Inspection on 30/04/07 for Kingswood House

This inspection was carried out on 30th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Kingswood House 24/04/08

Kingswood House 09/06/06

Kingswood House 14/12/05

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kingswood House Mays Hill Road Shortlands Bromley Kent BR2 0HY Lead Inspector Rosemary Blenkinsopp Key Unannounced Inspection 30 April 2007 09:30 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 Kingswood House DS0000063942.V334757.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. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingswood House Address Mays Hill Road Shortlands Bromley Kent BR2 0HY 020 8460 0273 020 8460 7836 kingswood.House@shaw.co.uk 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) Shaw Healthcare Ltd Sharon Disley Care Home 41 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (14), Old age, not falling within any other of places category (25) Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on the 25/05/2006 one Service user (male), with Dementia, between the age 63 -65 years can be accommodated within the home 11th October 2006 Date of last inspection Brief Description of the Service: Kingswood House is one of 6 homes, which are registered under Shaw Healthcare Ltd. The organisation has a number of residential and nursing homes throughout the UK and has its organisational headquarters in South Wales. Kingswood House is a large purpose built care home situated in a quiet residential area on the outskirts of Bromley. The home provides twenty-four hour care to a maximum of 39 residents. Residents placed in the home are admitted via the Social Services departments referral and placement system. The home has a Manager, Deputy Manager, support staff and a team of ancillary staff. The fees are £458.17 for the block contract beds purchased through the London Borough of Bromley. Privately funded residents are between £510.51 £600.00.Dementia care beds are between £624.00 - £700.00. The home provides information to residents and relatives in the form of a Service Users Guide and a Statement of Purpose is also available on request from the home. This sets out the type of accommodation and care provided. A copy of the last inspection report is also available on request from the home or the document can be viewed in the main reception area of the home. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted over a one day period by two inspectors. The Manager facilitated the inspection with the help of the administrator and staff on duty. All staff were courteous and helpful during the inspection. The inspectors spent time on two of the three units, the Dementia Unit and the Physically Frail ground floor unit. Residents were selected for case tracking including any new admissions, those with pressure sores or MRSA. Where possible residents were involved in discussions with the inspectors, and their key workers interviewed. The inspectors met with visitors in the home during the inspection. It was disappointing to note the pre inspection questionnaire was not returned to the CSCI, hence comment cards from residents and the multi disciplinary team could not be sent out prior to the site visit. The inspectors spent time observing the practice on the individual units, including the serving of lunch and the administration of medication. A selection of records were inspected including staff training and personnel files. Certificates and service agreements relating to health and safety issues were audited. Resident’s financial records, the Statement of Purpose and the registration certificate were other areas the inspectors addressed. What the service does well: What has improved since the last inspection? Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 6 Since the last inspection there have been several environmental improvements made in the home. Redecoration of communal areas and individual bedrooms was evident. As part of on going upgrading the kitchen is due to be refurbished. Staff felt that training opportunities had improved which provided them with better knowledge and skills to address the work they do. The Manager or team leaders are undertaking assessments prior to admission and there was evidence of this. The practice of administrating medication was safe. The Manager has completed the CSCI process to become the Registered Manager for this facility. 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. Kingswood House DS0000063942.V334757.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 Kingswood House DS0000063942.V334757.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are subject to assessment prior to admission. Information received from the funding authority and members of the multi disciplinary team was not always available, therefore the Manger would have limited information on which to base a judgement regarding possible admission. EVIDENCE: At the time of the inspection Kingswood House had, within the three units, the following number of residents: Dementia respite unit-12 residents Older Persons respite-10 residents Older Persons Permanent-10 residents. The Registration certificate requires changing to reduce numbers from 41 to 39 as the current bed numbers in use have changed. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 9 Dementia Unit The inspector selected two care plans, which included their assessment information. Within both of these care plans there was information received from the funding authority, which provided a good overview of the residents needs including physical, psychological and social aspects. One of the faxed copies was illegible due to smudging. There was an assessment conducted by one of the team leaders using the Shaw Healthcare documentation. These too were informative including areas of need and risk. The inspector was unable to locate any information received from the multi disciplinary team within either of the files. Both files contained service agreements, which had been signed by the next of kin. The property and valuables inventory was documented although not dated or signed by either the team leader or the relative, in one. The second inspector viewed records on the ground floor unit and the following information obtained. Shaw Healthcare assessment and care planning documentation was used. The inspector viewed the file of a permanent resident. The referral from Bromley Social Services had been obtained, but no core assessment under the Care Management procedures received. The home had completed it’s own company assessment form. However the individual had been admitted on 24/7/06 and the assessment was dated 28/7/06. There were gaps in the information including details of the resident’s weight on admission. A service user agreement had been provided which had been signed and dated. A property list had also been completed, although not signed or dated. The Statement of Purpose and other information were available in the reception area. The Statement of Purpose was found to be an out of date copy, although the Manager stated that the document had been reviewed and information updated. The updated copy should be made available. Please see requirement 1. Kingswood House DS0000063942.V334757.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments were not always in place, hence staff would be unable to address the care that residents required. All information relating to residents must be comprehensive in content with robust risk assessments to provide the best care for residents. Records relating to medication were to a variable standard and introduced an element of risk to residents. EVIDENCE: Dementia Unit. The inspector followed on from the assessment to inspect the resident’s care plans. These two residents were randomly selected; one had been recently admitted the second had been in for two periods of respite during the year 2007. The care plans were retained in individual files. In both files there was standard company paperwork covering risk assessments and the identified Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 11 areas of care resident’s required. The two files had records for next of kin and resident’s photographs. Both of these files were incomplete and many records blank, including essential items such as manual handling, nutrition and skin integrity. One resident had a falls risk assessment completed 31/1/07 which indicated moderate risk. The next entry was partially completed, no score indicated and the date was indecipherable. From this information it was difficult to determine the current level of risk. Both files had information relating to night care plans. In both cases, the daily records reflected physical health needs in the main, with little reference to psychological or social care. First names and initials were used in some cases, records need to be signed with full signatures, and dated. There were no entries in the GP or multi disciplinary sheet for the resident who had been in for respite on two occasions, and one GP entry for the newest admission. Neither resident had any areas identified under the care plan section. This was concerning as both residents had Dementia, one with associated aggression, and both had other physical health issues. The only available information, from which staff could identify the care needs, was that relayed in the assessment documentation One resident was on diuretic medication and was said to be incontinent on occasions. This resident was observed to be without fluids for a long period during the morning and left his mid morning tea and biscuits. It is essential that all residents have a sufficient fluid intake but particularly those on diuretics. There were no records relating to food or fluid intake or weight for this resident. The medication charts were inspected and part of the lunch time administration of medications observed .The medication charts themselves were reasonably well completed with allergies and photographs in place, with the exception of one. The medication policy was attached to the front of the medication file. Each resident is assessed for self-medication purposes. Medications, which are hand transcribed, need to have two signatures in place to confirm the accuracy of the information transcribed. This needs to be addressed. All medications to be administered “as required “ need to have full instructions including reason for administration, maximum dose and where applicable duration. One record was without the amount of medication received into the home. The observed practice was correct namely that each medication was signed for after it was administered and the trolley locked between residents. Staff Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 12 confirmed that only those who had received training in medication were allowed to administer mediations. On the ground the floor the findings of the inspector were as follows: The resident’s care plan and associated supporting documentation were viewed and found to be reasonably well completed and generally up to date. There were some gaps in the information including the need to ensure that the residents’ poor eyesight, which was one of the factors impacting on her mobility, was full recorded. Her poor eyesight also meant that she needed large print books. The care plan did not fully address the needs around her mood and emotions, which required regular medication and CPN involvement. In relation to her hearing needs, the guidance said speak loudly and clearly and said nothing about whether; it would be better if the person speaking to her, faced her, when talking. Risk assessments had been completed for all areas except pressure care. Those where there was a higher risk identified had been updated. Some of the risk assessments would require more action to be taken, for example where there is cause for concern, such as weight loss, there must be evidence of action taken to monitor nutrition and weight. Some entries on the weight chart were completed indicating weight gain, although on other occasions the resident had lost weight. The file of one other resident was viewed briefly and showed that despite being on the “permanent”` unit they had in place, a short-term care plan dated 04/06. This had not been updated to reflect the change in position. Discussion with the resident and viewing of the records confirmed that their healthcare needs were being addressed in the key areas, including visits by the Community Psychiatric Nurse and District Nurse and access to the GP. Medication is supplied by Boots pharmacy in blister packs whenever possible. They also supply printed medication administration records (MAR). Six records were viewed. Photographs were in place for those records viewed and allergies were generally recorded although there were some gaps. There were also a number of gaps in the administration, receipt and disposal of medication noted throughout the MAR charts. It was evident from viewing the blister packs and MAR charts, that there are different start dated for residents. This made it very confusing for staff to correctly administer and record medications accurately. Some of those medications checked, had the medication missing from wrong days from the pack. The home had not recorded where medication had been issued to a resident who was visiting family, or that brought back to the home. The medication trolley was stored in the medication room. The inspector noted a large supply of “ensure”, a food supplement drink, for the two residents prescribed it. One resident continually refused it whilst another record showed Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 13 the” ensure” to be crossed out. Neither resident had been given “ensure” as part of the meal supplement and there was no record of a food supplement on the one care plan viewed. The use of the food supplement should be reviewed to prevent over stocking and waste. Controlled drugs are kept in a CD cupboard and recorded in a CD register. However, in a number of cases the register had not been fully completed and was inaccurate with records showing medication still in the home when it was not, as the resident had been discharged and the medication returned to them. In one case the staff had started two different pages for one medication. This can lead to confusion and errors. There were some accurate recordings and correct amounts noted in the controlled drug register, and all but one recording had two signatures countersigning the recording. Please see requirements 2 and 3. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Daily life is based around routines and little choice evident which social activities limited, non participative and passive. Staff showed limited spontaneous interaction with residents the majority of the time this was task focused. In one unit the nutrition and hydration of residents was poorly addressed hence there is the risk of dehydration and nutrition related issues occurring. EVIDENCE: The inspector spent the morning observing practice on the Dementia unit. Through out the morning there were two staff located on this unit. For much of the time there was no one supervising the residents in the communal areas, where there were five residents in the sitting area and two in the adjacent dining area. The staff did intermittently pop into this area, although for long periods there was no supervision. Staff were busy addressing the needs of residents in other parts of the unit. There was a lack of fluids noted both in the communal areas, and, in individual bedrooms. Tea and biscuits was given out at 11 am .One gentleman whom the inspector was case tracking had tea and two biscuits provided. This remained untouched, until the tea was cold and taken away. Those residents who were able to drink Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 15 independently seemed to enjoy their tea, although there were others who simply did not drink at all. Fluids were provided just before lunch with the arrival of a third staff. Lunch was served at 12. 30 pm. Lunch was served – it was two choices stew and dumplings or mixed grill. Residents were either at the dining tables or in their own bedrooms. The dining tables were laid with serviettes, cutlery and a choice of juice was served with the meal. There was no salt pepper or other sauces provided on the tables nor was the menu. Plate guards, non slip mats and adapted cutlery were not used, these may have assisted residents to eat more independently. Three staff assisted with lunch, one serving the food, the second taking trays to bedrooms and the third assisted the resident, whom was part of case tracking, to eat. The inspector queried why this resident was being assisted as in his assessment information, there was no current care plan, it indicated he could eat and drink independently. The team leader explained that he had not eaten the day before therefore she wanted to ensure he had a meal today. This caused the inspector concern, as he had had nothing to drink that morning and was on a diuretic. The inspector was unable to identify if this resident had lost weight, as there was no records relating to this Another resident left all of her lunch and sweet, nor did she have her lunchtime drink. Once this was pointed out, staff did offer alternative food and spent time encouraging her to drink. Portion size was good although there was a lot of waste evident both on individual plates and in the food containers. More residents needed assistance than were provided with it. Staff need to be more pro active and aware in relation to food and fluid intake, particularly those who need assistance and supervision. During the morning session no activities took place. The TV was on, although no one seemed to take an interest in it , three resident sat with their eyes closed through out the morning . Within the care plans both of the records relating to lifestyle, leisure and activities were blank. Domestic style reality orientation aids were limited; clocks and calendars if at all, were in individual bedrooms. In the main the interaction with residents was task orientated, and the staff approach was variable. On the ground floor unit the inspector sat in the lounge/dining area for approximately two hours. During this time residents were observed to have Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 16 cold drinks by their side, and tea/coffee was later offered. However, it was noticeable that where residents were asleep they were not provided with a drink during this time. Most residents were sat in the lounge, dozing or occasionally striking up conversation with each other. One resident was provided with his daily newspaper. There were no activities taking place, although the activities coordinator was on duty and was well received by the residents with positive interactions taking place for a few brief moments. One resident said that he was “excellent”. The inspectors understand that bingo was taking place that afternoon. Discussions with some visitors and two residents confirmed that activities did take place and that they occasionally go out for pub meals during the day. Previous reports have highlighted the lack of activities and stimulation on the other two units. The Manager has stated that she has been addressing this. The lounge area had a number of books, magazines, newspapers and games available. One resident spoken to said that they required large print books and would ideally like to have the mobile library visit the home. This should be investigated. There was an orientation board on the unit to provide details of the date, day, weather etc. The board had not been updated to reflect the current day and situation. The lunchtime meal was observed with a choice of mixed grill or mince and dumplings. The mixed grill was very dry and according to one resident “very tough”. The mince was thought to be ok. Another resident, said the dessert of “bakewell tart”, to be “like a lump of lead”. One resident spoken to, said in general the meals were “dreadful” but admitted she had been used to high standards of catering in her life. The fish offered on Fridays was said to have “batter made by Blue Circle Cement”. Diabetic residents were offered yoghurts or ice cream. Staff were not aware whether the desserts provided were sugar free or contain sugar substitutes. The staff were unsure if residents could indulge in such desserts. This should be investigated with the dietician or diabetic nurse. The temperatures are recorded in relation to the hot meal. Unfortunately some staff are not aware of what they are actually recording. For example, where the recording should have been 81degrees the record said 8.1 degrees. The temperature of the last meal served should be recorded to ensure the food still reaches the required temperature. One resident said they were always getting the wrong laundry back and that they would like to put their own clothes away, rather than staff do it. Please see requirements 4 and 5. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints information is available for residents to access, although timeframes for responses through Shaw Healthcare are not always met. Staff need to have a working knowledge and understanding of adult protection so they can take the appropriate course of action should it occur. . EVIDENCE: Two staff interviewed were asked about adult protection issues. The two staff provided information on this topic although their level of understanding varied greatly. One staff had only a limited knowledge of the subject and did not indicate the need to report such actions either internally of through interagency guidance. The second staff demonstrated a good understanding of this topic and was fully aware of the need to report it and cited internal and external bodies. The organisation has a policy and procedure for the managing of complaints. This includes the timescale for investigating and responding to them. Brief details of how to complain are also contained in the Statement of Purpose and Service Users Guide. The Statement of Purpose states that information can be provided in other formats if required. It would be advisable that this information be written in large print as a minimum. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 18 Over the last twelve months there have been eight complaints recorded. Each contained details of the complaint with, in some cases, a report of the investigation completed. None of those viewed contained detailed information on the investigation route or whether the complainant was satisfied with the outcome of the investigation. The inspector also contacted the Local Authority complaints department to discuss any complaints received by them over the last twelve months. Of the twelve received (most of which had been logged by the home), nine were related to care. There continues to be issues about the standard of care provided by the home, as well as the lack of response, by the Provider, within the timescale. Please see requirements 6 and 7. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate . This judgement has been made using available evidence including a visit to this service. The environment is maintained clean and hazard free. Sufficient equipment and facilities are provided to meet residents needs. The spacious corridors, lift access and specialised equipment all add to benefit resident’s daily lives. EVIDENCE: The accommodation at Kingswood is laid out over three floors on three separate units. Each unit has private and communal accommodation. The main kitchen and laundry are on the ground floor, which also comprises the main offices. The home can accommodate 39 residents in the following categories; 13 respite residents with dementia; 12 older physically frail residents who are physically frail and 14 older people who are physically frail on respite care. The building itself is owned by the London Borough of Bromley, which means the Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 20 Home has to approach the landlord for any issues relating to the premises and the grounds. Within the Dementia unit there was evidence of redecoration in the corridors and the communal/dining areas. These areas were waiting to have pictures put up, which were stored in a corner of the dining room. The bedrooms on this unit were to a mixed standard some quite personalised others fairly bare, the standard of decoration was also variable some required attention with wallpaper peeling. The home itself was clean and tidy although an odour of urine prevailed in many areas particularly the corridor adjacent to the dining/ sitting room. Staff explained this was because there was a resident who urinated indiscriminately in any area. The kitchen area in this unit was satisfactory except that the kitchen bin which was full and contained food waste, was without a lid. Later the bin was emptied and the lid returned. The lift was in full working order although there was a sign on the Dementia unit to say this was out of order. Throughout the home the wide corridors, the addition of sitting and dining areas in each unit, are beneficial for residents. A brief tour of the ground floor was undertaken. The corridors were light and airy and individual rooms of a good size. Bedrooms were personalised containing possessions, which were brought in to the home by the residents. Two residents spoken to were happy with the standard of accommodation and the cleanliness of the home, although one resident stated that she had been promised another wardrobe for her room last year but this had still not been provided. Three visitors spoken to were also “impressed” by the standard of the accommodation and the cleanliness. One stated that they would have no “qualms” in coming to this home if they required care. Rooms viewed had individual furnishings and a selection of furniture. Many rooms were missing mirrors of any sort. Bathrooms were of a good size and contained soap and hand-towels. One bathroom had been fitted with a Malibu bath since the last inspection. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provided in sufficient numbers with an appropriate skill mix to meet the resident’s needs. Ancillary and administration staff work to support he care staff. Staff are subject to recruitment procedures. Staff are provided with training and induction to enable them to undertake the work they perform. EVIDENCE: On the Dementia unit there was initially two staff on duty, until just before lunch when third staff arrived. The inspector met with two staff excluding the team leader as they had been interviewed at a previous inspection. One staff was difficult to communicate with and hesitant in responses. However she did confirm that she had worked for about six months in the home and was part time She confirmed that all recruitment checks had been undertaken and that she had received the company induction. On asking her about specific issues little information was forthcoming. The topics that the inspector asked the staff about related to abuse, manual handling, infection control and Dementia care. She stated that she had not received training on Dementia care and was unaware of the term Clostridium Dificile, although related basic precautions in respect of infection control. She was unable to confirm if supervision had taken place. She advised the inspector that she was Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 22 undertaking an English course and was due to start NVQ 2 this month. The staff member was unable to identify any other training that she had attended. The second staff demonstrated a good knowledge on all of the topics she was asked about. She was a senior carer and had been in the home for one year although had worked within the company at another home prior to this. She had completed NVQ level 3. This staff member related to the inspector a lot of training that she had attended, including statutory topics and those pertaining to the resident population. The training record, obtained through the administrator, confirmed this. This staff was also unaware of what Clostriduim dificile was – this was related to the Manager as this is prevalent amongst older persons and is highly debilitating. The inspector viewed the files of three members of staff, two of whom were new employees. The personnel files relating to the two new employees contained the information required by the Regulations including application form, interview schedule, proof of identity, medical questionnaire, Criminal Records Bureau (CRB) check and two references. The inspector made the Manager aware that one of the references was from an employer not detailed on the application form and that there is a need to verify previous employment in care. Neither file contained copies of any certificates relating to training. The file of an acting team leader was also viewed. They had transferred from another home owned by the Provider. There was little information other than proof of identity and birth certificate. There was no evidence of CRB or POVA check, references or application form. It is recommended that the home retain details of the individual’s employment even where the staff member has transferred. There was no record of any interview or decision-making process, in relation to the individual being made up to acting team leader or change of location. The staff training matrix provided details of infection control training undertaken by staff at induction. Please see requirements 8 and 9. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced person, who is responsive to residents, relatives and staff. Health and safety servicing and maintenance is addressed to ensure the home is safe for residents. Quality assurance measures are limited therefore give little information on how the service can be improved upon to benefit residents. EVIDENCE: The Manager was successfully registered with the Commission in November 2006. She has a number of years experience as a carer and Deputy Manager before being appointed Manager of Kingswood House. She is supported in her role by Shaw Healthcare senior staff and within the home, team leaders and other departmental staff. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 24 The inspectors checked a number of service certificates including those for gas electrical; lift inspections, water and items of equipment. The health and safety file was well laid out with information easy to access, up to date and in order. The certificates and records confirmed up to date servicing and maintenance for all items inspected. The fire file was similarly maintained. There was a general fire risk assessment dated September 2006. Fire drills had been conducted at regular intervals including one for night staff. The numbers of staff attending varied depending on the time of day. The inspector was unable to assess if all staff had received fire training at least once in 12 months, however the Manager was fully aware of this. The Manager was also aware of the recommendation that night staff should be subject to four fire drills a year whist day staff need two. Induction training includes all of the statutory topics including fire and health and safety. All Shaw Healthcare staff are provided with this induction although there is sometimes a delay before staff attend this. In such cases the Manager must ensure that staff are instructed on manual handling and fire procedures on their first day. General health and safety was monitored during the tour including hot water temperatures, window restrictors and radiators, which were found to be satisfactory. The home has a designated health and safety officer who has completed training for this. A selection of resident’s finances, which were checked, were found to have appropriate supporting records for al transactions. Two staff signatures were in place, to confirm transactions, with receipts and petty cash vouchers as proof of purchase. These were securely maintained by the administrator. The quality assurance audits in some areas needed further attention particularly those items referred to in previous sections of this report. The Manager herself was aware of this. The two residents and three relatives spoken to felt that the home was being managed well and that they could approach the staff or Manager, if they had any concerns. Both residents were positive that they would be able to raise any concerns. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 25 The organisation has systems in place for monitoring the quality of the care provided. The CSCI has received very few Regulation 26 reports arising out of the monthly, unannounced visits conducted. This is subject to further correspondence. The Provider has been written to in February 2007 but no reports have been sent for a number of months. The Manager told the inspector that one had been undertaken just over a week ago but the report has yet to be provided. Please see requirement 10. Kingswood House DS0000063942.V334757.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 2 X x X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X x 2 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 X 3 x X 3 Kingswood House DS0000063942.V334757.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 OP3 Regulation 14 Requirement The Registered Manager must ensure that assessments made conducted prior to admission and are comprehensive in content The Registered Manager must ensure that care plans and supporting risk assessments are in place detailing all care needs. This requirement is repeated The Registered Manger must ensure that all medications are administered, stored and recorded safely and accurately. This requirement is repeated. The Registered Manager must ensure that residents are safely supervised 16 OP15 The Registered Manager must ensure that residents are provided with sufficient food and fluids to maintain hydration and nutrition status. The Registered Manage must ensure that all information relating to complaints is available, responses made within DS0000063942.V334757.R01.S.doc Timescale for action 30/06/07 2 OP7 15 30/09/07 3. OP9 13 30/06/07 4 OP12 12 30/06/07 5 30/06/07 6 OP16 22 30/06/07 Kingswood House Version 5.2 Page 28 7 OP18 8. OP29 13 18 the stated timeframes and record whether the complainant was satisfied with the outcome. The Registered Manager must ensure that all staff have a working knowledge of adult abuse and the reporting of such. The Registered Person must ensure that the required recruitment checks are made prior to employing new staff and those transferring within the company. This is a repeated requirement. The Registered Person must ensure that they provide staff with training specific to the needs of residents and that the there is a system for ensuring the training is implemented. The Registered Person must ensure that there is evidence of the visits required under Regulation 26. Copies of the reports must be maintained in the home and sent to the Commission. This is a repeated requirement. 30/06/07 30/06/07 9 OP30 18 30/09/07 10. OP33 26 30/06/07 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 OP22 Good Practice Recommendations The complaints procedure should be freely available in other formats such as large print. Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 29 Kingswood House DS0000063942.V334757.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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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