CARE HOMES FOR OLDER PEOPLE
Kingsway Care Home Kingsway Langley Park Durham DH7 9TB Lead Inspector
John Trainor Key Unannounced Inspection 10:00 22nd& 23rd May 2007 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.V339838.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.V339838.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 No E-mail address Ancyra Health Limited 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.V339838.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd May 2006 Brief Description of the Service: Kingsway Care Home is based in Langley Park, County Durham. The company owning the home Ancyra Healthcare was bought out in December of 2006. First registered in 1992, the home provides 24hr care for up to 47 service users 65 and over with dementia. The additional category allows them to take 10 service users under 65 with dementia. Accommodation is provided over two floors and all bedrooms offer single accommodation. The current fee level ranges from £402.50 to £576.00. Additional charges are made for hairdressing, chiropody, toiletries and outings. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and the visit to the home lasted 9 hours over two days. All of the key national minimum standards were inspected. The inspector spoke to some people who use the service, a visitor, staff and the manager and inspected some of the records in the home including care plans. Before the visit to the home the manager completed a self-assessment document to give the Commission for Social Care Inspection information required to aid inspection. What the service does well: What has improved since the last inspection?
The recording of the administration of medication had improved so people were getting the tablets they needed when they needed them. Some improvements to the building had been made.
Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 6 There was a new boiler and heating system. New carpet had been purchased and fitted. The home was cleaner and more attention was paid to infection control practices. The laundry floor had been repaired. Communal bathrooms and toilets had liquid soap and paper towels to promote good infection control. Toilets had bins. Management of the home had improved with more attention to health and safety matters to make sure the home was safe for people. Procedures and policies had also been reviewed to make sure they were appropriate. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 7 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.V339838.R01.S.doc Version 5.2 Page 8 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): 2, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People could make an informed decision to move into the home based on the home being able to meet their assessed needs. EVIDENCE: There were pre admission assessments on the files inspected. These were basic and could be developed to include more information. The home confirmed in writing it could look after people following assessment. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 9 One relative told us that the manager came to the house to do an assessment and that they felt they had enough information to make a decision. However they did not know if they had a contract. Ancyra Health had recently been taken over and the manager said new contracts needed to be issued. The home did not provide intermediate care. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 10 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s physical and personal care needs were planned for and met, though inclusion of personalised task specific detail and social and occupational needs would improve both the planning and delivery of care. EVIDENCE: All files inspected had care plans. These still did not have enough task specific detail to instruct how people should be cared for and ensure consistency of care at all times. The community pharmacist had done and audit of medication on 1st March and all was found to be well. Medication was administered and recorded well. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 11 Bed rails when used were fitted correctly and used within a risk assessed process to ensure people were safe. Staff were seen treating people in a friendly way respecting privacy and dignity. There was evidence of primary and secondary health care treatment in care files to show people had access to the doctor and specialist health care. The home had a seated scale so people’s weight could be monitored even if they had difficulty with mobility. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People could make choices in their daily lives, though for some lifestyle choices were limited by inconsistent recording of detailed personal preference. EVIDENCE: There was a full time activities co-ordinator. When interviewed they identified that people liked cards, dominoes and games and that people liked to watch older films. People did light chair exercises Mondays and Thursdays and had bingo at night. However some care plans lacked enough detail to show clearly what people’s preference would be. Discussions were held about building on individual activities plans.
Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 13 One of the people identified in the discussion and from care plans as liking to play cards was seen playing cards during the inspection. There was a coffee morning on Thursday mornings to which relatives were invited. There were also organised outings. One person living at the home said, “The meals are very, very good.” A relative said the people were fed well and that, “lunch is very tasty.” They also said, “I like the flexibility I have as a visitor, I can come anytime.” Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were protected by the home’s policies and procedures on protecting vulnerable adults. They could be assured complaints would be investigated and recorded. EVIDENCE: There were policies and procedures in the home on adult protection and complaints. Complaints were recorded so there was a record of what was done when people made a complaint. Staff had awareness of measures to take in case of abuse of a vulnerable adult. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a safe, clean and hygienic home. EVIDENCE: Communal and corridor areas were clean and well presented as were individual rooms. New carpet had been purchased and fitted. The laundry floor had been repaired. Communal bathrooms and toilets had liquid soap and paper towels to promote good infection control and toilets had bins. There were no unpleasant odours. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 16 There were only 2 assisted bathrooms. Some repairs and refurbishment were still needed and the home needed to have a written refurbishment plan to steer direction in this area. Radiator valves were broken in the office and some bedrooms. The dining room had a sign on saying lounge. This could be confusing to people with dementia. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were deployed in sufficient numbers and had sufficient training to meet the needs of the people resident. EVIDENCE: Staffing levels met the recommended level of the residential forum and over 50 of staff were trained to NVQ 2 or above. There was a commitment by the provider to encourage staff to train. Staff interviewed had received training including fire safety, moving and handling and food hygiene. A relative said they got on well with the staff and that consistency had enabled them to develop a relationship with people during the stay of their relative. “There isn’t the turn over in staff, they’re the same girls.” Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 18 There were gaps in the information required in the recruitment and selection files with one file missing a reference and one person deployed without the correct criminal records bureau check. This person was not going to be deployed from the day of inspection until the check was completed. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed in the interests of service users. EVIDENCE: The manager was qualified and capable. Management in the home was open and made sure people were safe. There were health and safety checks to ensure a safe environment. Service user finances were auditable and accurate.
Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 20 The home had a quality assurance system for checking the satisfaction of people resident and their relatives and carers. There were policies and procedures for managing personal allowances when the home looked after this money for people. The home had a quality assurance system. Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 21 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 22 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 OP19 Regulation 23 Requirement The registered person must produce a 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:Plan for increasing the number of assisted bathrooms in the home. Repair broken radiator valves to enable people to regulate the temperature in their rooms depending on personal preference. (Previous timescale of 31/08/06 not met.) Staff must not be employed and deployed without an enhanced police check from the Criminal Records Bureau, conducted by the provider. Timescale for action 31/08/07 2 OP29 19 (5(d(1))) 23/05/07 Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 23 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 OP3 Good Practice Recommendations Pre admission assessments should include information to enable the home to determine individual social and occupational expectation and so allow for a clear choice to move in to the home based on holistic assessment. Individual contracts should be reviewed to ensure they meet current office of fair trading guidance and allow for the regulatory reasonable notice within the trial period. Care plans should contain detail of people’s social and occupational expectation to allow care staff to meet their needs in this area. The registered manager should audit all care plans in the home to ensure all have adequate planning and review of care needs. Planning for activities and lifestyle choices should be improved to build on individual activity plans which record individual preference and choice. This will enable staff to help people keep their lifestyle choices as their capacity diminishes. Ensure signs on doors are accurate so as not to confuse people. Remove lounge sign from dining room door. 2 3 OP5 OP7 4 OP12 5 OP19 Kingsway Care Home DS0000000724.V339838.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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
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