Inspection on 03/11/08 for Kingsway Care Home

This inspection was carried out on 3rd November 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 15/05/08

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 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Kingsway Care Home Kingsway Langley Park Durham DH7 9TB Lead Inspector Nic Shaw Key Unannounced Inspection 10:00 3rd &4th November 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.V373073.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.V373073.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 www.aermid.com Aermid Health Care (UK) 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.V373073.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2008 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 24 hour nursing care for up to 47 residents who are 65 and over and who have dementia. They can also take up to 10 residents 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.V373073.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. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Before the visit: We looked at: • Information we have received since the last full visit on 15th and 16th May 2008. • 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 3rd &4th November 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. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? People with advanced dementia are now treated with dignity and respect. Some of the care plans now contain information about people and their past lifestyles. And care staff now read the information in them. Mealtimes have improved for people with advanced dementia. Tables are nicely presented and this is a pleasant experience for people. An activities co-ordinator has recently been employed. The manager has introduced a concerns/complaints book. Staff have had some training about the special needs of people with dementia. Some bedrooms have been re-decorated. The manager now keeps a record of the interview she has with prospective staff. This is to show that one has taken place and also to show that a good recruitment process is followed. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 8 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.V373073.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.V373073.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): 2 Previously this outcome area was assessed as good. We made this judgement using a range of evidence, including a visit to this service Not assessed on this occasion. EVIDENCE: We did not assess this outcome area as there have been no new admissions to the service. Kingsway Care Home DS0000000724.V373073.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 residents. Therefore guidance is not available to ensure that staff provide continuity of care to everyone. Staff care practices have improved and preserve the dignity and privacy of people with dementia. There are poor systems for the accurate administration, recording and storage of medicines. This puts people at risk of not receiving their medication safely and as prescribed and therefore affects their health and wellbeing. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has a care plan. Although many of these have recently been rewritten they are generic and do not reflect the personal and health care needs of each individual. We looked at the care plans for people who, as a result of their dementia, may become agitated or “wander”. The plans that had been written had generic interventions, which were vague and meaningless and do not guide staff. For example; phrases used included use diversional therapy, use unconditional positive regard, and “attempt to build a therapeutic nurse/client relationship”. Some care plans had not been evaluated since August 2008 and were not upto-date. For example; in one person’s care plan it said “ to be moved using 1 carer” and also “can mobilise independently”. In practise this person was no longer able to mobilise independently and required the assistance of 2 staff. Another person’s moving and handling assessment was written on 10/10/06 and monthly reviews ever since indicate no change. This plan was last reviewed in August 2008, when it stated they were independently mobile. However, this person also now needs 2 carers to walk, and this has not been updated in the care plan. The weight of residents is not consistently monitored. For example; in one person’s care plan there was no record of their weight, in a second person’s plan they had not been weighed since June 2008. In a third person’s weight records, between June 2008 and August 2008, they had significant weight loss of 4.3Kgs (about 9lbs) but there were no further weight records. The care plan for “eating and drinking” for this person, which was last reviewed in July 2008, stated appetite remains the same, no change to care plan despite the fact that they had lost weight. A referral was made to the GP on 30/10/08 for this person, up to 2 months after losing 9lbs. However, there was no new care plan in place about their nutritional needs and how to support them. This places them at risk of malnutrition. It was good that there was a new care plan in place about one person’ s postoperative care following a partial hip replacement. However, all other documentation in the care file did not reflect their care needs. For example; in the falls risk assessment they had continued to score 6 for the full year, which is low risk. Also in the monthly dependency assessment they continued to score 2, low risk, when this was no longer the case. In one person’s daily notes it said that they had been “agitated, disturbing other clients” but there was no care plan in place to advise staff of the best way to support this person when this happens. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 13 It is good that there is a recent care plan in place about one person’s cultural background and their choice to no longer follow their Sikh religion. However, virtually every care plan evaluation for the past year states no change and continue with care plan. In this way there is no progress update or review of what staff have done to support them with mobility/exercise/social care etc. Care staff said that they read the care plans and contribute to the daily recordings. However, many of the entries remain meaningless, for example, “quiet morning slept in lounge”, “resting in chair”, “good diet” and do not describe what care is being delivered and whether or not the intervention is meeting the person’s needs. Residents 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. When staff were not supporting people with personal care needs, they sat chatting and interacting with them. Staff knew about the resident’s personal histories and encouraged conversation by talking to them about this. Staff did not stand over people when talking to them and when supporting people, for example to walk, they made sure that they did so at a pace that suited the individual. In these ways the staff made sure that people were treated with dignity and respect. An internal audit of controlled drugs and antidepressants is part of the home’s medication policy. However, no record of this was on the current or last Medication Administration Record (MAR). When asked the manager confirmed that an audit of medication was taking place but no written records were kept or available. She could not explain how an audit of non- blister packed medication was carried out when in most cases any stock carried forward from month to month was not recorded. The ground floor treatment used for storing medicines was very hot, it was 28c on the day. There were poor records of the room temperature (only 5 records for October 2008) and also poor records of the fridge temperature. A prescribed cream, which should be stored below 15c, was in the cupboard and eye drops in use, which should be stored at room temperature, were in the fridge. Liquid medicines stored in the medicine trolley and eye drops, which have a short shelf life when opened, did not have a date of opening. The nurse handled tablets during the medicine administration round. There were no photographs for two residents on the MAR charts. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 14 Records of creams on the MAR charts were poor. MAR records show that creams prescribed twice daily for two different people were only applied once daily. There were no records of application for one cream and intermittent records for another. Prescribed eye ointments being used had not always been recorded on the MAR charts. There was an inhaler device on the trolley with no name on. An audit of loose medication did not match the MAR charts. It was not clear on one person’s MAR charts what medication they were currently taking. In their care plan it said their Doctor had visited them and changed their medication. This person had not been given this medication. Some tablets found in the medication trolley that had been administered that morning were not recorded on the MAR charts. Other tablets were available on the trolley, but not on MAR charts, staff were not sure if they were still to be taken. Medication had been given that morning to one person even though there was no medication available in the home prescribed for them (the nurse confirmed that she had used another person’s medication). Handwritten entries are not signed or countersigned. The controlled drugs cupboard meets requirements. Records kept were neat and accurately reflected MAR administration records. All stock balanced. Kingsway Care Home DS0000000724.V373073.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. Opportunities for people to take part in activities is improving, however, must continue to develop to fully meet the diverse needs of the residents. Some people with dementia are not helped to exercise choice and control over their lives, which prevents them from remaining independent. Residents enjoy a varied meal and the mealtime experience has improved, however, refreshments are not readily available, which compromises the health and well-being of residents. EVIDENCE: There is a full time activities co-ordinator who has recently starting working in the home. They were spending time chatting to some of the residents who live upstairs. The manager told us that they are currently finding out about people’s likes and interests before they develop the activities programme. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 16 Downstairs most people spent all day and evening in a main lounge together. Occasionally one person went for a walk along the corridors, and another asked to go to the smoking room. During the morning one staff played a game of Frustration with a resident, explaining the rules and showing them where to place the counters. One resident spent all day playing Patience card games by themselves. A domestic staff had a friendly chat with them. One care staff sat with the rest of residents but there was little conversation or engagement as five people were asleep in front of the television. Later in the afternoon the nurse on duty sat with some residents and was engaging and considerate in her conversations with them. Staff said that sometimes a support worker takes a couple of people to a local Dinner Club in the village. They said that residents occasionally go out on a one-to-one basis to the local shops. There is a significant age difference between residents, from 50 to 90, the equivalent to two generations. However, there is no indication that those people who have been placed here due to Korsokoffs or other younger persons dementia type illnesses receive any specialist support or care. Relatives were seen to come and go throughout the inspection. There are no restrictions on visiting times. One relative is able to help their family member with their meal, and in this way continue to be involved in their care. The environment has not been adapted to help people maintain their independence and make choices, although the manager is now beginning to look at ways to address this. For example; 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 continue to be unable to use their bedrooms, as many of these are kept locked and staff hold the keys. Although a generic risk assessment has been placed in each person’s care plan about keeping bedroom doors locked, which states “ staff to lock room to ensure personal possessions are safe, staff to ensure they unlock door when XXX requests”, many of the residents, as a result of their dementia, are not able to make such a request, and therefore not able to use their bedroom. There is a poster on the entrance door asking visitors not to open the door. This door has a baffle handle at the top of it, designed to prevent people from going out. However, there were no risk assessments in care files to show why people are restrained from leaving the building. Also there is no indication that mental capacity assessments have been carried out for the home to have made that decision. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 17 Meals are taken in the dining area of both the ground floor and first floor lounges, where everyone spends the full day. Tables were appropriately set with tablecloths, cutlery and serviettes. People who needed physical and verbal encouragement to eat their meals were sensitively prompted and supported by staff. People were given lots of time to complete their meals using their own skills. In this way meal times are unhurried and relaxed. However, one person downstairs was given juice to drink in a teacup, which is inappropriate as it could have been confusing for them. There were also no jugs of juice or water downstairs for people to have at any other time, even though it was extremely hot in the building. One relative said Mum has to be physically helped to eat her meals but is never offered omelettes or ice cream which they would find easier to eat. Kingsway Care Home DS0000000724.V373073.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 adequate We have made this judgement using a range of evidence, including a visit to this service. The home has an adequate complaints procedure so that people know that their views will be listened to. Although there are safeguarding policies and procedures in place, staff do not always follow these, therefore compromising the safety and protection of residents. EVIDENCE: There is a complaints procedure in place and a comments and complaints book in the entrance area of the home. The manager said that she had not received any complaints since the last inspection. Staff said that they had completed training in safeguarding adults. The manager has a copy of the local authority safeguarding procedure and the company has its own safeguarding policy and procedure. There were three potential safeguarding incidents in October 2008. These involved aggression and inappropriate physical contact. The manager was not aware of these incidents, nor had they been reported to the local authority in Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 19 accordance with safeguarding procedures. They had also not been reported to CSCI, which is a legal requirement. Kingsway Care Home DS0000000724.V373073.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): 19,25 & 26 Quality in this outcome area is poor. We have made this judgement using a range of evidence, including a visit to this service. The service does not offer residents a well maintained place in which to live. Although the home offers a service to people with dementia the environment has not been adapted to meet their needs. EVIDENCE: There has been very little improvement to the home to help people find their way around this large building. There are no pictorial signs on bathrooms and toilets to help people find them. There are numbers and name plates on most bedroom doors, but no other familiar clues to help people find their own room. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 21 The handrails in corridors are painted the same colour as the walls so are very difficult for people to see. This does not support their safe mobility around the corridors. Some residents’ bedrooms have been re-decorated, however, those that were seen were quite bare, and the decoration worn. One persons bedroom window looked out onto a large clinical waste bin. Bathrooms are also not well decorated and show signs of wear and tear. For example; cracked bath panels and scuffed paintwork. There are no handles on the inside of toilet and bathroom doors so it is very difficult to pull them closed in order to lock them. However, work had begun on improving the bathrooms on the day of our visit. One communal toilet, next to the main lounge on the ground floor, was very odorous and had pads and vinyl gloves on display. This compromises peoples dignity and also compromises the hygiene of those intimate items. There are three large drinks and sweets machines in the residents dining room on the ground floor. These are noisy and unsightly, and seem to be used only by staff. Residents are not able to use this room as there are baffle handles at the top of the doors. The lighting in this room is very poor and the noise level makes it very uncomfortable to sit in for any length of time. (At this time the dining room is not being used due to the lower occupancy levels.) One resident continues to have a safety gate across their bedroom door to prevent other residents from “wandering” into their bedroom. Although the manager said that the care manager had agreed to this there was no evidence of this in the care plan. One relative said : The state of the decoration is very poor, and the furniture is second hand. Noone should be paying fees for this state of accommodation. Kingsway Care Home DS0000000724.V373073.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): 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 and staff training is adequate, however, specialist training is not provided to help staff to meet the diverse needs of all the residents. Staff recruitment procedures protect residents. EVIDENCE: At the moment there are only 24 people living in this home, 10 upstairs and 14 downstairs. There are always 2 staff on duty on each floor plus a nurse who “floats” between both floors. The nurse on duty is the person in charge of both floors, however, much of her time is taken giving medication. Consequently there is little leadership or guidance for staff as much of their time is taken up with this task. The manager has provided staff with training in dementia care. However, none of the staff have had training about the special needs of people who have Korsakoff’s syndrome. The majority of staff have completed the NVQ level 2 qualification in care. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 23 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. The manager keeps a record of the interview she has carried out to show that this process has been thorough with appropriate questions being asked. Relatives commented positively on the attitude of the nurse in charge that day. Kingsway Care Home DS0000000724.V373073.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): 31,33,&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 an adequate quality assurance system, but could be developed further so that residents and/or their representatives know their rights and views will be listened to. Management systems do not ensure the health, safety and welfare of residents. 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 Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 25 settings both in hospital and in the community. Relatives said they found the manager to be approachable. 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. There is a quality assurance system. This involves the manager and area manager carrying out a bi-monthly audit of care standards. However, the reports completed following the audit do not provide information about what has been looked at. For example: it was unclear as to what the manager did to decide that “privacy and dignity” was 100 . Similarly, the home’s line manager completes a monthly report about the conduct of the home, which is a legal requirement. In this comments are recorded such as “the care plans continue to improve reflecting more accurately changes to both mental and physical needs”, however, there is no further information about, which care plans were looked at or how many. There have been 39 accidents during August 2008 and September 2008 and 19 in October 2008 but there was no evidence that the manager is monitoring the occurrence of these to prevent them happening again. There was one accident, which involved a member of staff finding a wardrobe on top of a resident’s bed. No one was hurt, however, the manager had taken no action, such as securing this to the wall, to stop this from happening again. We left the manager with an immediate requirement notice about this. This was to make sure that she did something about this straight away to stop residents from getting hurt. (The manager has since let us know that she has secured all wardrobes to the walls). As discussed earlier there have been some incidents in the home, which we have not been told about, which is a legal requirement. Staff have had training in health and safety issues such as moving and handling and fire safety. Although there was some evidence that the company has begun to get involved in the direction of the business, for example; work which has begun on the bathrooms, much work still needs to be done to the building to improve environmental standards for people. This issue has been outstanding now over the last four inspections of this service. Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 26 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 10 11 1 X X X X X 1 2 STAFFING Standard No Score 27 28 29 30 1 3 X 3 3 3 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 X X X X 1 Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 27 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 Regulation 15 Requirement Care plans must reflect individual residents’ health, personal and social care needs This is to ensure that continuity of care is provided and that the health and welfare of residents is fully promoted. All medication must be administered as prescribed and be available to administer. Accurate records must be kept for all medicines received into the home. This will help to make sure that people receive their medications correctly and the treatment of their medical condition is not affected. A system should be in place to record all medication received in to the home and medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. Medication must be stored securely and safely at temperatures recommended by Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 28 Timescale for action 31/12/08 2. OP9 13(2) 31/01/09 the manufacturer. A system must be in place to check expiry dates of medicines and to add the date of opening when necessary. This makes sure medication is safe to administer when needed Revised requirement outstanding from 30.6.08 Activities must be planned and provided to meet the individual and collective needs of residents This is to ensure residents enjoy an active fulfilled lifestyle. Revised requirement outstanding from 31/10/08 Where residents’ bedroom doors are kept locked and access for residents is restricted this must be clearly documented to show this action has been taken within a risk assessment framework. This is to ensure the independence and choice of residents is promoted. Revised requirement outstanding from 30.10.08 Refreshments must be readily available at all times so that residents can help themselves or be supported by staff to remain hydrated. New requirement. Systems must be in place to ensure the manager is informed of all safeguarding incidents. All safeguarding incidents must also be reported to the local authority for investigation. This is to ensure that residents are fully protected. Revised requirement Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 29 3. OP12 16(2)(n) 31/01/09 4. OP14 12(2) 31/01/09 5. OP15 16(2)( i ) 31/01/09 6. OP18 13(6) 31/01/09 7. OP19 23(2)(a) outstanding from 30.06.08 The environment must be 31/01/09 adapted to meet the needs of people living at the home. this is to ensure that the welfare and independence of residents is fully promoted. Revised requirement outstanding from 30.10.08 All areas, both communal and private, that residents have access to must be decorated to a reasonable standard. This is to ensure residents benefit from a well maintained place in which to live. Revised requirement outstanding from 31.08.06 Bathrooms must be refurbished to provide safe and comfortable facilities. This is to ensure residents are able to bathe in pleasant surroundings. Revised requirement outstanding from 31.08.06 Lighting in the home must meet recognised standards (lux 150) so that people can see properly. The home must be kept clean and free from offensive odours. This is to ensure that residents are provided with a pleasant environment in which to live. 8. OP19 23(2)(d) 31/03/09 9. OP19 23(2)(b)& 23(2)(d) 31/03/09 10. 11. OP25 OP26 23(2)(p) 23(2)(d) 31/12/08 31/12/08 12. OP30 18(1)(c) 13. OP31 37 New requirement. Staff must be provided with 31/12/08 suitable training so that they can meet the diverse needs of people living at the home. Any incidents that must be 31/01/09 reported under Regulation 37 are done so without delay. Revised requirement outstanding from 31.05.08 DS0000000724.V373073.R01.S.doc Version 5.2 Page 30 Kingsway Care Home 14. OP33 24 15. OP38 13(4)( c ) The quality assurance system must demonstrate that the home is run in the best interests of the residents. The incidence of accidents must be monitored so that trends can be identified and suitable control measures implemented. This is to ensure the safety of residents is fully promoted. New requirement. Immediate action must be taken to prevent wardrobes from toppling over. This is to make sure the health and safety of residents is fully protected. Immediate requirement notification issued on 4/11/08 31/03/09 31/01/09 16. OP38 13(4)( c ) 04/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Staff should sign and date any handwritten entries on medication administration records (MAR) charts and record the amount of medication received .The entry should be checked and countersigned by a second person this avoids transcription errors and means that people received their medication according to the most up to date dosage regime. The staffing structure should be reviewed to ensure staff are adequately supervised. 2. OP27 Kingsway Care Home DS0000000724.V373073.R01.S.doc Version 5.2 Page 31 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. 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