting. We saw on the EMI unit, which is fully occupied, that these areas were rather cramped when a lot of people were using them. There is a small additional seating area along one Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 20 corridor on this unit that people were using. The service does not provide separate facilities for smokers and the policies in place support a non-smoking environment. There is some outdoor space for people to use in a small garden area with a seat for 2 people. We spoke with one person sitting out there reading their newspaper; they said they enjoyed using the garden. Since the last inspection the small garden area has been planted and a small patio area created to make it more accessible. We discussed with the manager the lack of outdoor space that people with dementia could easily use. The service is looking at putting seating at the entrance area for people to use to try to improve matters. There are patio doors that lead from the dining room to the garden/paved area. There is a large frame to step over and there is not a ramp out into the garden to make it ‘mobility friendly’. This poses a health and safety risk of people tripping as well as not promoting the disability legislation. The manager must address this promptly through risk assessment and take action to minimise the risks to people living there who want to use the garden area. There are accessible toilet, washing and bathing facilities on each unit and all the single bedrooms have en suite facilities. However in some toilets and en suites we saw that the call bell was tied out of reach of people using the facilities and these must be accessible at all times for people to summon assistance. There are sluice facilities on each floor and on the top and ground floor we found these unlocked and to be untidy. We also found that the sluicing disinfectors showed little sign of use both being used to store baskets, waste bags, a vase and brush and dust pan on, so it was not easily accessible for the cleaning and disinfecting of commode pans. There are procedures in place for infection control, including barrier nursing. However we could not find clinical waste bins in the bathrooms and toilets only in the sluice. There were domestic style waste bins in use in toilets and bathrooms and in one of these we found a soiled continence pad, which we asked to be removed to an appropriate waste container. We asked a member of staff what they did with clinical waste. The procedure was to wear aprons and gloves when dealing with clinical waste and put items in a white bag then the yellow clinical waste bag. We could not find any white bags in toilets and bathrooms and gloves only in one. We discussed with the manager the lack of accessible clinical waste bins and protective clothing in areas where they are needed so staff can follow procedures and promote good hygiene and infection control. Suitable clinical waste bins and protective equipment must be provided and be easily accessible so staff can work to the home’s policy to minimise the risk of infection. Training records show that not all staff have had infection control training and they need to have this to do Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 21 their work safely. The training plan did show that infection control training was due to be given to staff next month and the manager was already aware of the need to make sure staff had this. We found that it was very warm on the units notably the first and second floor and little movement of air. The internal bathrooms were warm and airless. We discussed the lack of ventilation on the units with the management. They were able to show that this problem has already been identified through their own audit systems and an engineer is going to visit to assess and look at systems that can be used to improve this and so this will be addressed and monitored for improvement at the next visit. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 22 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): NMS 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. There are effective recruitment practices but staff training arrangements need to be strengthened to ensure all staff have the training they need to support residents and provide care specific to their needs. EVIDENCE: Staffing levels are, overall, satisfactory for the number and dependancy level of residents presently in the home. We looked at staff rotas and observation during the visit indicated that the home had sufficient staff on duty to provide personal care for the number of people currently living in the home. The surveys from residents and staff showed that some people felt that the home was occasionally understaffed usually this was due to sickness and the need to find cover quickly. We discussed with the manager the need to monitor occupancy and as it goes up they will need to re assess staffing against dependency and individual needs to maintain a consistent level of care. Staffing on night duty has been increased since the last inspection and the service is still actively recruiting new staff as occupancy increases. The service now offers a light breakfast and drinks for those residents on the EMI unit who get up early as the additional night staff are able to do this. We looked at the files for new staff and the home’s procedures had been followed and confirmed the home has robust recruitment procedures. Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks have Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 23 been done for staff. Some new staff were waiting for their CRB check to come back following a POVA check and these were on the rota as working under supervision and not involved in moving and handling until they had attended the course. Rotas showed they were working with other staff to be supervised on shifts. We spoke with a new staff member who was doing their induction. They confirmed they did not work alone and were presently just observing and were doing the Moving and Handling training the following week with other new staff. The training planner confirmed this was due. Staff files were clear and up to date and had records of all necessary documentation and references taken up prior to starting work. Staff we spoke with and staff surveys indicated that staff had had security checks and references taken before they started work. The service has had a high level of staff turnover in the last 12 months and this can make it hard to ensure a good skill mix with new staff in high numbers. We discussed this with the manager and it had already been noted that ‘skill mix of staff is proving difficult’ at the regular visits from the operations manager. We recommended that they did exit interviews with staff when they left to see if they could identify any areas they could address to improve retention. We also recommended that care staff were issued with the General Social Care Council (GSCC) code of conduct and practice to help them in their roles. Some staff already have National Vocational Qualifications and the home employs registered nurses. Other members of care staff are currently doing the NVQ level 2 course and when they complete the home should reach the target of 50 of care staff with this qualification. We looked at training records and the planned programme of training in use. We could see from records that not all staff had received training on dementia care and awareness and those staff who care and support people with dementia must have this more detailed training to provide the specialist dementia care the service offers to provide. We discussed with the manager and operations manager the need to make sure that training was structured and organised so the manager can easily keep track of training needs and no one is missed from at least mandatory training. Staff are expected to attend some training in their own time when it is outside the working day, which may present problems with compliance. The service should record the paid days training, including the in house training, to make sure they receive a minimum of 3 paid days training per year to obtain training relevant to their work. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 24 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): NMS 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Effective quality monitoring systems help safeguard people using the service and procedures are in place to safeguard resident’s interests and promote their health and safety. EVIDENCE: The service has a qualified and experienced registered manager who maintains her professional development through relevant training including having completed the Registered manager award (RMA). The manager has continued to develop the systems within the home and improved several areas of practice since their first inspection, notably around medication practices, care planning, quality assurance and activities provision. There was evidence that the manager is being well supported by her managers and the operations team through regular auditing of systems and visits to the home. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 25 Staff we spoke to felt they were generally being supported by the manager and deputy and confirmed that they felt they could speak openly to them. Staff also said they had 3 monthly staff meeting where they could raise and discuss practice matters. Records show regular staff meetings are being held. This allows staff feedback and new ideas to be introduced by nursing staff as well as internal reviews of policies and procedures and information sharing. Nursing staff we spoke to told us that they received supervision from the manager or deputy and that they gave supervision to care staff. Nursing staff also told us that they had access to training relevant to their role and some had attended courses to maintain and extend their nursing skills. There are also residents’ meetings to get feedback from those using the service and their ideas. The service also does its own quality monitoring across all areas of the service using audits. The organisation does its own annual full audit against the national minimum standards and with this had identified some areas for improvement that were noted during the visit and action was underway for some. The operations manager does spot checks on care planning and we saw where audits had been done, the operations manager also follows up any matters identified from their visits to the home. Records are kept of these visits for CSCI to examine, the visits are carried out frequently and detailed information is recorded. The service uses satisfaction surveys to obtain people’s opinions including families and also professionals coming into contact with the service. We could see that policies and procedures had been reviewed and the dates of the any amendments stated in the file. There are procedures to protect people’s financial interests and a sample of records were checked. Balance sheets show incoming and outgoing monies and transactions are witnessed by two people usually the manager and the administrator. Where purchases are made on behalf of the resident, receipts are checked. The manager is now informing CSCI of any incidents and accidents occurring in the home that affect people living there. We discussed the scope of these notifications so the manager was clear about what they need to inform CSCI about. Personal information about people living there is held securely. We looked at a selection of records required by regulation including accident reports. We looked at fire training records and saw that training was being given to staff but due to the method of recording it was difficult to be sure if training was being given at the required intervals for night and day staff and so could not adequately assess this for accuracy. We recommended that the manager looked at a recording system that quickly identified day and night staff and who needed training doing so no one was overlooked. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 26 The home has its own maintenance person who does weekly checks on safety equipment, lighting and water temperature testing and records this. Records of servicing, testing and maintenance of moving and handling equipment and emergency equipment were seen and gas and electrical safety tests are in place and up to date. Water temperatures are tested and recorded to reduce any risks from hot water and for Legionella. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 27 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 2 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 3 2 X 3 2 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 2 Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 28 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 OP20 Regulation 23 (2) Requirement Action must be taken to assess the risk to people using the patio doors into the garden area from the large frame they must step over to use the garden and action must be taken to minimise any risks from this. Call systems to summon assistance must be easily accessible in toilets and en suite bathrooms at all times to people living in the home. The manager must ensure that there are easily accessible clinical waste bins in toilets and bathrooms and protective clothing for staff to use and so follow infection control procedures and prevent the spread of infection. Staff working in the home with people who have dementia must have appropriate training in dementia care and awareness to ensure they are competent to fulfil their roles and support the specialist needs of people with dementia. Timescale for action 30/08/08 2. OP22 16(2) 10/08/08 3. OP26 13(3) 10/08/08 4. OP30 18(1) 30/09/08 Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 29 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. Refer to Standard OP1 Good Practice Recommendations The statement of purpose should include more detailed information on what specialist services and facilities they provide for the care of people with dementia so people are clear what is available for people living there with dementia. Information provided to prospective residents should make it clear that there are no smoking facilities for people in the home. Medicines administration records should be signed at the same time that medicines are given to prevent errors being made. Care plans should be in place for the disguising of medication in food to show that this is done in the best interests of the person, and to include discussions with people involved in their care. The service should continue with the improvements to its activities programme in relation to the more specialised needs of people with dementia and continue to develop its community links. Adapted cutlery, crockery and plate guards should be available at mealtimes for people if they need them to help maintain their independence and enjoyment of their mealtimes. People living in the home on the EMI unit should have a choice of meals and hot and cold drinks offered at mealtimes so they can chose what they want to eat and drink. To help safeguard people living in the home and promote their interests all nursing and care staff should have up to date and recent training on protecting vulnerable adults from abuse. Because of high staff turnover in the last 12 months the manager should consider doing exit interviews with staff that leave to see if there is anything the organisation could do to help retention. Care staff should be employed in accordance with GSCC DS0000068983.V368237.R01.S.doc Version 5.2 Page 30 2. 3. 4. OP1 OP9 OP9 5. OP12 6. OP15 7. OP15 8. OP18 9. OP29 10. OP29 Kingston Court Care Home 11. OP30 12. OP38 codes of conduct and practice and so should be given copies of the code to support their practice. The service should record the paid days training staff receive, including their in house training, to make sure they receive a minimum 3 days paid training per year to obtain training relevant to their work. The manager should consider recording fire training in a way that makes identification of staff on night and day duty easier so no one misses the training at the required intervals for each staff group. Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North West Regional Office 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 Kingston Court Care Home DS0000068983.V368237.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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