CARE HOMES FOR OLDER PEOPLE
Kingswood Park Kingswood Road March Cambridgeshire PE15 9RT Lead Inspector
Don Traylen Unannounced Inspection 10:00 24 November 2006
th 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 Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kingswood Park Address Kingswood Road March Cambridgeshire PE15 9RT 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) 01354 652381 01354 660304 home.mar@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged Mrs Sumiyo Berkeley Care Home 44 Category(ies) of Dementia - over 65 years of age (18), Learning registration, with number disability over 65 years of age (2), Old age, not of places falling within any other category (44) Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Staffing levels must not fall below 7 care staff from 7.30am - 10pm and 3 waking night staff throughout the night. 21st October 2005 Date of last inspection Brief Description of the Service: Kingswood Park is a spacious care home situated in a quiet residential area of the town of March in the Fenland area of North Cambridgeshire. The care is provided by Methodist Care Homes, who entered into a partnership agreement with Hereward Housing Association, after Cambridgeshire County Council sold the home in November 2001. Methodist Homes provide the care and lease the property from Hereward Housing. The home is registered to provide for 44 elderly people. Included in that number are a maximum of 18 people with a formal diagnosis of dementia and 2 people who have a learning disability. The home is divided into 5 units: Cherry, Redwood, Rowan, Maple and Willow. Each unit has 8 or 10 bedrooms, a dining room, a lounge and a kitchen. One unit is designated for people with dementia and another unit is for service e users with high dependency needs. These two units are accessed via a door with a combination lock. All bedrooms and the deputy manager’s office are on the ground floor of the building. The managers office, the administration office, a staff meeting/training room, staff toilets and a relaxation room and staff kitchen are situated on the first floor. A large central room on the ground floor is used for a community Day Centre provision. The Day Centre is staffed as an independent provision, separate from the homes staffing arrangements. Fees charged by the home at the time of inspection ranged between £340 per week, to £511 per week. The lower amount being the lowest funding provided by Cambridgeshire County Council and the higher rate being the fee charged for private funding individuals. Cambridgeshire County Council also fund service users with extra care needs, at a rate of £460 per week. On the day of inspection of inspection there were 37 service users living in the home, 6 of whom were funding their care privately and the remainder were part funded by the local authority/Primary Care Trust. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection was an unannounced visit to the home and commenced at 10.30 am and was finished at 15.30pm. The inspector spent approximately half of the time with service users and observed their care and sat and ate lunch with the service users in the extra care unit. Three visiting relatives were spoken to and asked for their opinions about the home. One care assistant was asked for her perceptions of the home and one of the deputy managers was observed carrying out her care tasks during the day. Care Plan and assessment details for three service users were read. The policies and documents for ensuring safety is maintained in the home were read. A discussion with the manager took place and feedback was given at the end of the inspection. On the day of inspection of inspection there were 37 service users living in the home, 6 of whom were funding their care privately and the remainder were part funded by the local authority/PCT. Feedback was given to the manager at the end of the inspection. What the service does well:
The home is very spacious and seems to have a relaxing atmosphere and allow for private areas and space. Because of this spaciousness the inspector was able to talk freely with service users and relatives in private and without interruption. The home is very clean and mostly bright and well maintained. The manager stated that making requests and arrangements for the maintenance to be carried out is not usually a problem and the response by Hereward Housing to aspects of the maintenance they are responsible for, is usually prompt. New paths in the enclosed rear garden area have been completed. Some bedrooms have been redecorated and fitted with replacement carpets. These are ongoing redecorations that occur as rooms become available. There were no noticeable unpleasant odours on the day of inspection. The home has employed an extra member of care staff during the mornings between 8 am and 10:30 am. The home also has two activities workers who work a total of 25 hours a week over five days each week, although these hours can vary according to a flexible working pattern. The home seemed to utilise her well so that she had a period to spend time with individual and small
Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 6 groups of service users in each unit. Sessions include drawing and craftwork and quizzes. It was refreshing to see there were no TVs on throughout the home and the care staff and the activities worker were spending time with the service users doing ordinary and did not appear to do this in an exaggerated or false manner. A cook and three domestic cleaners are employed each day. The home has promoted consistently good practice by their willingness to protect service users by reporting every incident that was considered as abuse. Many instances have been reported to the PCT Lead Practitioner for dealing with abuse. The home’s good practice for consistently making these referrals is acknowledged. A complaints record of all levels of complaints that have been heard has been very clearly written and maintained so that each complaint can be tracked. The deputy manager made herself available and to facilitate and assist the inspection. What has improved since the last inspection?
The home has employed an extra member of care staff during the mornings between 8 am and 10:30 am. The home has promoted consistently good practice by their willingness to protect service users by reporting every incident that was considered as abuse. Many instances have been reported to the PCT Lead Practitioner for dealing with abuse. The home’s good practice for consistently making these referrals should be acknowledged. The seven requirements made in the last inspection report on the 21/10/2005 have been responded to and met. The environment around the entrance/ reception area was clearer and inviting and had been carefully arranged so it was not obstructive. Two large tables in the main corridor that leads from the reception area were full of attractively presented and useful information about the home. Christmas cards were for sale as was craftwork produced by the home’s service users. The last three CSCI inspection reports, the homes chaplains services, service user feedback forms, menus, an entertainment programme and a number of informative leaflets from Age Concern, how to report abuse and Health and Social Services produced leaflet about care services were available to service users and any visitor to the home. ` The home achieved Methodist Homes Association’s award for the ‘Most Improved Home’ in May 2006. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 7 What they could do better:
The manager must ensure that all staff are informed of the risks to service users of falling and are competent and are trained in Preventing Falls. The manager and the organisation should ensure that Dementia related care is promoted to meet the needs of the increasing number of service users who are affected by dementia. All care staff should have opportunity and access to a continuous source of knowledge and practice based information to guide their dementia care practice. Further training must be promoted beyond a basic level for all staff. When care staff are intending to carry out any activity or offer any assistance or help to any service user, they should be prepared to slowly explain their intentions before actually carrying out the action. This was noticed to be absent on occasions and was not consistently given by different care staff throughout the home. For instance when staff were providing the lunchtime meal it was served on one plate and placed in front of people without any words being spoken. Given that some service users are affected by dementia and cannot anticipate situations, as they once could do, some of situations and staff actions needed to be explained and announced and acted out with the service users. For instance, placing the gravy bowl on the table after asking, “who would like gravy”, was not enough to ensure that service users really received a choice or had heard. There were no follow-up questions to establish if anybody would like help or if they could manage. Encouragement and assistance to eat was given, although this appeared to be slow and after a number of service users had started and some had finished their meal. The Redwoods area of the home appeared slightly dark compared to other parts of the home that were noticeable lighter and brighter. It is a recommendation when the less bright areas of the home are considered for redecoration and painting, lighter and ‘neutral’ light reflecting colours be considered. This might improve the general vision and spatial perceptions of service users with impaired senses and cognition and disorientation, caused by dementia. Not all doors had service users names attached to them. All doors should have service users names written on them, or next to them. Clear and nonconfusing signage for service users (and visitors) is recommended. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 8 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 Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5, Quality in this outcome area is good. Service users receive sufficient information about the home and have the opportunity to exercise their choice about living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Detailed and well-presented information about the home is contained in the Statement of Purpose and the Service User Guide that are made available to prospective service users. The home’s written admission procedures and practice, allow service users and relatives to visit the home prior to any planned admission and a trial period of one month is always arranged for new service users. Assessments from commissioning Care Managers are received prior to agreeing to an admission. The home has four respite places and sometime receives last minute information of assessments and medication information about these service users. During discussions with the manager
Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 11 she stated that any late assessment information would always be referred to Care Managers for additional information whenever this is needed. Service users can receive visitors at any reasonable time and this was confirmed by Three visiting relatives spoken to at the time of inspection confirmed visiting times are very flexible and agreeable to them. Service users are issued with contracts and these are contracts drawn up by the home and are in addition to the contract drawn up by the commissioning County Council. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11, Quality in this outcome area is good. Care planning is conducted to provide detailed information about service users needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans were extensive in the number of documents used and did address a range of needs. Falls prevention planning and a related risk assessment was not evident in the care plans that were read. It is recommended the files used are reviewed for the practicality of use by care staff and re-arranging the content of the care plans. Recent reviews of the care for service users had been conducted and these included Health Service professionals’ reassessments. Staff were observed treating service users with respect and acted politely and in terms that did not cause anxiety. Generally, the atmosphere that was created was calm and natural and allowed service users to express themselves
Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 13 and was pleasant to experience. One service users who had recently moved into the home stated that she was pleased to be living at there. A number of doors did not have service users names on them whilst some did. There was not apparent reason why some names should not have been indicated on doors. The home has a policy to try and establish each service user’s wishes and arrangements in the event of their death. The home’s medication policies are comprehensive and the observed medication procedures carried out by the deputy manager ensured that records were accurately completed and medication was checked as accurate. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is good. Service users seem to experience the lifestyle they expect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Family contact is strongly promoted by the home. Service users confirmed their various visits by their families. When questioned about their lifestyle one service user who has lived at the home for many years stated she is, ‘happy with things as they are’. The home has promoted and encouraged a group called ‘Friends of Kingswood Park’ although the initiative for this body lies with the members and not with the home. Menus are varied and well documented and made in an extremely clean and spacious kitchen. The meal served on the day was chicken and three fresh vegetables and an appetising apple crumble. Some service users had their meal prepared so that it was soft ands easy to swallow. Most service users were seen to eat all of their food. The inspector sat and ate a meal with service user in the extra care unit dining area and observed what appeared to be an enjoyable mealtime.
Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. Service users are actively protected by good reporting procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home maintain a complaints log that showed how the home has consistent records of complaints and has acted upon complaints they have been heard. Each complaint could be tracked. The same attention to reporting any suspicion, or concern, that ‘harm’ may have taken place and affected a service users had been followed. The home has a good record of raising these concerns and should be recognised for their vigilance and determination to be open in their reporting process. All staff have undertaken the Protection of Vulnerable Adult training provided by Cambridgeshire County Council and have ensured that this training has protected service users. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,23,24,25,26, Quality in this outcome area is good. Service users enjoy a safe and wellmanaged environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The suitability of the environment has been favourably commented on in previous inspection reports and remains a sound and well-maintained home. The environment was very clean and tidy and had sufficient natural light and electric lighting. There were some areas where the amount of natural light was not consistent, such as the ‘Redwood’ area of the home. It is recommended that more light reflective colours be considered when redecoration of this area is area is planned.
Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 17 Wheelchairs were stored in cupboards and none where seen to obstruct passageways or doors. The kitchen was particularly well maintained and clean. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is good. Staff are well trained and recruitment procedures ensure staff are suitable for their responsibilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In Rowans Redwood and Cherrie units there were 3 care staff attending to 21 service users whilst in the Maples and Willows units 3 care staff were looking after 17 service users. In addition a deputy manager also provided personal care and a morning care assistant is employed between the hours of 8am to 10:30am, plus two activities co-ordinators employed for a total of 25 hours each week. The manager works Mondays to Fridays. 20 service users spoken to stated they were able to ask for assistance when they needed help and stated that staff were responsive and available to them when they required help. Recruitment records indicated sound recruiting procedures. The home has a comprehensive recruitment policy. When the home has wanted to start an applicant after receiving a ‘POVA first’ check and prior to a full CRB check, the manager has always consulted the CSCI.
Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 19 Staff training records indicated good training plans and included a satisfactory induction arrangement and basic training. More staff are booked for dementia training and this was being undertaken at the time of inspection. It was discussed with the manager that she should ensure that all staff should have access to continuous and advanced dementia care training. Training in protecting vulnerable adults from abuse has been received by all staff and the manager has recently become a key Cambridgeshire County Council awarded, ‘key practitioner’ in this topic. All staff had not received training in ‘Falls Prevention’ and this is considered as an appropriate training requirement for all care staff. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37,38, Quality in this outcome area is good. Service users live a well managed home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager, who has been in post for 3 years, demonstrated she is motivated to provide the best possible outcomes for service users. She is a qualified ‘Dementia Care Mapper’ awarded and ratified by Bradford University. Staff reported they felt supported by the manager and the management system operated by the home.
Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 21 Staff meeting are held every three months and unit meetings are held monthly. The minutes showed that POVA issues had been discussed as an agenda item. Regular one to one supervision is arranged. The records for weekly fire point checks, fire alarms and servicing were read. Safe water temperature records are maintained. The home did not keep a specific record of falls although they had been recorded in the accident books and regulation 37 reports sent to the CSCI. Records of hoist servicing were read. Audits by the organisation care Management team are operated to ensure that internal quality checks are carried out. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 22 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 3 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 2 Standard OP7 OP30 Regulation 13(4)(c) 18, (1)(c(i)) Requirement Care plans must include risk assessments for service users risk of ‘falls’. Training in Falls Prevention must be provided and undertaken by all care assistants. Timescale for action 31/01/07 31/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP24 OP25 Good Practice Recommendations Care plans should be formulated and arranged so that information about service that has been is recorded in different places can be cross-related. Bedrooms should have service users name written on them or next to them. It is recommended that lighter colours are utilised to enhance perceptual awareness and cognition when redecorating is being considered. Kingswood Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Park DS0000015196.V293747.R01.S.doc Version 5.2 Page 25 - 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!
