Inspection on 15/05/08 for Kingsway Care Home

This inspection was carried out on 15th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kingsway Care Home 05/05/09

Kingsway Care Home 03/11/08

Kingsway Care Home 22/05/07

Kingsway Care Home 23/05/06

Kingsway Care Home 18/10/05

Kingsway Care Home 13/04/05

Kingsway Care Home 02/11/04

Kingsway Care Home 01/06/04

Kingsway Care Home 25/02/04

Similar services:

Park House

Huntercombe Centre

Wellburn House

First Step

St Helens Care Home

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

CARE HOMES FOR OLDER PEOPLE Kingsway Care Home Kingsway Langley Park Durham DH7 9TB Lead Inspector Miss Nic Shaw Key Unannounced Inspection 9:30am 15th &16th May 2008 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 Kingsway Care Home DS0000000724.V365022.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. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingsway Care Home Address Kingsway Langley Park Durham DH7 9TB 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) 0191 3736167 0191 3735945 manger.kingsway@aermid.com Aermid Health Care Group Plc Mrs Andrea Blenkinsop Care Home 47 Category(ies) of Past or present alcohol dependence (4), registration, with number Dementia (10), Dementia - over 65 years of age of places (47) Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2007 Brief Description of the Service: Kingsway Care Home is based in Langley Park, County Durham. The home is owned by Aermid Healthcare PLC and was first registered in 1992. It provides 24hour nursing care for up to 47 service users 65 and over who have dementia. The additional category allows them to take 10 service users under 65 who have dementia. Accommodation is provided over two floors and all bedrooms offer single accommodation. There is a spacious garden and a car parking facility is provided at the front of the home. The home is situated close to local shops, pubs, and places of worship. The current fee level ranges from £411 to £550. Additional charges are made for hairdressing, chiropody and toiletries. Kingsway Care Home DS0000000724.V365022.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 0 star. This means that the people who use this service experience poor quality outcomes. Before the visit: We looked at: • Information we have received since the last full visit on 22nd May 2007. • How the service has dealt with any complaints & concerns since the last visit • Any changes to how the home is run • The provider’s view of how well they care for people • The views of people who use the service and their relatives. The Visit: An unannounced visit was made on 15th & 16th May 2008. During the visit we: • Talked with people who use the service, visitors, staff & the manager • Looked at how staff support the people who live here • Looked at information about the people who use the service and how well their needs are met • Looked at other records which must be kept • Checked that staff had the knowledge, skills and training to meet the needs of the people they care for • Looked around parts of the building to make sure it was clean, safe and comfortable • Checked what improvements had been made since the last visit • Spent time observing what happens in the home for people with advanced dementia. • A pharmacist inspector spent the day looking at how the home manages medication. We told the manager what we found at the end of the visit. What the service does well: The manager makes sure she gets a copy of the social work assessment and completes her own assessment for all prospective service users. This is so that she knows that Kingsway is able to meet their care needs. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 6 Relatives and friends can visit anytime they like. They can even have a meal in the home and are invited to spent Christmas day with their family members. The majority of staff have completed the NVQ level 2 qualification in care. The manager is a qualified nurse and has many years experience of care in a number of different settings. Relatives and service users said that they felt they could approach the manager if they had any concerns. There is an obvious warm relationship between the manager, relatives and service users. There are good procedures for monitoring how many accidents there have been and looking to see how the number of these can be reduced. Relatives said: “we think the general welfare is absolutely brilliant” “we feel dad is well looked after” “you are always made to feel welcome” “Christmas day you are invited to come in for lunch”. “the staff are polite” Residents said “it’s a nice place” “the food is good and there is plenty of it” “I would speak to the staff if I was unhappy” What has improved since the last inspection? What they could do better: Care plans need looking at, as most of the information is out of date. There is also no information about people’s past lifestyles, routines, likes and dislikes. This is important to make sure their health and personal care needs are fully met in the way that they prefer. When a person develops a pressure sore a care plan must be put in place straight away. This is so that staff know what to do to make sure it improves. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 7 The medication needs sorting out as there are many problems with this. For example: gaps on the medication record, staff not contacting the GP when a service user regularly refuses their medication, and two lots of the same medication in the trolley for one person who had been in hospital. People with dementia must be treated with respect and should not be talked about as though they were not there. Staff should not talk about people in terms of their behaviour, for example “attention seeking”, as this does little to promote person centred care, (that is treating each person as an individual and valuing and respecting their similarities and differences). There needs to be lots more activities for older people with dementia and staff need to make sure people are able to make choices in their daily lives, for example, where to spend their day. Mealtimes need looking at, as this is not a nice experience for some people with dementia. For example, tables should be nicely presented with table clothes and condiments, so that they are familiar and “homely” for people. Staff should sit and support people on a 1:1 basis and not intermittently offer help when passing. There also needs to be more dining tables and chairs upstairs as there are not enough for the number of people who can be accommodated here. The manager must keep a record of “niggles” including what she has done about these. This is important to show that she listens and acts upon what people tell her. The manager needs to look at some of the staff practices, such as when medication is used. This was given to one person who had tried to leave the building a number of times during the night. Without any evidence of the staff trying, for example, to divert the person or involving them in an activity first, this could be seen as unacceptable restraint. The manager also needs to make sure that all incidents which involve the safety of service users are reported to the Local Authority. This is to make sure that if needed, a full investigation is carried out to make sure people are safe. The building also needs attention. Many parts of the home are in a poor state of repair. Bathrooms are bare and institutional and not very homely, pieces of carpet are missing from two bedrooms seen and paintwork is damaged throughout the home. The environment must also be changed to help people with dementia remain independent. (The manager told us that one carpet has been replaced in one of the bedrooms seen). Staffing levels need looking at as there were not enough staff at lunchtime to give everyone the support they needed in a person centred way. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 8 There is also only one nurse in charge of both floors. This needs looking at as there was little leadership or direction to staff on the first floor to make sure people with dementia were treated with dignity and respect. Staff need more training in dementia so that they know how to meet the different needs of the service users and so that they understand about person centred care. The manager should keep a record of the interview she has with prospective staff. This is to show that one has taken place and also to show that there is a good recruitment process followed. The manager must tell us when there has been a serious incident involving a service user. This is a legal requirement. There must also be a process in place for monitoring the quality of care provided and for obtaining the views of service users and relatives. This is so that the manager knows what things need to improve and to assure relatives and service users that their views will be listened to. Fire doors must not be wedged open as this is a hazard in the event of a fire. The manager must arrange for a review of the use of the “safety gates” which have been fitted across some service users bedroom doors, as such a practise could also be viewed as institutional abuse. This must include each service user’s care manager and their families and involve looking at the potential risk of using these, for example in relation to fire safety/evacuation. (The manager has since written to us telling us what she has done about this). Relatives said: “we are not aware of any activities” “ the home needs a makeover” “the toilets aren’t very nice” 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. Kingsway Care Home DS0000000724.V365022.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 Kingsway Care Home DS0000000724.V365022.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): 3 Quality in this outcome area is good. We have made this judgement using a range of evidence, including a visit to this service. The admissions process ensures that people are adequately assessed prior to care being offered. This means that service users are offered the right type of care at the home. EVIDENCE: For prospective service users funded by the Local Authority the manager obtains a copy of the needs assessment and care plan from the care manager. In addition to this the manager always visits prospective service users in order to complete her own pre-admission assessment documents. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9&10 Quality in this outcome area is poor. We have made this judgement using a range of evidence, including a visit to this service. The care plans do not reflect the health and social care needs of service users. Therefore guidance is not available to ensure that the staff provide continuity of care to everyone. Furthermore, staff care practices do not preserve the dignity and privacy of people with dementia. Medication administration procedures do not protect the service users. EVIDENCE: Each service user has a care plan. These are generic care plans, based on a medical model of care. They focus upon health care needs with little information about each individual’s social and previous lifestyles, which is important when attempting to provide person centred care. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 12 For those people, who as a result of their dementia may become agitated, a generic care plan is placed in their personal file. Such plans provide no information about the person and what might trigger their agitation. Care plans are not evaluated regularly. For example, one care plan for “agitation” had not been evaluated between 11.03.07 and 9.01.08; another care plan for “personal cleansing and dressing” which had commenced on 28.9.05 had only been evaluated once on 9.01.08; and one care plan had not been evaluated since it was written in November 2005. In some of the care plans it was clear that the evaluations for a number of months had been written on the same day, by the same person and therefore of little value. Many of the entries made in the daily records are meaningless, for example, “had a quiet day”, “no changes” and “noisy day” and do not describe what care is being delivered and whether or not the intervention is meeting the individual’s needs. There were also significant gaps in the daily records. Risk assessments for “pressure sores”, “choking” and “nutrition status” had been written. However these are also not evaluated regularly. For one person assessed as at high risk of malnutrition, there was no care plan in place or any evidence that their food and fluid intake was being monitored. In one person’s daily notes it had been identified that that they had developed a pressure sore. There was no care plan written to make sure they were being provided with the care that they needed. In this same person’s daily notes on 8.5.08, it had been recorded that they had blood in their urine, however, the next entry was not until 10.5.08, with no further information about what had been done about this. Care staff who support people with dementia do not read the care plans, which are written by the nurses. Therefore it is difficult to understand how care staff can effectively ensure that the service users needs are met. There is little evidence that the relatives and the service users with dementia are involved in the care planning process. Relatives said they had not seen their family members care plan, nor had they been involved in writing it. Service users have access to all NHS facilities. There are regular visits from GP’s and other health professionals, including opticians and chiropody services, and speech and language therapists, although a comprehensive list of these visits is not maintained. Although the home has comprehensive medication policies and procedures for staff to follow, there is no record available to show who has read them. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 13 An internal audit of controlled drugs and antidepressants is part of the medicines policy, however, no record of this was available to show that it had taken place. Medicines which are not contained in a “Blister pack” (this is a sealed package dispensed by the pharmacist) are not returned to the pharmacist at the end of the month and there is no “carried ove” figure transferred onto the new Medication Administration Record (MAR), which makes auditing difficult. Good waste medicine records were available for April and May 2008. This is a new system as there were no previous records available. The ground floor treatment room used for storing medicines was very hot. There was no record maintained of the room temperature. The controlled drugs cupboard was of adequate size and records were kept in a bound book. Entries were neat, countersigned and accurate and matched with entries on the MAR charts. The stock balanced on the day of the inspection. Liquid medicines stored in the medicine trolley, which have a limited storage after opening, did not have a date of opening. One medicine had no label on the pot. One nurse in charge gave the morning medicines to all people in the home. During this time, medicine administration by the nurse was interrupted on three occasions, twice to obtain extra stock and once to answer a telephone call. On all occasions the trolley was not locked but left in view of a care assistant sitting in the communal room. Medicine pots were available on the trolley for the medicine round, but there was no oral dose syringe available for administering a 2.5ml dose. People were given plenty of encouragement and time to take medicines. However, on one occasion, a service user who had been given their tablet by the nurse, later spat this out onto the table in front of them. A care assistant, in passing, saw the tablet, picked it up and popped it back into the service user’s mouth. This is very poor practise as this care assistant, who had not observed the nurse give the tablets, could not know that this tablet belonged to this service user. When looking at the daily notes it had been recorded that a service user had drank another service user’s medication. This shows that nurses who give medication do not always make sure that service users take their medication, placing the individual and other service users at risk. This was a serious incident and although the nurse had taken appropriate action at that time, we had not been notified about this, which is a legal requirement. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 14 There were gaps on the MAR charts and some information had not been copied correctly from the medicine container onto the MAR chart. This meant that one person was not receiving the correct amount of medication. For one person who had been in hospital there was a duplicate stock of medicines for them in the trolley, some of which had different medication administration instructions. The nurse was asked to sort this out at the time of the visit. For one person who goes out for the weekend and takes their medication with them, there was no record of this on the MAR chart. There were also no recent photographs of some of the service users, which would help with the medication administration procedure. One person had regularly refused to take their eye drops, yet there was no action taken to inform the GP about this. The medication profile section in the four care plans looked at did not correspond to the current medication from the MAR charts. Some service users who have dementia are not treated with dignity and respect. During lunch on the first floor of the home, one person was told to “sit still until everyone has finished”. People were spoken to as if they were children. For example, one person, who as a result of their dementia went to take food of another person’s plate was told not to do that or they would have to “sit over there”. Sometimes staff stood over individuals when assisting them to eat. People were told to “open wide”, “drink up” and referred to as a “attention seekers”. When the meal was over, service users were encouraged to leave the tables. Staff then sat at the dining tables, talking amongst themselves, with very little interaction with the service users. Staff talked about people as if they were not there. For example: staff discussed whether or not one service user had “opened” their bowls” and asked if someone was “soaking” in earshot of everyone in that room. On one occasion a member of staff did show good practice when they knelt by a service user and encouraged them to eat their meal independently, however, this good practice was in the minority. Relatives, whose family members live on the ground floor, said that they felt that the staff treated them well. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14&15 Quality in this outcome area is adequate. We have made this judgement using a range of evidence, including a visit to this service. Although younger adults with dementia enjoy a variety of activities, the range of activities available to older people with dementia is poor and therefore opportunities to lead a fulfilling lifestyle are limited. Service users are able to maintain family and other contacts to a good degree should they wish. This ensures they do not become socially isolated. However, opportunities for some people to exercise control and choice over their lives are limited, which prevents them remaining independent. Although service users receive a varied menu, eating food in the home is not an enjoyable experience for some people with dementia and does not promote their general health and wellbeing. EVIDENCE: There is no activities co-ordinator, although the manager is trying to recruit the right person for his job. There is also no activities programme. Younger people with dementia have the opportunity of taking part in a range of Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 16 community activities, for example shopping in Durham, however, the same opportunities are not provided for older people with dementia living upstairs in the home. There was very little information about people who have dementia, their likes, interests and social histories, which is very important when developing activities for people with dementia. There was also no evidence available to show how people’s spiritual needs are being met. Relatives commented that social activities were an area which could be improved. One relative commented that they would like their family member to be able to use the garden more regularly. The majority of service users living on the first floor of the home have little to do through the day, other than listen to music, watch TV, sit passively or “wander” along corridors. The main events of the day consist of being taken to and from the dining area and toilet. Staff were busy caring for service users’ physical and healthcare needs and had little time to arrange group or individual activities. As already mentioned, even when staff sat in the lounge /dining area, there was little engagement with service users. Visitors were seen to come and go throughout the inspection. They are able to use the lounges or service user’s bedrooms for visits. There are no restrictions regarding visiting times. One relative is able to have their lunch in the home. They said that they felt as though they were at home and were made to feel welcome by the staff. Some service users who have advanced dementia are not able to exercise choice about where and how they spent their day. The environment has not been adapted to help people maintain their independence and make choices. There is nothing to help people find their bedroom if they wanted to spend time in private, such as a photograph or picture from the past, familiar to them. Many people living in the home are not encouraged to use their bedrooms, as many of these are kept locked and staff hold the keys. Some younger people with dementia said that they had keys to their bedrooms and could choose to spent time in private. There is a dining room/lounge on both floors and a separate dining room on the ground floor. Although there is a menu board, the home does not have a menu displayed either in large print or in picture style, to help people with dementia choose what they would like to eat. The mealtime experience on the first floor of the home was not a pleasant one. Although tablecloths were on the tables before the meal, these were removed at the time of the meal. There was also no salt and pepper on the tables. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 17 There are only two dining tables for everyone accommodated on the first floor. This means that some people have their meal from their lounge chairs, or remain in their bedrooms. People with dementia were not offered a choice of what to eat at the time the meal was served, although the manager did state that this normally takes place. Staff did not offer assistance in a discrete, sensitive manner, rather stood over people telling them to “open their mouths”. There was no continuity, for example; staff began assisting those people who needed support, however, had to leave them to attend to other tasks. As previously discussed, some people with dementia were not treated with dignity and respect at this time. Relatives commented that there was always plenty of food. The manager said that the cook always ensures that for those people who require soft or puréed food, this is always presented in an appetising manner. There is plenty of choice on the menu, including a range of home made foods, such as soups and cakes. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 Quality in this outcome area is poor. We have made this judgement using a range of evidence, including a visit to this service. The home has an adequate complaints system so people know that their views will be listened to and acted upon. However, staff care practices do not ensure that the service users are protected from abuse. EVIDENCE: Relatives said they said they would have no hesitation in speaking to Andrea, the manager, if they had any concerns. The manager said that there have been no complaints since the last inspection only “niggles”. However, there is no record of how the manager has dealt with these, as evidence of a robust complaints process. There is a copy of the local authority safeguarding procedure in the manager’s office and the company has its own policy and procedure about prevention of abuse. Staff said that they had not read these policies, however, knew who to speak to should they witness or suspect abuse. The manager has arranged for some of the staff to complete a thirteen week distance learning course on safeguarding. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 19 Daily records showed that there have been incidents where the protection and safety of service users has been compromised. For example, a service user was found with an “entire” jug of juice poured over them and a box of rubber gloves on top of them. One service user had thrown a wooden chair at another service user and another service user was found with artificial flowers and rubber gloves in their mouth. None of these incidents were reported to the local authority or us and there was no evidence available, other than the generic provision of “safety gates” across some bedroom doors, to show how the future prevention of such incidents is to be managed. Staff practices demonstrate that staff do not understand about institutional abuse and restraint issues. For example: routinely locking bedroom doors, telling people to “sit still” and the provision of “safety gates” across some service user’s bedroom doors. Also the use of medication, as was suggested in one person’s daily notes, to control “ritualistic behaviour”. This was administered to one person after they had come out of their bedroom and made their way to the fire exit four times during the night, with no evidence of the use of diversional strategies being implemented first. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25&26 Quality in this outcome area is poor. We have made this judgement using a range of evidence, including a visit to this service. This service does not offer service users a well maintained environment. Although the home offers a service to people with dementia the building has not been adapted to meet the specialist needs of this group of people. EVIDENCE: The home is a large purpose build building. It is divided into two units, over two floors, each with its own lounge and dining areas. Each operates independently of one another and are separated by a key pad system. It was evident that there has been little investment in maintaining the environment in recent years. For example: Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 21 Service users bedrooms: Only a small sample of bedrooms were viewed as the majority of these are kept locked by staff. However, the following concerns were identified: • Pieces of carpet missing from two bedrooms seen. This is because when the carpet was laid it had been fitted around fitted furniture, some of this furniture has now been removed. The manager told us that a new carpet is planned for one of these bedrooms. Paintwork on walls damaged and in one room a piece of plaster was missing from the wall exposing wire. (The manager addressed this issue immediately at the time of the inspection). In one room there was a large patch of different coloured paint on the wall. Furniture stained. Use of “safety gates” across some bedroom doors to prevent service users from “wandering” into rooms when service users are lying in bed. One bedroom has a stable type door. This room is not being used at the moment but the manager said this door was installed so that staff could see into the room and make sure that the person previously using it was safe. This compromises the person’s right to privacy. • • • • Toilets and bathrooms: • There are cold unpleasant areas with stained floors and pull cords which, once white, are now black in colour with dirt. Relatives commented about the poor state of these areas. On the first floor of the home only one bathroom is being used for 20 people, as the others do not have an assisted bathing facility. This issue has been raised during previous inspections but has not been addressed by the company. Toilet seats and grab rails are a similar colour to the floors and walls and therefore may be difficult for some people with dementia to see. Attempts have been made to make these areas easier for people to find. However, the handwritten “toilet” sign stuck on these doors with cellotape looks shabby. • • • Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 22 Lounge/Dining areas: • Upstairs there is only one lounge/dining area. There are only two dining tables in here, which can seat up to sixteen people. This does not reflect the number of people who can be accommodated on the first floor of the home. There was very little upstairs for people to do. There was nothing in the environment for people to engage with such as books, magazines, or rummage boxes. Downstairs, in the main dining room, an assortment of dining chairs are used, some of which are badly worn. The carpet in the smoking lounge is badly damaged by cigarette burns. • • • General: • There was very little in the environment to help people with dementia. Photographs of people as they are now had been placed on some people’s bedroom doors, but for people with advanced dementia and short term memory problems, this will be of little help to them as they will not recognise themselves as they are now. The lighting throughout the home is quite dim and may cause difficulties for some people. Paintwork on doors is damaged from trolleys and wheelchairs. There is a beautiful well maintained garden. However, at the moment service users cannot independently use this area. The manager said that this is because the ramp leading from the conservatory to the garden is not suitable. • • • Staff knew about infection control and used protective gloves and aprons appropriately. The manager has arranged for all of the staff to complete a distance learning course in infection control. There is a small laundry area. Pieces of paper had been wedged in the mesh window, which had been installed for ventilation purposes. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29&30 Quality in this outcome area is adequate . We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are not sufficient and staff do not work as a team. This prevents staff from providing person centred care. Staff training is adequate, however, specialist training is not provided to meet the diverse needs of the service users, which prevents staff from effectively meeting the care needs of people with dementia. Staff recruitment procedures protect the service users. EVIDENCE: Service users have high care needs and many people with dementia living upstairs require assistance particularly at mealtimes. Some service users, as identified by the use of “safety gates ” across their bedroom doors, need constant supervision in order to ensure their safety. However, there are not enough staff around to provide people with the support they need. During the visit, on the first floor of the home, staff concentrated on attending to service users personal, nutritional and health care needs. Staff did not provide anything more than basic care. Although the majority of staff have Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 24 completed the NVQ level 2 qualification in care, none of them have completed training in dementia care or Korsakoffs syndrome (this is the name given to people who have alcohol related dementia) to help them understand about person centred care. One relative commented about downstairs that there were always two staff in the lounge and that they “watch the patients very carefully”. Care staff are not involved in care planning. This means that the staff team do not plan and work together to make sure that individuals receive a person centred approach to care. Communication is poor and neither the staff nor the nurse in charge knew when a service user, who had been staying for a short break, was due to return home. There is only one nurse on duty each day, who is the person in charge of both floors of the home. However, as previously mentioned much of their time was taken by giving medication. Consequently there was no leadership or guidance on the first floor of the home to make sure that staff provide care to people with dementia in a dignified, respectful manner. Relatives said “they are very good with her here” and the staff are “genuinely nice”. Staff files showed that a job application is completed and two written references and Enhanced Criminal Records Bureau check obtained prior to a new person working in the home. However, the manager does not maintain a record of the interview she has carried out to show that this process has been robust with appropriate questions being asked. All new staff shadow experienced staff for 3 days, as part of their induction process. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35&38 Quality in this outcome area is poor. We have made this judgement using a range of evidence, including a visit to this service. The home operates a poor quality assurance system and therefore service users and/or their representatives do not know their rights and views will be listened to. Furthermore management systems do not ensure the health, safety and welfare of the service users. EVIDENCE: The manager is a qualified Registered Mental Nurse and has managed this home for 4 years. She has a range of experience in a number of different settings both in hospital and in the community. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 26 Visitors said that they found the manager approachable and she clearly has a good relationship with service users and relatives. Relatives described her as “lovely”. The Annual Quality Assurance Assessment (AQQA), this is what we ask for before we do an inspection, was returned to us when we asked for it. However, it was brief, with little information. It did not give a reliable picture of the service. There is little or no understanding of person centred thinking in the home, with no evidence of management structures in place which could change this. For example, a person in charge of each floor who understands person centred planning and who could challenge and change the culture within the home, a culture which currently does not promote the rights of all people with dementia. As discussed earlier there have been a number of incidents in the home, which we have not been told about. This is a legal requirement. The use of “safety gates” across some bedroom doors may pose a potential hazard. The risk assessment, which had been carried out for these, was brief and generic. It had not been dated and did not include why they had been provided or any potential hazards associated with them, such as the risk of service users trying to climb over them. These gates are not easy to open and the risk assessment did not include what staff should do in the event of a fire. One service user who had a “safety gate” also had their bedroom door wedged open. Staff are provided with training in health and safety matters. The personal allowance records demonstrated that receipts are maintained for all transactions, however two signatures are not always obtained, which would be good practise. There is a system in place for monitoring the occurrence of accidents. It was evident during this inspection that the company is not sufficiently involved in the control and direction of the business and there is no evidence of long term strategic planning. The manager stated in the AQAA that a barrier to improvement has been funding as a result of low service user numbers. Kingsway Care Home DS0000000724.V365022.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 X x 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 1 X X 1 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 1 1 X 2 X X 2 Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 OP8 Regulation 15 Requirement Care plans must be developed to ensure that all aspects of the service users health, personal and social care needs are met. This must include the immediate development of a care plan for the person who has developed a pressure sore. Timescale for action 31/12/08 2 OP9 13(2) 3 OP10 12(4)(a) 4 OP12 16(2)(n) All staff must read the care plans. This to ensure that continuity of care is provided. Medication storage 30/06/08 arrangements and administration procedures must improve as discussed in the body of this report. 31/10/08 The manager must ensure that people with dementia are treated with dignity and respect at all times ensuring that their well being is fully promoted. For example: staff should not treat people as though they were children. A range of activities must be 31/10/08 offered to all people with dementia, to ensure that opportunities to lead fulfilling DS0000000724.V365022.R01.S.doc Version 5.2 Page 29 Kingsway Care Home 5 OP14 12(2) lifestyles are provided. The manager must ensure that people with dementia are helped to exercise choice and control over their lives as part of living an independent lifestyle. For example: • Staff should not lock people out of their bedrooms. 30/10/08 6 OP15 12(4)(a) The environment must be adapted to help people with dementia find their way around A review of the mealtime arrangements must be carried out to ensure that people with dementia are offered the support they need. There must be sufficient dining tables and chairs available to reflect the number of people who can be accommodated on the first floor. This is so that everyone who chooses to can have their meal at a table. A record of all complaints, including “niggles” must be maintained. This must include any action taken by the manager. This is to ensure people’s views are listened to. All potential safeguarding issues must be reported to the Local Authority. This is to ensure that service users are fully protected. Staff practices on the first floor of the home must be reviewed to reflect best practise in dementia care. For example: when medication is used and how staff respond to service users who “wander”. This is to ensure people are not subject to what DS0000000724.V365022.R01.S.doc • 31/07/08 7 OP16 17(2) Schedule (4)(11) 31/07/08 8 OP18 13(6) 30/06/08 9 OP18 13(6) 30/06/08 Kingsway Care Home Version 5.2 Page 30 10 OP19 23(2)(a)& (p) 11 OP19 23 could be regarded as institutional abuse. The environment must be 31/10/08 adapted to meet the needs of people with dementia. The manager must make reference to relevant up-to-date guidance to help her achieve this. The manager must produce a 31/07/08 comprehensive refurbishment plan, based on an audit of the environmental needs in the home and detailing timescales for implementation to improve the environment. This must include:Service users bedrooms where there are gaps in the carpet and where paintwork is damaged. Lounge/dining areas including number and quality of dining chairs and tables. Bathrooms and toilets, particularly flooring, paint work and pull cords. Previous timescale not met: 31/08/06, &31/08/07. The garden must be accessible to people living in the home. The number of assisted bathing facilities must be increased to meet the needs of the service users. Previous timescales not met 31/09/06 & 31/08/07. Service users must be provided with keys to their bedroom doors unless their risk assessment suggests otherwise. The lighting in corridors must meet recognised standards (lux 150) so that people can see DS0000000724.V365022.R01.S.doc 12 13 OP20 OP21 23(2)(o) 23(2)(j) 31/07/08 31/10/08 14 OP24 13(7) 31/08/08 15 OP25 23(2)(p) 31/12/08 Kingsway Care Home Version 5.2 Page 31 16 OP26 23(2)(b) 17 OP27 18(1)(a) properly. . The paper wedged in the ventilation in the laundry must be removed. (The manager confirmed that this has now been addressed). Staffing levels and the staffing structure must be reviewed to ensure care is provided to service users in a person centred way and to ensure the safety of service users. 31/07/08 31/08/09 18 19 OP30 OP31 18(1)(c) 20 OP32 21 OP33 22 23 OP38 OP38 Training must be provided so that staff can meet the diverse needs of people with dementia. 37 The manager must notify us of any incident, without delay, which affects the well-being of service users. 12(1)(a) The management approach and structure of the home must ensure that people with dementia receive person centred care. 24 A quality assurance system must be implemented to ensure that the home is run in the best interests of the service users. 23(4)(e) Fire doors must not be wedged open. 23(4)(e),1 A review of the use of “safety 5(1), gates” must be carried out. This 13(4)( c ), process must involve the service &13(8) user’s care manager and their relatives and include a detailed assessment of the risks associated with their use. 31/12/08 31/05/08 31/10/08 31/03/09 16/05/08 16/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 32 No. 1 2 3 Refer to Standard OP18 OP29 OP35 Good Practice Recommendations The training arranged for staff in safeguarding should go ahead as planned. This is to ensure the safety of service users. The recruitment procedure should include a record of interview. This is to show that appropriate questions have been asked to ensure the right people are employed. Two signatures should be maintained for all financial transactions made on behalf of the service users. Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Kingsway Care Home DS0000000724.V365022.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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