Inspection on 30/01/09 for Kingswood Lodge

This inspection was carried out on 30th January 2009.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kingswood Lodge 08/09/08

Kingswood Lodge 22/11/07

Kingswood Lodge 16/03/07

Kingswood Lodge 14/02/06

Kingswood Lodge 06/09/05

Kingswood Lodge 02/04/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

Extracts from inspection reports are licensed from CQC, this page was updated on 20/03/2009.

CARE HOME ADULTS 18-65 Kingswood Lodge 25 Railway Street Gillingham Kent ME7 1XH Lead Inspector Nicki Dawson Unannounced Inspection 30th January 2009 10:10 Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 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 Lodge DS0000028918.V373935.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 Adults 18-65. 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 Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kingswood Lodge Address 25 Railway Street Gillingham Kent ME7 1XH 01634 580797 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) Doson Ltd Manager post vacant Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 18. Date of last inspection 8th September 2008 Brief Description of the Service: Kingswood Lodge provides accommodation and support for up to eighteen adults with a learning disability. The home is located in the centre of Gillingham. It is a short walk from the high street and other amenities. It is close to the main railway station and bus services. The home is owned by Doson Ltd who own a number of other residential care homes. The home provides accommodation on three floors. There is a lift to the first floor. There are sixteen single rooms and one shared room. Residents have use of two lounges, an activities room and a dinning room. There are three bathrooms and a shower room. There is a garden to the rear of the home, some of which has been laid to lawn and another area that is paved and suitable for the wheelchair users. There is a small car parking area. At the time of the inspection the registered provider said that the current fee levels are £299.25 to £884.20 per week. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This service has been judged as providing Poor outcomes for residents. The inspection was unannounced, which means that the residents and staff did not know that the inspector was calling at the home. The inspection started at 10.10 am and took 8 hours. The main focus of the visit was to see if the home had made a number of improvements identified at the last inspection visit, just less than 5 months ago. Therefore the majority of time was spent looking at records to do with resident’s care and safety and talking with the appointed manager. Some discussion took place with residents and a senior carer to gain their views and knowledge of the level of care, provided by the service. The shared areas of the home and most resident’s bedrooms were entered. The registered manager of the home has resigned since the last inspection. The homeowner has appointed another person to be in charge of the home on a day to day basis. This person is not registered as a manager with us. This person will be referred to as the appointed manager throughout this report. Compliance to Requirements were assessed, those not met at this Inspection have been referred to the Enforcement Team. What the service does well: What has improved since the last inspection? Care plans are all up to date, with except of one that is missing. Care plans are person centred, explaining the care needs of a resident from their point of view. They now include residents communication needs and personal choices. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 6 There is a clear system in place for recording residents monies, so that it can be certain that any monies used on their behalf are spent in their best interests. The home has sought the advise of a number of healthcare professionals to make sure that they are meeting residents healthcare needs. The way that the home records complaints has improved so that this information can be used to identify any areas of the service that need to improve. The home environment has improved and no longer looks tired and worn in all areas. Parts of the home that have been repainted look bright and welcoming. The downstairs shower room has benefited from a complete refurbishment. New chairs, TVs, sensory equipment, and a Nintendo WII have all been purchased for the benefit of the people that live at Kingswood Lodge. What they could do better: One resident had no care plan so that there is no information to guide staff about how to care for this person. This means that staff have to rely on their memory to care for this person appropriately and do not have the details of how to get in contact with important people in this persons life. This is an unmet requirement from the previous inspection and we are now following our enforcement pathway. When assessed needs have been identified, there are not always clear plans in place for staff to follow to met residents assessed needs. This does not promote good healthcare for the people who live at the home and could put them at risk. This is an unmet requirement from the previous inspection and we are now following our enforcement pathway. There is not effective written guidance in place for staff to follow to keep a resident safe if they have an epileptic seizure. There is not effective written guidance in place for staff to minimise the occurrence of pressure sores developing, or the care needed if there is a break down in the integrity of a residents skin. This is an unmet requirement from the previous inspection and we are now following our enforcement pathway. There is no written guidance in place for staff to follow when medicines are prescribed to be taken as required or when changes are made to medicines by a GP. This can put residents at risk of receiving the wrong dosages of a medicine. Information in the home that is intended for residents, such as the Service User Guide and complaints procedure are written in a way that has little meaning to the people that live in the home. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 7 There are areas were identified during this inspection that could potentially place residents at risk of harm. These include scalding hot water and a potential lack of maintenance of the electricity and gas services supplied at the home. There is not an effective quality assurance system in place at the home. The service has failed to take the appropriate action to improve where poor areas of the service have been identified at the previous inspection. 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 Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard 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. No progress has been made towards giving people who are living at, or considering moving to Kingswood Lodge, information about the home, in a format that they can understand, so that they can decide whether or not it is the right place for them to live. Progress is being made towards staff being trained to care for residents specialised and individual needs. However, there is not always evidence that this training is put into practice for the benefit of residents. EVIDENCE: At the last inspection it was found that the aims and objectives of the home are set out in the home’s ‘Statement of Purpose’, but that information about the communal rooms available to residents was inaccurate and needs to be updated. The Statement of Purpose available at the home on the day of the inspection was dated 2005. It is inaccurate since it does not contain this updated information, nor the correct details of the person managing the home. It is required that the Statement of Purpose is kept up to date. At the last inspection it was stated that the information in the Service User Guide would be developed into a pictorial guide so that the document is Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 10 accessible to those people for whom the service is intended. The Service User Guide remains in its original format so that it has little meaning for the people that use or may plan to use the service. It is recommended that the format of the guide be changed so that it is meaningful to the people who live in the home. Information obtained from the local authority evidences that they are not currently placing any new residents in the home due to a number of concerns. The last time that a judgment was made around the quality of assessments was two years ago, when the standard was met. There is evidence that the home is not good at assessing the health needs of people who live in the home. (See section on individual needs and choices). The appointed manager said that he would develop a new assessment tool before any new residents were admitted to the home. Some residents in the home have specific care needs such as dementia, epilepsy, diabetes and autism. All staff have received a one day training course in how to care for people with dementia and the care of people with epilepsy. Others have undertaken training in learning disabilities, diabetes, and stoke awareness. Staff demonstrated that they have some understanding in how to identify and respond to the needs of people with epilepsy, but this was not evidenced in residents care plans. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the 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. Not all residents have care plans. Care plans do not contain clear instructions for staff to follow so that they can look after residents safely and residents cannot be sure that their needs will be met. Residents can be confident that their monies are spent in their best interests. EVIDENCE: There has been an improvement in the way that residents care plans have been developed. Each plan has been written from the residents point of view and these plans are referred to as person centred plans. The care plans each contain a life story, which contain important information about the residents past history, daily routine, personality traits and communication needs. The life story of each resident is a good piece of work and gives a lot of individual information about each resident, written in an easy to understand way. Each Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 12 person centred plan has sections so that the health, social and personal care needs of each resident can be identified together with any goals and areas of risk identified. The personal centred plans for four residents were looked at. One plan was missing and two plans contained insufficient guidance for staff and risk assessment around these residents healthcare needs. Neither a care plan to guide staff in how to care for a resident, nor any basic information such the residents next of kin, was available for one resident. An immediate requirement was made that an up to date plan of care be provided for this resident. The registered provider sent us an improvement plan after the last inspection. In this plan he said that procedures for managing epilepsy fits are in place at the home. However, for residents that have been assessed as having epilepsy these plans are not written in sufficient detail to guide staff. For example, the risk assessment for one resident that has epilepsy, states that all staff have had epilepsy training, have read and signed that they understand the guidelines for the administration of any medication needed and that any seizures are recorded. There is no procedure for staff to follow which guides them about what action they should take to make sure that the resident remains safe or when they should seek medical help. A requirement was made to address this shortfall at the last inspection, which has not been met. For a resident that has a history of suffering from pressure sores, the care plan states that the resident must be checked 2 hourly at night. There is no risk assessment in place to guide staff about what to do to minimise the risk of sores developing or the action to take if pressure sores should develop. A requirement was made to address this shortfall at the last inspection, which has not been met. For residents using cot sides, valid consent has been obtained from an appropriate health professional. This consent is needed or the practice could be seen as form of abuse, in limiting the person’s freedom of movement. It is good practice to also obtain consent from the residents next of kin. Care plans now contain residents choices and preferences. For example, one resident does not need a buzzer, but it is noted in their care plan that this person prefers to have one as it makes them feel safe. Each plan contains a list of likes a dislikes. Some residents use a communication passport, which helps them to communicate with other people. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 13 The home takes responsibility for the management of some residents monies. There has been an improvement in the keeping of these records. At the last inspection the records viewed were disorganised. Now there is a clear audit trail of outgoing and incoming monies with receipts so that it can be certain that residents monies are being used in their best interests. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are offered a range of activities, in and outside the home. Residents would benefit from an individual activity plan so that it can be sure that their needs and choices are met. Residents enjoy their meals. EVIDENCE: For residents to have the opportunity for personal development, their wishes, aspirations and goals need to be identified together with a plan of action setting out how to work towards them. There is evidence in residents care plans that this consultation has begun to take place. Some residents attend adult education classes and local day opportunities centres. One resident talked about their experience of this. In addition, the home has a dedicated room and support worker to provide activities for all Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 15 residents at home during the week. This is highly commendable. It is now clear from the staff rota that a support worker is allocated to the activity room all day Monday to Friday. Residents interests are now recorded in their care plans. However, there is still no programme showing what activities are on offer each day to match residents assessed interests. The appointed manager explained that this is because the activity support worker is required to assist with all residents personal care needs throughout the day and this takes him away from his main task. Also, many residents require one to one support for their chosen activities and there is only one support worker to do this. The number of hours a driver is available to take residents out shopping and to lunch has increased to every weekday and alternate weekends. However, currently there is only a driver available for half of this time. An outside activity organiser visits the home twice a week to offer aromatherapy and chair exercises. This was taking place during the inspection visit. Some residents attend a local club one evening a week. Residents have been provided with new plasma screen TVs in both lounges and a Nintendo WII. At the last inspection it was found that residents family members are encouraged to visit the home. On the day of the inspection the routines in the home were flexible. Some residents were in the activities room, some were watching television and some had chosen to spend time in their bedrooms. The menu is on display in the dining room. One resident said that she was offered a choice for lunch that she knew what she was eating that day and was looking forward to it. Work has begun to develop a pictorial menu for residents so that they can be enabled to make more choices. A cook is employed to prepare the lunchtime and evening meal during the week and alternative weekends. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the 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. Residents receive personal support in the way that they prefer. Residents health is placed at risk, since clear guidance is not in place for staff to follow to meet and monitor their assessed healthcare needs. EVIDENCE: There is now written guidance for staff to follow so that they can ensure that they offer personal support to residents in the way that residents prefer and require. For example, the preference for a bath or shower is recorded in each residents care plan. At the last inspection a number of areas of concern around the management of residents healthcare were identified. The registered owner sent us an improvement plan. In this plan he told us that all care plans contain information about the management of residents health care needs. However, whilst there have been improvements in some areas, a number of concerns identified at the last inspection have still not been addressed. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 17 As set out in the section, individual needs and choices there is no procedure in place for staff to follow to attend to the needs of people with epilepsy. The type of seizures that a person may experience is not recorded in their care plan. When a person does have a seizure the date and length of the seizure is recorded but not the type of seizure or a signature of the member of staff making the observation. It is important to know if the seizure is similar to others that the person experiences or if not, which member of staff to talk about this. As set out in the section, individual needs and choices there is no procedure in place for staff to follow to attend to the needs of people at risk of pressure sores. In the daily notes of one resident it was highlighted in red pen that an area of their skin was deteriorating. However, there was nothing in the daily notes of this resident the following day to say whether the area had improved or that further intervention was needed. The senior member of staff on duty on the day of the inspection did not know that about this concern, even though it had only taken place two days ago. This is evidence that not only is there no procedure in place for staff to follow if a person skin integrity starts to break down, but that there is not effective communication between staff to safeguard residents health. A requirement was made to address this shortfall at the last inspection, which has not been met, we are now following our enforcement pathways. At the last inspection there were concerns that a number of residents weights had reduced and no action had been taken to address this. In one care plan that was viewed it was recorded that a residents weight had reduced and a dietician had been informed. A nutritional assessment leaflet on healthy eating for reduced weight had been obtained and an assessment made in the care plan that this resident requires a balanced diet. There is evidence that the home have sought the advise of a number of healthcare professionals, including the district nurse, occupational therapist, physiotherapist and speech and language therapist. A new nursing bed has been obtained for one resident and staff commented that it is now easier to care for this persons care needs and more comfortable for the resident concerned. Consultation has taken place with the view to purchasing an overhead hoist for one resident and a nursing bed for another resident. More suitable eating equipment has been obtained for some residents so that they can be more independent. The home uses a pre-dispensed system for administration of medicines. This system is used to reduce the risk of residents receiving incorrect doses or Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 18 incorrect medication. Staff who administer medication have received training in how to do so safely. At the last inspection a senior carer said that he regularly assesses the competency of staff to administer medicines. However, there was no evidence that this competency assessment has taken place. There are no gaps in the medication administration record (MAR) indicating that residents receive their medication as prescribed by their GP. However, a member of staff has changed the frequency of one residents medication on the MAR sheet. There was no record of the name of the staff member who had made the changes or the reason for the change. Changes to medication can only be made by a qualified health professional. The appointed manager explained that the change had been made by the residents GP, but the details of this discussion had not been recorded or cross reference to the MAR sheet. It is required that this procedure is followed in future so that residents receive the correct dosage of their medicine. At the last inspection there were no written protocols in place for medication that is given when required referred to as PRN. Of particular concern was a PRN medication that requires staff to be trained by a specialist nurse before it can be administered safely. The registered person sent us an improvement plan stating that a procedure for PRN medication has been developed and that all staff dispensing medication have been briefed and a personal copy issued them. However, at the inspection there was no evidence that this procedure was in place. A record is now kept of which staff have received the necessary training, but not the agreed circumstances when this medication should be used. A requirement was made to address this shortfall at the last inspection, which has not been met, we are now following our enforcement pathways. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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 has a procedure for dealing with complaints, but it is not prominently displayed or written in a way that the people who live in the home can easily understand. Although staff have received training in how to protect vulnerable adults, evidence suggests that not all staff feel confident in blowing the whistle if any form of abuse has taken place. EVIDENCE: Neither the home nor the commission have received any complaints about the service since the last inspection, five months ago. At the last inspection the information kept on complaints received by the home was disorganised and it was not possible to establish a clear record of all complaints received, together with the outcome and any response made by the home to the complainant. There has been an improvement in the way that this information is now kept. The homes complaints procedure is not prominently displayed because it is in the conservatory, which mainly used by staff. The procedure is written in a way that is not easily understood by the people live in the home. It is recommended that the complaints procedure is given and/or explained to each resident in an appropriate format. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 20 The home has been subject to an ongoing safeguarding vulnerable adults investigation since December 2007. A new alert has been raised in respect of a recent incident reported by the appointed manager. He has shown that he knows what to do when he suspects that residents may have been placed in a potentially vulnerable situation. All, but two members of staff have received formal training in safeguarding vulnerable adults. At the last inspection staff said that they felt confident to report any potentially abusive incidents to a more senior member of staff or to follow the whistle-blowing procedure if this is needed. However, the circumstances of this recent alert are evidence that this is not the case in practice. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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 benefit from the improvements made to the decoration, furnishings, equipment and cleanliness of their home. Residents are put at risk of scalding by dangerously hot water being available and by checks not being in place to ensure that it is kept at a safe temperature at all times. EVIDENCE: Action has been taken since the last inspection to address a number of potential risks to residents. It was observed that trailing wires in residents bedrooms that could cause a tripping hazard have now been safely secured to the wall. Bedroom windows on the first floor are being replaced with windows that minimise the risk of residents falling and hurting themselves. The registered owner has informed us that the two fire doors in residents bedrooms that lead to a fire escape have now been alarmed to protect Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 22 residents. Residents are provided with call bells so that they can call for assistance when needed. When a call bell was activated during the inspection, there was a quick response for a member of the care staff team. At the last inspection the water temperature in one bathroom had been consistently recorded at a temperature that would feel cool for those using it. The temperature of this water was still cool on the day of the inspection. The hot water in the first floor bathroom was recorded on a bathroom thermometer as at a temperature that could scold anyone who uses it for a bath. No records could be found to show that the temperature of the bathwater is regularly checked to ensure that it is at safe levels. An immediate requirement was made with respect of minimising the risk of resident being scalded. There has been a major improvement to environment. At the last inspection there were a number of areas of the home that looked worn and tired. The home is currently being decorated. Areas that have been repainted look bright and cheerful. New furniture has been purchased for the second lounge. This no longer looks like a room used for meetings. It is bright and inviting and a resident was seen using the room on the day of the inspection. The downstairs shower room has been completely refitted with a new floor and shower chair. Staff commented that it is now easier for them to attend to residents personal care needs. The registered owner has informed us since the last inspection that he intends to provide wash hand basins in all resident bedrooms to meet the National Minimum Standards. One resident is currently without such an important facility. A number of residents bedrooms were entered and contain personal belongings that are important to the people to whom they belong. Each resident now has a single room and no one has to share. The service has demonstrated that it is gaining the advise of professionals to obtain the necessary specialist equipment for people that live in the home. The home has recently purchased specialist chairs, a nursing bed and has consulted a healthcare professional about the suitability of an overhead hoist. The registered owner has informed us that an occupational therapist has been also been consulted about the widening of a doorway on the ground floor to aid access for wheelchairs. There has been an improvement to the cleanliness of the home. The majority of the home was clean on the day of the inspection. The areas that are still not hygienically clean and unattractive are two toilets and a bathroom, which staff state are due for refurbishment. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 23 Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents benefit from being supported by a qualified staff team. Residents are protected by the staff recruitment practices in the home. EVIDENCE: The staff rota indicates that there is always three care staff on duty from 8am to 8pm. In addition an activities coordinator is available during the day. The staffing from 8pm to 8am has been increased from one waking and one sleeping member of staff to two waking night staff. A cook is employed during the week to cook the lunchtime meal and teatime meal and alternate weekends. There are two part-time drivers who provide a service each week day and alternative weekends. There is also a handyman and some cleaning hours provided. At the last inspection visit 90 of staff were trained to NVQ level 2 or above. This high percentage is commendable. This award is useful because it helps staff develop good care practices and their skills in working with people who live in a residential care home. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 25 At the last inspection two staff files for care staff could not be found. A staff file is now available for all staff employed at the home. Three staff files were viewed and contained all the relevant checks and documentation showing that the recruitment process followed protects the people that live at Kingswood Lodge. Only one of the staff files contained a photograph of the member of staff and this copy was of such poor quality that the person was not identifiable. It is required that all staff files contain an identifiable, recent photograph. Care workers need to undertake a number of training courses that develop their skills in caring for the people that live in the home. A staff training matrix has been developed which identifies the training that each member of staff needs to achieve. There are very few gaps in this record indicating that most staff are currently up to date with their mandatory training. The appointed manager said that he is currently arranging fire training, which is due for all members of staff. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the 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. Residents benefit from the management style, which is open. The overall management of the home remains ineffective in keeping residents safe and ensuring that they receive a quality service. EVIDENCE: There has been a change in the person who is responsible for the day to day running of the home. A new manager has been appointed who is not yet registered with us. He has been employed at the home for one month. The appointed manager has told us he has twenty years experience of working with adults with a learning disability and eight years in a management role. He has achieved NVQ 4 in Care and the Registered Managers Award. These awards are recognised by the commission to be useful because they help people who Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 27 manage residential care services to have the competencies that are necessary to do so. Staff, who were spoken to were very positive about management style of the appointed manager. One member of staff said, there has been a change of atmosphere since (the appointed manager) has come to the home. He listens……There have been a lot of changes and they have all been for the better. The appointed manager was open and cooperative throughout the inspection and showed that he is aware of the large task ahead of him to make the necessary improvements to the service. At the last inspection the registered owner stated that he is awaiting feedback from relatives before he compiles a report of the views of residents and relatives about the level of care provided at Kingswood Lodge. There is no evidence that such a report has been compiled. The appointed manager said that the registered person and a representative of the company regularly visit the home to monitor the quality of the service. He said that he has seen the reports that are written about these visits, but they could not be found on the day of the inspection. It can be seen from the number of statutory requirements that have not been met since the last inspection, that these visits are not effective in ensuring that the home provides a good level of care. It is required that an effective quality assurance system is in place for the home to run in the best interests of residents. Poor practices in relation to care planning, risk assessments, supporting health needs and appropriate guidance for staff in relation to PRN medication were evidenced. Statutory Requirements made at the previous inspection in these areas have not been complied with, despite information provided by the Provider in an Improvement Plan to CSCI that these had been addressed. These areas are now subject to our enforcement pathways. At the last inspection the fire log and a fire risk assessment could not be found. Evidence was seen at this inspection that an outside company has recently maintained the fire system. However, it was noted that regular checks by the home of the fire system and fire fighting equipment had not taken place between October 2008 and December 2008 and had only commenced in January 2009. The maintenance folder was viewed. It contained a note from the registered owner to the appointed manager, serious problems in maintenance contracts. Please take action as per my notes on an urgent basis. The notes stated that the maintenance of gas, and electricity in the home have been undertaken, but that this cannot be certain as the certificates of the services cannot be found. The notes also state that there are no records of weekly nurse call system checks. The appointed manager said that due to other responsibilities he has Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 28 not had time to ensure that all items of equipment in use in the home remain in good working order. It is required that the maintenance of the home is given more priority. Effective environmental risk assessments have not been completed to make sure that any potential risks to residents have been minimised. Residents are at risk of scolding themselves on very hot bathwater. A staff training matrix identifies that most staff are trained in the necessary areas. Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 X 1 3 1 2 1 2 X Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 30 Yes 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 YA6 Regulation 15 (1) Requirement The registered person must ensure that each service user has an up to date plan of care as to how their needs in respect of his/her health and welfare are to be met. A written response as to how this will be achieved must be provided to the Commission by the date given The registered person must ensure that service user plans are in sufficient detail to provide clear guidance to staff on the action to be taken to meet their health, social and personal care needs. Previous compliance date 08.12.08. This has been referred to enforcement pathway. The registered person must ensure that there is clear guidance for staff in how to minimise any risks to residents, which are identified in the care planning process. Previous compliance date DS0000028918.V373935.R01.S.doc Timescale for action 09/02/09 2. YA6 15 (1) 20/03/09 3. YA6 4 (c) 20/03/09 Kingswood Lodge Version 5.2 Page 31 08.12.08. This has been referred to enforcement pathway. 4. YA19 12 (1) (a) The registered person must 20/03/09 ensure that written records are kept of all service users assessed healthcare needs, together with the action that staff need to take to closely monitor these assessed needs. Previous compliance date 08.12.08. This has been referred to enforcement pathway. The registered person must ensure that written guidance is in place for the safe to administer all PRN medicines. Previous compliance date 08.12.08. This has been referred to enforcement pathway. The registered person must ensure that there is a clear procedure in place for when a healthcare professional makes changes to the name, dosage or frequency of prescribing a resident’s medication and that staff follow this procedure. 20/03/09 5. YA20 13 (2) 6. YA20 13 (2) 20/03/09 7. YA27 13 (4) (a) The registered person must 09/02/09 ensure that residents are not put a risk of scalding when taking a bath. A written response as to how this will be achieved must be provided to the Commission by the date given. The registered person must establish and maintain an DS0000028918.V373935.R01.S.doc 8. YA39 42 (1) 20/03/09 Kingswood Lodge Version 5.2 Page 32 effective system for evaluating the quality of the service. 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 YA1 Good Practice Recommendations The service user guide should be written in a format that residents’ can understand and made available to each resident The complaints procedure should be written in a format that residents’ can understand and be prominently displayed in the home. Each resident should be provided with a wash hand basin in their bedroom. 2. 3 YA22 YA26 Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kingswood Lodge DS0000028918.V373935.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!