Inspection on 09/06/06 for Kingswood House

This inspection was carried out on 9th June 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kingswood House 24/04/08

Kingswood House 30/04/07

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 Wendy Owen Key Unannounced Inspection 09:00 9TH June 2006 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.V288655.R01.S.doc Version 5.1 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.V288655.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kingswood House Address Mays Hill Road Shortlands Bromley Kent BR2 0HY 020 8460 0273 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 ** Post Vacant *** Care Home 41 Category(ies) of Dementia - over 65 years of age (15), Learning registration, with number disability over 65 years of age (1), Old age, not of places falling within any other category (25) Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th December 2005 Brief Description of the Service: Kingswood House is one of 6 homes which from April 1 2005 have seen a change in the registered provider to 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 service users at present. It has been developed over the last few years into a respite unit providing care to elderly service users and a small number who have a diagnosis of dementia. This year has seen the development of a unit for permanent residents who are physically frail. Residents placed in the home are admitted via the social services departments referral and placement system. The accommodation at Kingswood is set on 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 home has a Manager, Deputy Manager, support staff and a team of ancillary staff. The Home’s kitchen provides a catering service to another residential Care Home in the area. The building itself is owned by the London Borough of Bromley, which means the Home has to approach the landlord for any issues relating to the premises and the grounds. The fees are the contracted prices for the London Borough of Bromley set between £434.68 and £543.80 dependent on whether the resident is being placed on the physically frail or dementia unit and whether the resident is funded by the Local Authority, self funded or a private placement. 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 Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 5 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.V288655.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the course of two days with two inspectors taking 10 hours to complete the site visit on day one and a Pharmacy Inspector visit on day two. The inspection process included undertaking of relative and service user surveys; discussions with staff, Manager and Deputy Manager, tour of the premises and viewing of a number of records. What the service does well: The home provides a clean, homely and comfortable environment. The laundry also provides a laundry system that takes pride in the way clothing is laundered, although there are occasions when items have been mislaid. The pre-admission procedures provide opportunities for prospective residents to visit the home with their relatives or representative and for staff to discuss their needs, as well as viewing the environment. There are systems in place for monitoring and auditing the quality of care. The current management of the home is more organised and aware of the shortfalls in a number of areas. The management team have a positive approach to ensuring these areas are improved and are open to advice and guidance. Feedback, in general, was positive with a number of residents saying they are well cared for: A resident on one of the units stated that; “Staff are attentive and cheerful”. Whilst another resident said; “I think the staff are very fair and I’ve been lucky to stay here. I’m really happy here. I wish my husband was alive to see this place. He’d approve”. There was also good feedback regarding the meals provided which are nutritious and varied with some choices available and served in a pleasant and relaxed environment. The organisation provides all new staff with a four-day induction training which takes place outside of the home environment. This is comprehensive and covers the areas required by the Skills Sector Council for inducting of new Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 7 staff. Some of the core training is provided each year to enable staff to update themselves in key areas. What has improved since the last inspection? What they could do better: Whilst pre-admission procedures allow for prospective residents to visit the home providing staff with the opportunity to assess the individual’s needs, there has been little progress in the completion of the assessment, care plan and risk assessment records. The home also has limited information provided by the placing authority. This must be improved as it presents potential risks to residents’ health, safety and well-being. The recent inspection showed that there has been an improvement in the way medication is being administered. However, further improvement is required to minimise risks to residents as far as reasonably practicable. Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 8 The feedback from resident and relatives showed mixed feedback regarding the competency, quality, knowledge and attitude and approach of residents. Three residents comments reflected the following: “Some (staff) are helpful some aren’t. Depends who is on duty.” “I talk to staff about things I want and sometimes they don’t answer.” The inspectors also found that, despite training being provided, some staff have difficulties in turning their newly acquired knowledge into practice within the home environment. The training and attitude and approach of staff must be addressed by the Manager to ensure residents receive consistent, good quality care. Whilst an activity co-ordinator is employed in the home, previous reports have highlighted that residents do not feel stimulated and there are limited activities on offer. There continues to be mixed feedback and now, especially with permanent placements being made this must be addressed. There has been some progress regarding the recruitment of new staff with essential checks being made including the Criminal Records Bureau and Protection Of Vulnerable Adults Register and with some minor improvements. Healthcare Ltd 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. Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 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 Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service have adequate information about the home in order to make an informed decision about whether the service is right for them, although choice is restricted due to the agreement between the Local Authority and the Provider. The pre-admission assessments procedures, whilst good in some areas do not provide staff with enough information to ensure residents receive the full care and support to residents. EVIDENCE: The Statement of Purpose and Service Users Guide is currently being updated in relating to the registration categories and numbers. Service Users Guides are available in residents’ bedrooms. One resident who had recently arrived was seen reading the “Guide”. The resident and others had visited the home prior to admission and discussed their needs with a member of staff in the home. One relative wrote that: “On the fist initial visit we went over what his requirements are. The home’s procedures are comprehensive with information Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 11 from the Care Manager and the home’s assessment to be completed before admission. However, the home does not always fully implement these procedures. The written information in respect of the residents’ needs was limited in many cases, especially in relation to the Care Manager assessments. This was not always enough to provide staff with the basic information they need to determine whether they are able to meet residents’ needs. Some assessments had not been reviewed since previous visits. (See requirement 1) There was evidence of some residents receiving and completing the contract provided by Shaw Healthcare Ltd. There was mixed feedback from residents regarding the information provided and the provision of a contract. The home should review what information is provided prior to admission and how this is provided to prospective residents. (See recommendation 1) Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improving, the variable practice regarding the planning and delivery of care and medication recording means that all residents cannot be sure that their health and personal care needs will be fully met. EVIDENCE: Conversations with staff showed that they had a satisfactory understanding of the residents’ needs and the surveys completed by residents and relatives provided evidence that, in general, they felt that they received adequate care and support. However, there were a number of comments about the variability of staff and the care provided. One resident said that, “it depends on how busy they are.” Whilst another said “it depends on whose on duty.” Another said that staff “Are attentive and cheerful.” Residents on all the units looked well presented and well groomed with attention to detail such as make up, jewellery and hair groomed. Staff Records showed that Shaw healthcare Ltd has a comprehensive system for developing care plans and risk assessments. However, this is not being fully utilised and does not reflect the care and support required to meet the residents’ health, welfare and social needs. In some cases there were written assessments but no care plans, whilst in others there was some evidence of a Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 13 care plan being commenced. Where falls, pressure care and nutritional assessments had been completed, in some, there was no further information on how these risks were being addressed or minimised. In one, the risk assessment for wandering was limited and inappropriate terminology used i.e. “ Supervision at all times”. This would not be manageable unless the resident was on one to one care, which she was not. This assessment was dated 17/02/06, as were all the others. This was also true of the records in relation to a resident who had been admitted with diabetes. However, the member of staff did show an understanding of her needs. Very few relatives or residents were aware of a care plan or the reviewing of the residents’ needs. (See requirement 2) The daily records, care plans and supporting documentation show limited information relating to the healthcare accessed on behalf of residents, except for DN, GP and hospital appointments. However, as many of the residents are admitted on respite access to NHS healthcare such as Dentist, optician and chiropody is not required. The Manager is aware of the need to access such healthcare for permanent residents and has commenced referrals to a number of healthcare professionals. Recent complaints have highlighted that staff do not always recognise or take action where there may be health concerns. This is also linked to the comments regarding the training of staff in basic health and care practices. The Manager and Area Manager are aware of these issues and are currently trying to address them. There is no evidence of weights taken on admission but some evidence of weights being recorded for the longer stay residents. (See requirements 2 & 3) In general dates and signatures were absent and reviews overdue. The pharmacy inspector found that overall the management of medicines had improved since the last inspection particularly in relation to policies and procedures and record keeping. The policies and procedures relating to medicines had been reviewed and amended as required by the previous inspection apart from the procedure for leave medicines which still stated that staff could re-dispense medication which is against NMC guidelines. Medicine policies and procedures were available on each floor for staff to refer to and staff were audited on their adherence to the procedures regularly which allowed any deviations to be noted and addressed. Medicine records of receipt, administration and disposal were seen for all residents and were found to be clear and without gaps but administration records did not record the amount actually given if a variable dose was prescribed. This was a requirement of the previous inspection. Medicine records for three residents were checked against supplies of medicines available to determine the accuracy of the records. Records were found to be Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 14 accurate for two of the residents, but for one resident the quantities of medicines remaining from the records did not correspond with the amounts actually available. For two medicines the quantities remaining were greater than those calculated from the records, possibly indicating that one or two doses had not been administered but had been recorded as such. One of these medicines was an antibiotic which should be given regularly in order to be effective. For seven medicines the quantities remaining were less than those calculated from the records possibly indicating that one extra dose had been administered but not recorded. Alternatively there may have been errors in the records of receipt for the medicines for this resident. Staff were asked about these discrepancies but could not explain them. The resident was confused and could not give any information relating to this. Storage of medicines was good and medicine trolleys and cupboards were clean and tidy. The temperature of the refrigerators was monitored and recorded but the thermometer available did not measure minimum and maximum temperatures so the records only related to the point in time when they were made. If the refrigerator had gone out of range at another time it would not have been noted or acted upon and therefore medicines may have deteriorated. The previous three inspections have required that a minimum and maximum thermometer is obtained for each medicine refrigerator and the minimum and maximum temperatures are recorded as well as the temperature at the time of recording. Supplies of medicines were obtained from Boots pharmacy and were packed in a monitored dosage system which allowed staff to check easily whether a dose had been administered or not. However, one medicine was found without the appropriate warning on the label regarding administration in relation to food. As a result this medicine had been administered at breakfast time which would result in reduced effectiveness. One service user was self administering medicines following a risk assessment, but the frequency of monitoring compliance was not stated and monitoring was not documented. Therefore it was not known whether he was taking his medicines correctly. Another service user was to start self administration of inhalers but the inhalers were found on the bedside locker in the resident’s room as a lock had not been fixed to the resident’s bedside drawer. As the room was not kept locked the medicines were therefore not secure and accessible to other residents. (See requirements 4-7) The home seemed calm and well managed. Staff attended to residents in a caring polite manner. Throughout the visit the inspectors observed service user’s being treated with respect and dignity. This was also confirmed by the majority of relatives who provided feedback to the inspector. Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 15 Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A limited range of activities within the home and community mean the service users do not have a range of opportunities to participate in stimulating and motivating activities. Meals and mealtimes are good with residents enjoying the quality of food and the social interaction. The Manager has showed a good understanding of the areas of weakness and there is a good capacity for the service to improve. EVIDENCE: Residents spoke of flexible routines with early morning routine of tea and biscuits. There was evidence of choices during the day in respect of how residents wished to spend their day. Feedback from relatives expressed concerns over the lack of activities and stimulation in the home and mixed feedback from residents regarding activities with most written feedback showed that the residents said there were usually activities but they chose not to participate. The validity of the feedback should be treated with some caution with the activity co-ordinator assisting with their completion. Viewing of supporting records showed limited information on residents’ involvement in activities. On unit three, interaction between residents was spasmodic with very limited interaction between the agency Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 17 member of staff. Within the top floor unit there was good evidence of well being, in so much, as residents were engaging with one another the staff and the inspector. Staff spoke of the Pat a Dog visit once a week, church services once a month and hairdresser once a week. However, there was little evidence of any other activities, entertainment or outings. (See requirement 8) The feedback relating to the meals provided was positive, both in written and verbal communications. This was evidenced during observations made at breakfast and lunch time periods. Tables were well laid out and pleasant. Choices were available and offers of second helpings heard by the inspector. Choices of drinks were also offered during the mealtimes and the course of the morning. However, records of the foods taken must be made clear in the residents’ records, especially where there are issues relating to the nutritional needs of residents, for example poor appetite and special diets such as a diabetic diet. (See requirement 9) The Environmental Health visit of February 2006 gave the home two gold stars for main kitchen and satellite kitchens showing good systems in place. All relatives who provided written feedback said that they felt they were welcomed into the home and are able to visit at any times. Visitors can be seen in residents’ private rooms or in any one of the communal areas which afford some privacy during parts of the day. The majority of the home provides short stay accommodation and therefore the bedrooms provide the furniture and furnishings to meet these needs. It would neither be realistic or reasonable to expect residents to bring in furniture etc for the period of their stay. However, the admissions of permanent residents on one unit should now take into consideration the needs of the residents and enable furniture and possessions to be brought into the home, if the residents wish. (See recommendation 2) Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are some robust systems in place to ensure residents feel listened to and protected. EVIDENCE: Shaw Healthcare Ltd has developed good procedures in relation to the management of complaints and the protection of vulnerable adults. The investigation of complaints has improved over the last six months, although there are some further improvements which would be of benefit. For example, the date the investigation report was completed should be included on the investigation report and complaints should be investigated within the required timescales or the complainant contacted with the reason for the undue delay. (See requirement 10) Discussions with the Manager showed that she is aware of what is required to manage complaints, including visits to the complainant, where it is required and introducing herself to new residents to enable them to put a name to a face should they wish to discuss any concerns. The residents have access on how to make a complaint within the Service Users Guide and feedback from residents confirmed that they generally knew who to complaint to. The complaints procedure should be made available in other formats including large print etc to enable everyone to complain or make suggestions for improvement. (See recommendation 3) The home has a number of complaints since December 2005. The complaints have generally been referred to the home from Social Services to enable the home to undertake the enquiry. The complaints are, in the main, related to quality of care and basic care practices. The Area Manager is aware of the Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 19 issues and, along with the Manager and Deputy Manager, is trying to address these issues with staff. Up until recently only one resident in the home had permanent residency and is therefore the only resident who had been entered onto the electoral register. The home is aware of the need to ensure those residents recently admitted on a permanent basis are also entered onto the register. The home also has good adult protection procedures with staff provided with information on this during induction training sessions. The organisation has been robust in its management and investigation of incidents which have been raised, as a concern, by staff and others associated with the service. Staff spoken to had a reasonable understanding of what constitutes abuse and what they would do if they saw any incident of abuse. Staff would also benefit from an understanding of the wider scope of referring incidents to other agencies such as Social Services, police and the Commission. The home is currently investigating an allegation made by a member of staff and the appropriate actions has been taken to date. Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The maintenance and renewal of equipment and facilities mean that service users are protected from equipment that may be unsafe. The condition of the décor and fixtures and fittings is good which means that service users live in a clean and comfortable environment. EVIDENCE: There has been some good progress in relation to the decoration and refurbishment in some areas of the home. The reception area and ground floor corridors provide a clean, fresh and airy feel with the dining/lounge area also redecorated and new flooring. The kitchen on the unit has also been refurbished to provide much fresher look. The Manager is still awaiting further work, including the provision of coffee tables, pictures and the fitting of a hearth to make the area more homely. There is an ongoing programme of works, which includes updating of baths within bathrooms. Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 21 The lower ground unit was of an adequate standard and would benefit from a change of furnishings such as curtains. The bedrooms were of a good size and were adequately furnished with new beds replacing metal frame beds and adequate furniture in place. However, the TV in Room 334 was not working and should be repaired without delay. (See requirement 11) The Manager must note the comments made previously regarding the unit admitting permanent residents and the choice of bringing in their possessions and furniture to the home. It was good to note that all windows were open to give fresh air on this rather hot day. All residents who fed back to the inspector thought the environment was good, fresh and clean and that their rooms suited their needs. The WCs and bathrooms were located close to private and communal spaces throughout the units and were fitted with soap and hand towels with evidence that Parker baths had been serviced. One of the baths was not in use due to the need to fit new seat. The Manager said that this is hand. The laundry area was well organised and items very well laundered. Washing machines had a sluice facility and disposable bags were available for soiled or infected laundry items. All staff are provided with infection control training during the four-day induction by Shaw Healthcre Ltd. A supply of gloves and aprons were available throughout the home. The laundry assistant had a sound knowledge of infection control within the laundry environment and kitchen staff all had food hygiene training. Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff knowledge and understanding of the care needs of residents is variable. Whilst training is provided some staff have difficulty in transferring this knowledge into practice which means that all residents cannot be sure that their health and personal care needs will be fully met. With a little improvement in recruitment practices the home will have robust checks in place to protect vulnerable residents. EVIDENCE: The Inspector received mixed feedback regarding the attitude, knowledge and competency of the staff within the home. Feedback also commented on the number of agency staff and the negative effect this has on the standard of care. This variance was confirmed through the discussions with staff and management and through viewing of the complaints made. The home must address these staffing issues to ensure all staff members are providing a consistent quality of care. There have been some agency staff working within the home, although the records show that the home has domestic and laundry vacancies and only a few support workers and team leader post still vacant. The home has also increased the staffing levels recently in light of the changes to the ground floor unit. However, the new staff levels during the day have not yet been implemented due to small number of residents on the unit. This leaves residents unsupervised at times which may also may be a factor to be taken Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 23 into consideration in some of the comments made by residents regarding staff presence and lack of attention at times. One relative stated that on the unit there was “often no-one about at all….” (See requirement 12) Three care staff met with the inspector. Each had been in post for some time. Staff confirmed that they had received the company induction and other training. One staff member stated that she had received training in dementia, report writing, care planning and continence. The staff member demonstrated a reasonable knowledge on care practices including continence, pressure sores and infection control measures. The second staff also confirmed that she had attended the company induction and other training sessions. She had attended a two-day dementia course, manual handling, COSHH and fire training. She had a reasonable knowledge of the topics, although needed prompting with elements of care required by dementia suffers. A third member of staff had received induction and training in relation to the care of older people, equality and diversity but felt that training in dementia; Parkinsons’ Disease, diabetes and catheter care would be beneficial. One member of staff who commenced in the home on 2/3/06 was on this day attending a four-day induction. The training matrix provided confirms regular updates in core training and showed of 36 members of care staff 14 had received some kind of dementia training. The issue appears to be that staff have not been able to put into practice the knowledge from training attended. Training for team leaders include supervising staff including also working in partnership with relatives, ethnicity and diversity, leadership skills for team leaders. (See requirement 13) Out of thirty care staff there are currently thirteen with NVQ 2 and 4 with NVQ 3. Viewing of four staff files showed recruitment procedures to be adequate with no staff member commencing employment until satisfactory police and POVA checks received. References are obtained also. However, improvements must be made in ensuring application forms and references are checked more vigorously to ensure full and accurate information has been provided. (See requirement 14) Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements are identifying the shortfalls in meeting the needs of the service, and the quality of the service is improving. EVIDENCE: The home has seen a succession of managers over the last few years. The current Manager has been in post since February 2006 with the deputy in post for a little longer. The Manager has begun the process of making an application to the Commission in relation to her registration. The Manager has had a number of years experience of caring for older people as a carer and deputy manager. She has the NVQ 4 in care and is currently undertaking the Registered Manager’s Award. It is positive to note that the Manager and deputy manager are aware of the shortfalls in a number of areas and are Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 25 trying to address these. They are open to advice and guidance on how improvements could be made. The Manager monitors the health and safety of the residents and staff through regular servicing of equipment, undertaking of regular fire drills and the induction of new staff to ensure they provide safe environment. However, the fixed wiring remedial work and the servicing of the lift every six months must be undertaken and more information is required in relation to the fire drills to include times and names of staff attending. (See requirement 15 & 16 & recommendation 4) The organisation has a system in place to monitor the quality of care through regular audits which includes resident and relative surveys. There is some work to be done by the Manager to ensure information provided is clear and current. It is positive to note that Managers from other Shaw homes are undertaking the audits. The monthly visits, required to be undertaken by the Provider, have been more regular than in the past. However, there are still gaps in the reports held by the home and received by the Commission. Whilst the Manager states that these have been completed there is little evidence of the visits taking place over the last few months. The reports to date have reflected the issues and areas for improvement. (See requirement 17) The Manager has also produced a business plan for 2006/07 and the organisation is looking to be successful in achieving Investors in People accreditation in September 06. Staff induction incorporates core training which is then updated each year in relation to infection control; moving and handling; adult protection, food hygiene and first aid. The Manager recognised that staff have not benefited from regular supervisions but is addressing this. There are systems in place for supervisory responsibilities and staff who are responsible are provided with training, except the cook, who has to supervise kitchen staff. (See recommendation 5) Four residents monies were audited. Three residents had no money retained in the home. One resident’s records were inspected. The money itself was correct against the balance sheet. Any deposits of large amounts of money are paid into Shaw central accounts. It must be confirmed that the individual resident obtains any interest due to them. (See recommendation 5). The inspector noted that a recent independent audit of the financial arrangements showed them to be satisfactory with some recommendations for improvement. All money is returned to residents by way of cash payment unless otherwise requested. Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 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 2 3 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 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 3 18 3 3 3 3 x 3 2 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 x 3 1 x 2 Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 27 No Are there any outstanding requirements from the last inspection? 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 Person must ensure that service users admitted to the home are fully assessed prior to admission and a record of the assessment maintained by the home. Previous requirement with timescales of 01/09/05 and 1/1/06 expired The Registered Person must ensure care plans are developed for all service users admitted to the home. The care plans must reflect the needs of the service users. This is an outstanding requirement with the timescales of 01/09/05 & 1/02/06 expired. The Registered Person must develop risk assessments for any areas of identified need including pressure care. The risk assessment must record the appropriate action to minimise the risk. This is an outstanding requirement with the previous timescales of 01/09/05 & 1/2/06 expired DS0000063942.V288655.R01.S.doc Timescale for action 01/08/06 2 OP7 15 01/09/06 3 OP8 13 01/08/06 Kingswood House Version 5.1 Page 28 4 OP9 13 The Registered Person must ensure policies and procedures for leave and for verbal orders are reviewed and revised in line with NMC guidelines. (This was a requirement of the previous two inspections). Current policies are clearly identified and readily available to staff 01/09/06 5 OP9 13 01/09/06 The Registered Person must ensure all medicines are listed on administration records including those administered by the district nurse. Directions hand written onto administration records are checked and initialled by a second member of staff (This was a requirement of the previous two inspections). When variable doses are prescribed, the amount actually administered is recorded. (This was a requirement of the previous two inspections). Administration records are complete without gaps. (This was a requirement of the previous two inspections). If service users have more than one administration record this is clearly marked at the top of each record sheet. The Registered Person must 01/08/06 ensure photographs are available for each service user. A minimum and maximum thermometer is obtained and positioned correctly in each refrigerator. The minimum, maximum and current temperature is recorded daily. (This was a requirement of the previous two inspections). 6. OP9 13 Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 29 8. OP12 16 The Registered Person must ensure that appropriate activities take place for service users and a record of these activities must be made. Timescale expired 1/4/06 The Registered Person must ensure that the home maintains a records of food provided to residents. The Registered Person must ensure that the home maintains full records of complaints made. These must be dated and signed. The Registered Person must ensure that the TV in room 334 is repaired. The Registered Person must ensure appropriate staffing on all units and that residents are monitored and supervised. The Registered Person must ensure that they provide staff with training specific to the needs of residents and that the there s a system for ensuring the training is implemented and quality of care improved. The Registered Person must ensure that the required recruitment checks are made prior to employing new staff. Previous timescale of 01/01/06 has expired. The Registered Person must ensure that the lift is serviced every six months as required under LOLER. The Registered Person must ensure that the remedial work required in relation to the fixed wiring is completed. The Registered Person must ensure that there is evidence of the visits required under Regulation 26. Copies of the DS0000063942.V288655.R01.S.doc 01/09/06 9 OP15 17 01/09/06 10 OP18 22 01/09/06 11 12 OP24 OP27 23 18 01/07/06 01/09/06 13 OP30 18 01/09/06 14 OP29 17 01/08/06 15 OP19 23 01/07/06 16 OP38 23 01/08/06 17 OP33 26 01/08/06 Kingswood House Version 5.1 Page 30 reports must be maintained in the home. 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 2 3 4 5 6 Refer to Standard OP2 OP14 OP22 OP38 OP36 OP35 Good Practice Recommendations The home should check that all residents or their representatives are receiving information on the terms and conditions of residency on admission to the home. The Manager should ensure there are systems in place to enable residents to bring in furniture and personal belongings in to the home. The complaints procedure should be freely available in other formats such as large print. Fire drill records should be completed with full information including names and signatures of staff and time fire drill took place The Manager should arrange supervision and appraisal training for the Cook. There should be clear accounting of residents monies’ held by the home, including the apportioning of interest according to individual amounts held. Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kingswood House DS0000063942.V288655.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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