CARE HOMES FOR OLDER PEOPLE
Kington Court Health and Social Care Centre Victoria Road Kington Herefordshire HR5 3BX Lead Inspector
Sandra J Bromige Unannounced Inspection 10:45 19 & 20 October 2006
th 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 Kington Court Health and Social Care Centre DS0000066097.V301152.R02.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. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kington Court Health and Social Care Centre Address Victoria Road Kington Herefordshire HR5 3BX 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) 01453 546746 01453 544218 Blanchworth Care Ltd Mrs Thembelihle Claries Nzama Care Home 48 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (37), of places Physical disability over 65 years of age (3), Terminally ill (1), Terminally ill over 65 years of age (1) Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The Registered Manager`s span of management control is limited to the registered care home facility only. The minimum staffing levels to be maintained for Unit 1 (Eardisley), with 16 places for older persons requiring personal care to include a maximum of 6 dementia places (DE/E) must be 360 separately rostered care hours per week. The minimum staffing levels to be maintained for Unit 2 (Logan Jack & Staunton Wings), with 32 places for care with nursing to include a maximum of 3 physical disability (PD), 1 terminal illness (TI) , 1 terminal illness (TI/E) and 27 older persons (OP) must be 981 separately rostered care hours per week. All care staff employed to provide care for service users, with dementia and as part of the Home`s mandatory training, must begin NVQ Level 2, Unit CLI & W2 within the first 6 months of employment. 18th February 2006 3. 4. Date of last inspection Brief Description of the Service: Kington Court is a care home providing personal care and accommodation for 16 older people, 12 Intermediate care places, which include 2 social services re-ablement beds, 8 older people and 4 for people under the age of 65 and 20 nursing places for older people. In total it is registered to accommodate 48 residents. It is owned by Blanchworth Care Ltd. The Home is located on the outskirts of a small market town of Kington, close to shops, and other amenities. The Home was purpose built and opened in June 2003 and consists of a twostory building, which was built to provide a Health & Social Care centre for the town and surrounding rural area. The care home facilities are now entirely situated on the first floor of the building. The care home is divided into three units; Eardisley (personal care), Logan Jack (Intermediate) and Staunton Wing (nursing). The Home offers 46 single rooms, and one double room, all with en-suite toilet and shower facilities. There is a passenger and a service lift provided. The Home has gardens at the rear and to the side of the building that are accessible via the ground floor lounge/dining area or outside via an entrance off the car parking area. The home is accessible throughout by people with a physical disability requiring the use of a wheelchair. A range of equipment is
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 5 provided for residents with physical disabilities. The fees charged range from £350 - £654 per week. Additional items charged for include: Ambulance transport (if a charge is made it is charged to the individual resident). Aromatherapy & reflexology. Private chiropody. Escort duty for non-emergency hospital admissions & appointments are charged at a cost of £22 per hour for a registered nurse & £11 per hour for other staff. Mileage/travel – in the event of staff being required to use their own care or a company vehicle on behalf of residents, a charge of 45p per mile will be charged to the resident. Newspapers. Where Blanchworth Care collect pensions and/or act as appointee a charge of £5 per week will be charge to each individual resident. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over 2 days by 1 Inspector and lasted for the duration of 16 hours. The purpose of this inspection was to assess the outcomes for residents against the key National Minimum Standards. Information to inform the inspection has been sought from many sources. The Commission gathers information from the date of the last inspection to inform the next inspection. This information comes from notifications that the home sends into the Commission, monthly reports provided by the organisation of their unannounced visits to the home, any concerns, complaints or allegations, written feedback from residents, relatives and visiting General Practitioner’s and a visit to the home which includes case tracking a number of residents care. The last inspection made reference to a current safeguarding adult investigation. This investigation was in relation to theft of monies from a resident. The Police have now concluded this investigation and the perpetrator has been dealt with through the judicial system. The organisation have cooperated with the multi-agencies throughout the investigation. The Commission via Social Services have received one complaint/safeguarding adult issue since the last inspection. This was taken up by Social Services and investigated by the organisation. The allegations were not confirmed by the investigation. What the service does well:
The home provides information about the service offered to prospective residents in the format of a Statement of Purpose & Service User guide. Residents are provided with a contract upon admission. The home offers care for people in need of rehabilitation in a separate dedicated intermediate care unit for this purpose. Residents are able to make choices about the gender of carer they wish to have look after them as the home employs male and female staff. This is recorded in the residents care records. The home provides a good range of equipment for the comfort of the residents and to enable staff to move and lift the residents safely. The residents seen during the inspection were clean and with the exception of one resident well presented. Their clothes are nicely laundered and the bed linen is fresh and clean. Residents are respected by staff and their privacy & dignity is respected. Staff were seen to address residents in a caring and friendly manner. Written feedback about the staff includes ‘all staff are excellent and have treated me with great dignity and respect, can not fault my stay here’ and ‘I found the staff very supportive and kind’.
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 7 Residents are offered a choice of a balanced & varied diet. They are able to eat in one of the dining rooms or in the privacy of their bedroom. An Activity Co-ordinator is employed by the home for 30 hours each week to co-ordinate a programme of recreational therapy for the residents. Visitors are made welcome in the home and are able to visit at any time. Meetings are held every three months for residents & relatives to attend and a neutral person not connected or employed by the home chairs it. The home has a complaints procedure that is displayed in the home and residents and relatives are encouraged to raise any concerns as suggestion/comment forms are provided at the entrance to the home where visitors sign in and out. The home is a modern purpose built building situated in a small rural town in Herefordshire, close to the Welsh borders. It is within walking distance to the shops and the facilities that the town provides. All bedrooms are en-suite with a shower, toilet & washbasin. The home is tastefully decorated and is well maintained. The home is clean and there are no bad smells. A relative commented that ‘the home is very clean’. Staffing levels were satisfactory at the time of the inspection. The organisation provide a good programme of induction and core training for staff and have exceeded the requirement in relation to staff with an NVQ 2 or above qualification. The home is being managed by a competent manager. There is a calm and happy atmosphere in the home. Systems are in place for the monitoring of the quality of the service. Services and equipment in the home are regularly checked and serviced to ensure that the safety of the residents, staff and people visiting the home. What has improved since the last inspection?
The recording within the risk assessments for the use of bedrails has improved. There is more variety and frequency of social activities available in the home for the residents and designated care staff are now assisting the activity coordinator to ensure that activities continue to be provided when the activity coordinator is not on duty. The serving arrangements for meals now ensure that the meals remain hot during service and residents who eat in their bedrooms are not being served with their main course and dessert at the same time.
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 8 Staff have received further training about safeguarding the residents in the home from abuse. Changes have been made to the facilities in the home as some of the carpets in the bedrooms have been replaced and the sitting room which was situated downstairs has now been moved upstairs into the home allowing easier access for residents and their supervision by the staff. The deployment of staff across the two nursing units has been reviewed and revised so that nursing and care staff work across both units to ensure that the ratio of staff available is sufficient to meet the needs of the residents. The manager has now been registered with the Commission. Staff are now receiving regular supervision. What they could do better:
A copy of the current Statement of Purpose & Service User guide should be displayed at the entrance to the home to include a copy of the most recent inspection report. Due to the changes to the Care Home Regulations 2001 that came into force on the 1st September 2006, the homes contract must be reviewed to ensure that it provides the information now required to be given to all residents who are in receipt of a nursing care contribution. All registered nurses employed in the home must receive training in the setting up and use of syringe drivers from a professionally recognised trainer. This requirement has been required on 3 previous occasions and has only been partly met. Failure to meet this requirement may result in enforcement action being taken. The quality of the information provided in the care plans across all three units has declined since the last inspection. All residents are not being thoroughly assessed prior to admission or re-admission to the home. Care plans are not identifying all of the needs of the residents and do not set out in detail the action that needs to be taken to ensure that the health, personal & social care needs of the residents are being met. All the care needs of each resident must be in the care plan to ensure that the staff know what care is needed for the resident. Care plans must be reviewed and updated when any changes take place or at least every month. Consent must be obtained prior to the use of bedrails as this is a form of restraint and must be discussed with the resident and/or their next of kin and evidence in the care plan. Maintenance checks must be carried out and recorded according to the instructions in the individual risk assessments or at least monthly to ensure that they continue to be safe to be used.
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 9 Medication must be given to residents as prescribed by the General Practitioner. This can be checked through the home carrying out random audits checks each month on individuals’ medication. Written care plans need to be written for medication that is prescribed ‘as required’ so that all staff are aware about the consistent use of the medicine as intended by the doctor. Records for the receipt of medication must be available and accurate entries must be made for the administration of the medicines. It is strongly recommended that the results of blood tests for residents prescribed warfarin are always received in writing to include any dosage changes. A record of all complaints and the action taken by the registered person must be kept in the home. Staff must ensure that washbowls are thoroughly washed and dried after use and that urinals are sanitised after use to prevent any cross infection. The registered person must ensure that they check with the Nursing & Midwifery Council that trained staff have renewed their Personal Identification Number and are still registered to practice. Written evidence of the date and outcome of these checks must be available within the individual’s employment records. The procedures for the recruitment of staff must be more robust for the protection of the residents living in the home. Receipts for all money held within the home and spent on behalf of residents must be provided and to make it easier to audit the individual accounts they should be numbered so that they can be cross-referenced with the balance sheet. All chemicals must be securely stored at all times for the safety of the residents. 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. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 10 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 Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 11 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 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ contracts do not provide the information that is now required to be given to them about the payment and/or deduction of the nursing contributions paid by the Primary Care Trust. All residents are not being assessed prior to admission to ensure that the home are able to meet their individual care needs. Sufficient training is still not being provided for all of the trained staff on the nursing units to ensure that the specialist needs of residents admitted for palliative care will be met by the Home. EVIDENCE: The Service User guide on display at the entrance to the Home is dated March 2005. This is not the most recent version of this document. This was pointed out to the Provider in the last inspection report. A copy of the most recent published inspection report was not on display in the home. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 12 Contracts had been issued and signed by all residents’ case tracked during the inspection. The homes contract must be reviewed due to the changes made to the Care Home Regulations which came into force on the 1st September 2006. Further information now has to be supplied to residents regarding the nursing contribution. There was only one pre-admission assessment undertaken for the 3 residents case tracked. Two residents requiring nursing care had been admitted to the home without any evidence of a pre-admission assessment. See management section. Not all trained nurses have received training in the setting up and use of syringe drivers. Evidence provided by the home show that syringe drivers have been in use since the last inspection. This requirement has been made on 3 occasions prior to this inspection. Healthcare professionals from the Primary Care Trust have also highlighted through meetings with the Provider the need for syringe driver training to be provided. This non-compliance with the requirements made in relation to this training has been pursued via correspondence with the Provider outside of this report. The Provider has submitted a list of the staff requiring training and the dates that they will attend. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 13 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): 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. The care records are not identifying all residents care needs and are not providing a clear action plan to ensure that the residents’ receive appropriate and consistent care at all times. This has the potential to place residents at risk. Social care plans are not in place to show that the individual residents’ social and emotional care needs are being met. Individual risk assessments need to be in place and reviewed on a regular basis to ensure that any potential risks to residents are identified and acted upon. The homes management of medicines needs improving and to ensure that medication is given consistently as intended by the doctor. The privacy & dignity of residents is respected. EVIDENCE: Three care records were reviewed as part of case tracking these residents. The quality of the information was poor. One resident had been admitted for a second time to the home. There was no evidence that the day care plan, activities of daily living and moving & handling, nutritional and skin risk
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 14 assessments had been undertaken since April 2006. This person is spending all the time in bed; the Waterlow skin assessment was not completed and no pressure relieving equipment was prescribed to be in use. There was no evidence to show that this resident was being repositioned to prevent skin damage. The resident did have an appropriate air mattress on the bed. There was no care plan for continence. Bedrails & bumpers were in use. There was no evidence of consent to the use of bedrails and no records to show that they were being checked every 2 weeks for safety as stated in the risk assessment. The resident when visited appeared comfortable and had a clean nightdress and bedclothes. The resident had clean hair but also told the Inspector that ‘it needs cutting & attention’. The resident had facial hair and the fingers nails were dirty. The resident did not have any access to a call bell and no drink within reach. Daily records for a resident contained information the resident needed a dressing on their leg, but there was no wound care plan. The care plan for the management of an insulin dependent diabetic was poor. There was no clear and specific directions about the type of foods to be eaten, no information on what signs & symptoms to look for if the resident has too high or too low blood sugar levels. The ‘reluctance to eat and drink’ care plan did not state that the resident was diabetic (there is a separate care plan for ‘Diabetes’) and did not contain the information from the assessment on admission informing staff of the support required by this resident to eat their meals. Care plans are not in place for the management of all of the residents care needs such as heart problems, depression, the use of warfarin and continence. Pen profiles are not being completed for all residents and the care plans are all healthcare based and do not show any consideration of the social and emotional needs of the residents. There was information to show that the residents are given a choice of gender of carer. Written feedback from 8 residents state that they are receiving the care and support they need. Staff were observed to respect the privacy and dignity of residents by closing the door when giving personal care and knocking on the door prior to entering. Feedback from visiting healthcare professionals to the home stated that staff sometimes have to be prompted to move residents from the dayroom to the privacy of their own room to allow them to be seen in private. Medication Administration Records are being handwritten and signed and checked by 2 nurses. The General Practitioner signs medication Administration Records on Logan Jack. There were no signature gaps on the Medication Administration Records seen. Care plans are not in use for medication being
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 15 prescribed for use ‘when necessary’, such as paracetamol & medication for periodic chest pain. This information needs to be readily available so that all staff are aware about the consistent use of the medicine as intended by the doctor. Audits of two medicines showed discrepancies in the stock levels. Random audits of controlled drugs were checked and correct. The nurse in charge could not find the records of receipt of medication on Logan Jack. The temperatures of the fridges and medicine stores are being monitored and recorded each day. The records for Staunton Wing show that there were 12 days in July 2006 when the temperature of the room exceeded 25°C and has reached 28°C on 4 occasions. It is recognised that this was during a heat wave, but the home needs to continue to closely monitor the room temperature and if it is exceeding the maximum temperature at other times, need to take appropriate action to reduce the temperature. This will be monitored in future inspection visits. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 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. The variety and frequency of the activities provided by the home has improved giving more choice for residents regarding the provision of social care. The individual care records do not provide information that the home are fully exploring, identifying and recording the recreational interests and social needs of the residents to ensure that their social and emotional care needs are being met. Residents are able to keep in contact with family and friends. A varied menu is being provided to enable residents to exercise choice and control over what they eat. The service of meals has improved, although this area needs further improvement to enhance the presentation of meals served to residents in their room and in the dining room. EVIDENCE: The home employs an activity co-ordinator for 30 hours each week. She also assists with personal care of residents particularly at mealtimes. The organisation has produced a generic programme of activities for the afternoon session each week Monday to Friday. The activity co-ordinator is responsible for implementing this programme and ensuring that someone else in her absence takes the sessions. Group and 1:1 activities take place during the
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 17 mornings. During the 2 day inspection residents were observed watching television in their rooms, reading, a group of residents were playing dominoes and 17 residents were seen actively participating in the musical entertainment provided one afternoon. Residents spoken with were aware of the range of activities available and some choose to join and others do not wish to participate. The arts & craft sessions appeared to be popular with the residents and their seasonal creations were very colourful and displayed in the home. Records of the residents’ case tracked during this visit did not all contain social profiles for these residents and activity logs were not up to date. The social and emotional care for the residents is not identified and supported through social care plans. It is the Inspectors opinion that the nursing, care staff and activity co-ordinator are not working as a team to identify, record, evaluate and provide the social and emotional care that is needed by the individual residents, as it appears that they see healthcare and social care as two separate issues and not as an holistic need for residents to ensure their physical and mental wellbeing. Written feedback from 8 residents showed that 2 did not wish to join in the activities, 2 said there were ‘always’ activities arranged they could take part in, 2 said ‘usually’ and 3 said ‘sometimes’. Funding for activities and for the provision of the equipment for activities is paid for from money raised by the home. The residents receive many visitors throughout the day. Written feedback from 10 relatives all confirmed that the staff welcome them in the home at any time. Comments ‘such a lovely atmosphere – good cheer & such kindness’ and the staff are ‘very courteous & polite’ were received. The menus provided are generated by head office and are displayed in the home. Staff were observed offering residents a choice of meal on the Friday which was fish & chips, baked potato or an egg dish. The lunch served on the Thursday was sausage & mash, frozen green beans, Cornish pasty or packet soup with a dessert of plum & cinnamon crumble & custard, ice cream or cheese & biscuits. Meals were served by the cook for Logan Jack & Eardisley and plated and served from the hot trolley in Staunton Wing. The temperature of the meals was being checked and maintained during service and the desserts were served after the main course. Residents were observed eating in their rooms and in two lounge/dining areas. No tray papers were used for serving meals on Logan Jack & Eardisley, although they were used on Staunton Wing. The trays used for service are very worn and no condiments or sauces were provided on the trays or the dining tables with the exception of the Eardisley lounge/dining room where condiments were provided. On Staunton Wing no cold drinks were provided on the table with the meal, there were 7 residents eating in the lounge and only 3 residents had a drink. One carer who went to assist a resident with their lunch asked her if she would like a drink before she started to give the resident their lunch. Residents were seen being discreetly assisted by staff to eat on a 1:1 basis treating it as a social occasion. Comments received about the meals include ‘very good, choice of food every day’, ‘more than enough to eat’, ‘very nice’, ‘choice –yes, more or less’, ‘if you
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 18 do not like the main course, will rustle you up an alternative, ‘excellent’, ‘my mother loves her breakfast’. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 19 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to the homes complaints procedure and are protected from abuse. The homes records of complaints, investigation and outcomes need to be thoroughly documented to inform their internal quality assurance systems. EVIDENCE: The last inspection made reference to a current safeguarding adult investigation. This investigation was in relation to theft of monies from a resident. The Police has now concluded this investigation and the perpetrator has been dealt with through the judicial system. The organisation have cooperated with the multi-agencies throughout the investigation. The Commission via Social Services has received one complaint/safeguarding adult issue since the last inspection. This was taken up by Social Services and investigated by the organisation. The allegations were not confirmed by the investigation. The homes complaints records were seen. A letter was on file from the daughter of a resident raising concern about staff shortages in the home. There was no evidence to show that this had been investigated or the complainant had received a response. There was evidence of another complaint and information to show that it had been thoroughly investigated and the complainant responded to. The outcome of the complaint was not
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 20 noted. The file also contained many ‘thank you’ type letters complimenting the home. Information from residents confirmed that they knew whom they would speak to if they had any concerns and one response said ‘but am very happy thank you’. With one exception all written feedback from relatives confirmed that they were aware of the homes complaints procedures. Comments and suggestions forms are available at the entrance to the home. Staff records and all staff spoken with were aware of the need to safeguard the people living at the home and have received training within the organisation. Staff recruitment records show that POVAfirst and enhanced Criminal Records Bureau checks are being carried out on staff prior to employment. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The design and layout of the home enables residents to live in a safe, wellmaintained and comfortable environment. EVIDENCE: The home is a modern purpose built building and the accommodation for the care home is situated on the first floor of the building, as it is part of a health and social care centre. Since the last inspection some of the bedrooms have been re-carpeted and the sitting room that was downstairs has been moved upstairs into what was the education centre. The manager was advised that the sign on the door needs replacing as it still states ‘education room’. This room has been well furnished with a dining table, chairs and easy chairs and facilities for watching television and listening to music and a bookcase containing a good collection of audio books. Residents’ were using the room during both days of the inspection.
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 22 All parts of the home seen were clean and tidy and there were no bad smells. A written comment from a relative says ‘the home is very clean’ and written feedback from 8 residents unanimously stated that the home is ‘always’ fresh and clean. The home and grounds are well maintained. The laundry is well organised and good systems are in place for the handling of foul laundry to prevent cross infection. There are plenty of gloves, aprons and hand washing facilities located around the home. Washbowls containing a small amount of water were found in one sluice stacked together and a urinal was mouldy inside and smelt offensive. An immediate requirement was made to address these issues. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 23 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. The deployment and numbers of staff on duty at the time of the inspection were sufficient to meet the needs of the residents. The procedures for the recruitment of staff are not sufficiently robust to ensure that they offer protection for the people living in the home. The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. EVIDENCE: At the time of the inspection the home were caring for 40 residents in total, 25 nursing residents and 15 residential residents. For the nursing residents there were 2 registered nurses and 4 care staff on duty on the Thursday and 2 registered nurses and 5 care staff on the Friday. These numbers included the manager who was based on Staunton Wing. On Eardisley there were 3 care staff on duty both days this included the residential team co-ordinator. These staffing levels are satisfactory. Written feedback from relatives about staffing levels was very positive, only one person felt that the staffing levels were not sufficient. One person stated that staffing levels were ‘not always sufficient in the past but better now’. A written comment from a resident stated ‘the staff do not seem to be changing
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 24 as much as they were at one time and this is better for patients & relatives to see the same faces’. The last inspection report made a requirement to review the staffing levels on Staunton Wing. The manager reported that this was discussed with the Assistant Director of Care and from April 2006 the two nursing units have a joint staffing rota with cross unit working as required. Discussion with the manager confirmed that she will be working at least 72 hours without a day off and her last day that she was able to spend doing the administrative side of her role was the 12th & 13th October 2006. The amount of hours being worked without a day off and time set aside for administration needs to be monitored by the organisation to ensure that the manager has the time to manage the home effectively. The pre-inspection information provided by the organisation state that they have 15 care staff with NVQ 2 or above. Three staff records were seen via the Blanchworth Intranet. One file was not accessible via the computer so head office faxed the details through to the home. These records showed newly employed staff have received induction training at the company headquarters and within the home to the appropriate standard. One file for a carer recruited from overseas showed gaps in the person’s employment history and the interview form did not confirm that these gaps had been explored at interview. References had been obtained, although the reason for leaving had not been fully explored as the reason given was ‘got another job’. Another file contained a testimonial ‘To whom it may concern’. This is not acceptable, as the employer needs to ensure that references are authentic for the protection of the people living at the home. The persons Nursing & Midwifery Council Personal Identification Number permitting them to practice as a registered nurse had expired on the 31st August 2006 and there was no evidence to show that the employer had carried out any checks to see if the person was still registered to practice with the Nursing & Midwifery Council. The pre-inspection information states that 7 staff have left employment at the home since the last inspection. The reason for 4 staff leaving was unknown. The Commission have received 5 notifications of staff shortages in the home since the last inspection. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 25 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 good. This judgement has been made using available evidence including a visit to this service. A well-qualified and competent manager is managing the home. Quality monitoring systems are in place to measure the standard of the service provided. Systems are in place for the management of residents’ monies, although they need slight adjustment to ensure that residents’ monies are fully accounted for at all times. Staff are receiving supervision to monitor that they have the skills and competence to carry out the care required by the people living in the home. Systems are in place for testing and servicing the utilities and equipment in the home for the protection of the residents, staff and people visiting the home. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 26 EVIDENCE: The manager has been approved and registered by the Commission since the last inspection. She receives administrative support within the home and through the staff at the organisations headquarters. She receives supervision from her line manager and has attended recent clinical updates in skin and wound care. Her Nursing & Midwifery Council Personal Identification Number is due for renewal shortly. During both days of the inspection there was a happy and calm atmosphere throughout the home. Discussion with staff confirms that there is a good atmosphere in the home. Comments received include ‘staff are excellent particularly the No.1 & No. 2 nurses’ The home has an internal quality assurance programme which is included in the Statement of Purpose & Service User guide and displayed in the home. The most recent quality assurance audit was carried out in June this year and the results are published in the above guides. The outcome showed that there are two areas in need of attention, hair care and admissions. The manager confirmed that the home were not involved in the quality assurance monitoring and that the questionnaires were all sent out from the organisations headquarters. The manager was asked to confirm what action had been taken in response to the outcome of the audit and she said that they had employed a full time hairdresser, but was not aware of any action taken with regard to admission procedures. Please also refer to section one. Meetings are held with the residents every 3 months and these meetings are not attended by any staff from the home. Feedback is informal and not recorded. Guidance was given to the manager to ensure that she records the feedback and any action taken so that the information can be used as part of the homes quality monitoring. The pre-inspection information provided by the organisation confirms that none of the current residents manage their own financial affairs and none are managed by the organisation. The manager holds small amounts of money on behalf of residents. A random check of these records was made. All of the balances of money remaining after expenditure were correct. There were not receipts available for all items purchased. Records and discussion with staff confirm that supervision is now in place. There were no records available in the home for the risk analysis of food since September 2005 and the staff spoken with were not aware of the changes to the legislation. The Environmental Health Officer has followed this up. A
Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 27 number of bottles of chemicals and a bottle of plant food were found unsecured in one of the sluices in the home. The pre-inspection information and records and equipment seen at the time of the visit confirm that routine maintenance checks are being carried out for the services and equipment in the home. Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 28 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 2 1 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5A, 5B Requirement The registered person must provide to all residents where a nursing contribution is paid in respect of nursing provided, a statement specifying the date of payment & amount and the date that the nursing contribution is to be paid to the resident or deducted from the fees. All registered nurses must be trained in the setting up and use of syringe drivers by a professionally recognised trainer. Timescale of 28/02/05 & 31/12/05 partly met. Timescale of 31/03/06 not met. Failure to meet this requirement may result in enforcement action being taken. Care plans must identify all problems and needs of residents and set out in detail the action that needs to be taken by the staff to ensure that all aspects of the individual residents health, personal & social care needs are met. They must be reviewed and updated when any changes
DS0000066097.V301152.R02.S.doc Timescale for action 31/12/06 2 OP4 18 15/11/06 3 OP7 15, 17 31/12/06 Kington Court Health and Social Care Centre Version 5.2 Page 30 4 OP7 12, 13 5 OP7 13 6 OP7 13, 17 7 OP9 13, 17 8 9 OP9 OP16 13, 17 17, 22 10 11 OP26 OP26 13 13 12 OP29 19 take place or at least every month. Consent must be obtained from the resident or their representative for the use of bedrails prior to their use. An urgent action letter was sent on the 24/10/06. Maintenance checks must be carried out for all bedrails in use according to the written specified control measure within the individual risk assessment or at least monthly. Records of these maintenance checks must be held in the home. An urgent action letter was sent on the 24/10/06. Care plans must show how the social & emotional care needs of the resident are met. Timescale of 31/03/06 not met All medicines must be given to residents according to the doctors’ directions and with written plans in place for medicines prescribed to use ‘as required’. Full & accurate records for the receipt and administration of all medicines must be maintained. A record of all complaints and the action taken by the registered person in respect of any complaint must be kept in the care home. The identified urinal must be sanitised. An immediate requirement was made. Washbowls must be washed & dried after each use & stored upside down singularly on a shelf or rack. An immediate requirement was made. The manager must ensure that all staff employed by the home has a current Nursing & Midwifery Council Personal
DS0000066097.V301152.R02.S.doc 29/10/06 29/10/06 31/12/06 30/11/06 30/11/06 30/11/06 20/10/06 20/10/06 29/10/06 Kington Court Health and Social Care Centre Version 5.2 Page 31 13 OP29 19 14 OP35 17 15 OP38 13 Identification Number. Written evidence of confirmation of the PIN must be available. An urgent action letter was sent on the 24/10/06. The registered person must ensure that the recruitment of staff is robust and must explore and evidence all the information required through this Regulation The registered person must keep a record in the home of the purpose for which the money of any resident has been used. All chemicals must be secure at all times. An immediate requirement was made. 30/11/06 30/11/06 20/10/06 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 OP1 Good Practice Recommendations A current printed copy of the homes Statement of Purpose & Service User guide should be on display at the entrance to the home to include a copy of the most recent public inspection report. It is strongly recommended that the results of INR tests for residents taking warfarin be received in writing to include any dosage change prior to alteration of the Medication Administration Records by the home The manager should ensure that condiments and sauces are readily available for all residents who wish to use them. The receipts for expenditure of residents’ monies should be numbered against the item logged on the individual balance sheet. 2 OP9 3 4 OP15 OP35 Kington Court Health and Social Care Centre DS0000066097.V301152.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Worcester Office The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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