Inspection on 04/06/08 for Kington Court Health and Social Care Centre

This inspection was carried out on 4th June 2008.

CSCI found this care home to be providing an Good service.

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

Other inspections for this house

Kington Court Health and Social... 13/01/09

Kington Court Health and Social... 18/09/07

Kington Court Health and Social... 19/10/06

Kington Court Health and Social... 18/02/06

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

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 4th June 2008 07:00 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.V365703.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. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.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) 01544 232333 01453 544218 suzanne.line@blanchworth.co.uk Blanchworth Care Ltd Manager post vacant 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.V365703.R01.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. 13th March 2008 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 two social services re-ablement beds, eight older people, four for people under the age of 65 and 20 nursing places for older people. In total it is registered to accommodate 48 residents. The care home is owned by Blanchworth Care Ltd and 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 twostorey building, which was built to provide a Health & Social Care centre for the town and surrounding rural area. The care home facilities are 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 Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 5 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 provided for residents with physical disabilities. The home offers accommodation for male and female residents. There is no information in the current statement of purpose & service user guide about the range of fees charged by this service. Fees are available upon request. A copy of the home’s statement of purpose & service user guide is in display in the home, this includes a copy of the most recent inspection report. Reports for Key Inspections are available on our website www.csci.org.uk. Reports for random inspections are available upon request from the regional office via email enquiries.westmidlands@csci.gsi.gov.uk or telephone 0121 600 5300. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. We, the commission undertook an unannounced inspection of this service over one day. This was a Key inspection of the service, which addresses all essential aspects of operating a care home and was carried out by the Link Inspector, an Inspector from the Regional Enforcement Team and a Pharmacist Inspector. A Key inspection seeks to establish evidence, which shows continued safety and positive outcomes for residents. The pharmacist inspector looked at the arrangements for the management of medicines to check that the improvements found at the inspection on 1st February 2008 had been sustained. During the visit to the home care records, staff records and other records and documents were inspected. There was a tour of parts of the accommodation and interviews with staff, including the manager designate and other senior staff. Time was spent speaking privately with residents in their rooms as well as spending time out and about in the home observing what was happening. Three people who live at the home were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ and where evidence of the care provided is matched to outcomes for residents. It was not possible to obtain any further comments other than those included in this report from the residents’ case tracked due to their general health and frailty. During an unannounced inspection in September 2007, a representative from Herefordshire Primary Care Trust and Herefordshire Council accompanied us. Poor outcomes were identified for a number of identified residents. For example, lack of sufficient fluids and staff not taking appropriate action when residents were consistently losing weight. Staff in the home were not sufficiently trained or skilled and available in sufficient numbers needed to support the people using the service. Consequently, the home was referred to Herefordshire County Council, who has the lead responsible for co-ordinating investigations about safeguarding concerns. The home continues to be monitored through safeguarding. During this period Herefordshire Primary Care Trust and Herefordshire Council, who purchase care from the service have not placed any new residents at the home. Since the last Key Inspection in September 2007, we have carried out seven unannounced inspections of the service and have monitored the staffing Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 7 levels and any notifications of death, illness and other events we have received from the service. Some of these random inspection visits showed shortfalls in the provision and management of the health and personal care for people living at the home and this placed them at risk of harm. We took action and issued four statutory requirement notices, as there was evidence of breaches in regulations and in response, we issued a notice of proposal to prevent the providers from admitting more people into the home. A notice of proposal to withdraw the home’s registration, which if successful would mean the home could no longer operate as a residential care home. Blanchworth Care Ltd has appealed against these notices. Since January 2008, four residents have been referred to the safeguarding team due to complaints about healthcare and an allegation of money missing, which was referred by the provider. These have been investigated by the lead agency for safeguarding with the co-operation of the provider. It is evident from this inspection that residents benefit from having their health and social care needs met. Having recognised significant improvements we have decided to withdraw both the Notice of Proposal for Cancellation and the Notice of Proposal to prevent further admissions. The conditions of withdrawal have been clearly set out in a letter we have sent to Blanchworth Care Limited. What the service does well: Residents were observed being treated respectfully by the staff and bedroom doors were closed when staff were assisting residents with personal care. Staff were seen to address residents in a caring and friendly manner. The medicines people needed were all kept to administer as the doctors prescribed. Medicines were stored safely and with the appropriate recording arrangements. There were regular management audits of medication. A variety of activities are provided in and outside the home by the activity coordinator to support residents to continue to enjoy their hobbies and interests. A varied choice of meals are provided. Visitors are made welcome in the home and are able to visit at any time. The residents have access to a complaints procedure to enable them to express their concerns. 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 walk in shower, toilet and washbasin. The home is tastefully decorated and Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 8 well maintained. The home is clean and well lit and all areas are accessible to people with mobility problems. What has improved since the last inspection? The home have reviewed their statement of purpose and service user guide and a copy is available at the entrance to the home for prospective residents and their relatives to read. The home have sent letters to existing residents to inform them about any nursing contributions received and how these are taken into account as part of their individual fees. The contract has been reviewed for any new residents to include this information. A thorough assessment is being carried out before residents are admitted to the home to make sure the home are able to meet their individual care needs. Health and social care records have improved, they are being reviewed regularly and updated as care needs change so that consistent standards of care are provided and care staff know what care is needed. Peoples’ choices about medicines were clearly shown with consideration of the provisions of the Mental Capacity Act 2005. Arrangements were in place so that there was confirmation in writing of anticoagulant dose changes. Residents are receiving a varied and nutritious diet according to their individual assessed needs and records of food eaten are being maintained for residents at risk of malnutrition. The competencies of the trained staff working in the home has been assessed and reviewed and an action plan put into place and carried out to make sure they receive the training needed to enable them to have the correct skills to meet the needs of the people living in the home. The training needs of the care staff have been reviewed and an action plan put into place and carried out to make sure they receive the training needed to enable them to have the correct skills to meet the needs and ensure the safety of the people living in the home. Systems have been put into place to make sure the lifting equipment provided by the home is serviced at the correct intervals to protect residents and staff from harm. Documentation has been provided to record maintenance checks for any bedrails in use. Communal flannels have been replaced with disposable wipes to prevent any risk of cross infection. Sufficient staff are being provided to make sure they are able to meet the needs of the residents. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 9 Criminal Records Bureau checks are being obtained for new staff before they start work at the home to make sure residents are protected from harm. New staff are receiving a 12 week induction programme, which is in line with the Common Induction Standards. More robust systems have been put into place to enable the home to audit the quality of the service provided and to ensure action plans are put into place and carried out where needed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.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.V365703.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Contracts are issued to residents to ensure they are fully aware of their rights and terms and conditions of stay at the home. Prospective residents needs are assessed prior to admission so they can be assured their needs can be met. Intermediate care is provided by this service, although at the time of the inspection there were no residents receiving intermediate care. EVIDENCE: A copy of the home’s statement of purpose and service user guide is on display at the entrance to the home. The home’s contract has been reviewed to include information about the nursing care payments. Contracts were seen for the three residents’ case tracked. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 12 Two residents had been admitted since the last inspection. A pre-admission assessment of one of these residents was inspected and showed the assessment had been carried out by the manager (designate). The assessment provided a good picture of the holistic needs of the resident. With the exception of one trained nurse, all trained staff have received training in the setting up and use of syringe drivers. No syringe drivers are in use at the moment, although an action plan is in place for the identified trained nurse in the event of a syringe driver being prescribed for use whilst they are awaiting training. The requirements made following the previous key inspection of the service have been met. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There has been considerable improvement in the quality of the care records thus supporting individualised care and more positive outcomes of care for the people living in the home. There were safe arrangements for the management of medicines and this had been sustained since the last inspection of medication in February 2008. Residents’ privacy and dignity is not being maintained at all times. EVIDENCE: We looked at the care records belonging to three residents and we found the quality of the care records has improved considerably since the last inspection. There were some good outcomes of care seen. The resident’s nutritional risk assessment showed they are underweight and had a reduced appetite. Weights recorded for this resident show they have slowly but consistently increased in weight over the last six months. This is a good outcome of care for this resident. Records of food and fluid intake were seen being recorded for this resident, although the total fluid intake had been Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 14 added up incorrectly for two identified days. This had been identified by the management through their care plan audits and the action taken to try and prevent these errors. The resident confirmed that the staff get them what they need and are nice to them. They told us ‘If I ring the bell they will bring me a drink- No I am not kept waiting’. At 07:40hrs two residents were sitting in the lounge on Staunton wing. Neither resident had access to a call bell. A resident told us they wanted to go to the toilet and they had told the carer but the carer told them to use their pad. With their permission we called for assistance, the manager came and was told what the resident had said. This shows the resident’s needs are not being met in a timely manner and staff were not promoting the health and welfare needs of the resident. Another resident’s care records identified they preferred a female carer to attend to their personal care, although on the day of the inspection they were washed and dressed by a male nurse. A carer told us the trained staff always get this resident up and dressed and the trained nurse on the unit that morning was male and this was the reason why a male nurse attended to her today. This is not the resident’s preferred gender of carer. The resident had a fall and an accident form was completed. This had not been reviewed after 36 hours as required by the home’s procedures. The trained nurse carried out this review straight away after we identified this. The resident has a problem maintaining their weight. This is being closely monitored by the home. They were receiving a high protein diet, and prescribed supplements, being reviewed regularly by the general practitioner and had been referred to the dietician. This is good practice. The care plan for ‘risk of pressure sores/delicate skin’ has an action point which states ‘turn 2 hrly at night to ensure pressure relief is maintained’. The turn chart was seen and this showed the resident was lying on their back all the time. The manager designate stated the resident moves themselves in bed and the care plan needed reviewing to reflect this. The manager designate changed the care plan immediately. The resident was observed sitting in their armchair sleeping. They were clean and well presented. The call bell, water to drink and their daily newspaper were within reach. The en-suite had a blue slide sheet for moving and handling the resident. This was not in line with the mobility care plan as this care plan stated a yellow slide should be used for this resident. The manager designate stated they had just thrown some slide sheets out and were waiting for the new ones and they were meanwhile using the blue slide sheet. The manager designate told us they ‘need to update care plan’. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 15 Two care staff spoken with had a good knowledge of the care needs of an identified resident case tracked. We saw one of the nurses administering some medicines to people living in the home following safe procedures. We spoke to one person who told us about her three particular health needs. The care plan contained information about these and discussions with staff indicated the appropriate action was taken to address these needs. The care plan contained information about the medication used although some more specific information was needed about use of inhalers and analgesics in particular. Staff added this information during the inspection. A mouth gel had not been used three times daily as indicated in the care plan so this also needed review. The times of administration of this person’s analgesics should be reviewed so as to give a more even spread of doses throughout the 24-hour period. The deputy manager told us he is considering changing to an earlier time for the morning medicines for everybody so this would help. We looked at the arrangements to record medicines received, administered and taken from the home or disposed of. We found that with very few exceptions these records were properly kept and indicated that on the day of the inspection all the medicines needed were in stock. Audit checks we made on the amount of medicines remaining in stock indicated that residents were being given their medicines according to the doctors’ directions. Anticoagulant doses changes were now authorised by the doctor in writing in accordance with the national safety alert for this group of medicines. With each persons’ medication records there was a form indicating their individual choices about medicines. Where medicines were prescribed to use ‘as required’ this was cross-referenced to care plans where information about these medicines provided further direction to the staff responsible for administering medication. Medicines were all stored safely and there were the correct arrangements for handling controlled medicines. Dates were written on medicine packs when first opened to use so that audit checks could be made and stock rotated correctly. We did find however that five bottles of eye drops were in use beyond the 28-day period stipulated for eye drops in order to reduce risks of contamination. New stock was available and the deputy manager put these into use immediately. Other eye drop bottles we looked at were within the correct period of use. Proper arrangements were also in place for the disposal of medicines no longer needed in the home. There were warning notices where oxygen was used. In one room we advised that more specific wording could be used. There was a medication policy and procedures available so that all staff were aware of how the company expected medication to be handled in a safe way. The company has recently revised this policy and the manager was aware of these revisions. Regular medication audits were in place and we saw that Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 16 these were carried out twice in Staunton and Eardisley during May 2008 with actions noted. There were new stocks of homely remedy medicines with records. The protocol for using these needed updating with signing and authorisation by the doctor and new manager. We looked briefly at medicines on Logan Jack and found that the specific issues raised at the inspection in February 2008 about managing medication on this unit had been attended to. With the exception of the two examples given above, staff were seen to respect residents privacy and dignity at all times. The 13 requirements relating to health and personal care made following the previous key inspection of the service have been met. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. Residents would benefit if staff ensured their preferences and choices are carried out at all times. Social care plans are in place identifying the social care needs of the residents. A variety of activities are provided in and outside the home to support residents to continue to enjoy their hobbies and interests. Residents have a varied choice of meals to ensure their likes, dislikes and nutritional needs are met. EVIDENCE: The pre-admission assessment for an identified resident had looked at the provision of social care for this resident. There are social care plans in place. This has improved since the last inspection. The social care plan for an identified resident indicated the resident had one to one time with the activity co-ordinator. Evidence of this was seen in the activity co-ordinator’s diary, but this was amongst information for other residents. This information needs to be written in the care plan as part of the records evidencing and supporting the care for this resident. The activity co-ordinator had organised a trip to Llandudno for the day of the inspection. A resident told us they had been asked if they wished to go on the Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 18 trip but they had declined. Activities are provided by the activity co-ordinator Monday to Friday and they are published on the notice boards throughout the home. Activities are held in groups and on a one to one basis. Multidenomination religious services are held in the home each month. It is evident from the visitors’ book that residents can receive visitors at any time. Care plans are person centred, although preferred identified choices are not always followed through. For example, a resident’s preference was for a female carer but on the day of the inspection they received personal care from a male nurse. Male and female nursing and care staff were on duty in the home at the time of the inspection. Residents are able to choose their preferred time of rising and going to bed. A choice of meals are provided. Residents were observed being served breakfast between 9-10am. On Staunton wing the bowl of porridge was left on top of the hot trolley uncovered and was not being kept warm during the service of breakfast. This needs to be addressed. A resident told us they could choose what they want for breakfast and stated,’ they have everything, bacon and eggs, or porridge and cornflakes’. Residents were seen eating breakfast in their bedroom, in the lounge and dining room areas. We had breakfast with a resident. The toast was cold by the time the resident had eaten their cornflakes and the resident and I were of the opinion the bread was not very good quality. Food supplements are prescribed and given to residents who are nutritionally at risk. The manager designate completes weekly nutrition reports. This enables the home to review the nutritional status of each resident and to ensure this information is shared with the catering staff to make sure they provide the correct diets for each resident, including the likes and dislikes of residents. These were seen in use by the catering staff. High protein snacks were being sent up in between meals particularly for residents who are nutritionally at risk, although all residents are able to consume these snacks. The requirement made following the previous key inspection of the service has been met. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.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. 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. People who use this service have access to a complaints procedure to enable them to express their concerns. The provision of healthcare, staff training and recruitment has improved to ensure residents are protected from harm. EVIDENCE: The home’s records of complaints were seen. The complaints had all been investigated in line with the home’s policies and procedures. It is evident from the complaints file that residents feel able to complain and are listened to. The Director of Care audits complaints twice a year. Care staff spoken with were aware of the home’s complaints procedure. A representative from Blanchworth Care’s head office audits complaints twice a year as part of their quality monitoring systems. This is good practice. It is evident from the care records that staff are carrying out risk assessments, for example for falls, mobility, nutrition and reviewing them regularly and responding appropriately to any changes in care needs to make sure residents are protected from harm. Due to serious concerns relating to the health and welfare of the residents identified by us, Herefordshire Primary Care Trust and Herefordshire Council in September 2007, the home was referred to Herefordshire County Council, who is the lead agency for safeguarding people. The home continues to be Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 20 monitored through safeguarding. During this period of time the commissioners have not placed any new residents at this service. We have carried out seven unannounced inspections since September 2007 and have closely monitored the staffing levels in the home and any notification of death, illness and other events received from the service. These visits showed shortfalls in the provision and management of the health and personal care for people living in the home and this placed residents at risk of harm. We took action through issuing four statutory requirement notices, as there was evidence in breaches of regulations and we issued a notice of proposal to prevent them admitting any further residents and a notice of proposal to withdraw their registration, which is required by anyone wishing to provide a residential care service. Since January 2008 four residents have been referred to the safeguarding team due to complaints about healthcare and money missing from an identified resident. These have been investigated by the lead agency for safeguarding with the co-operation of the provider. These investigations have now been concluded and it is evident from this inspection visit that the standards of health and personal care provided by the service has considerably improved for the people living in this home. Staff files for two new care staff were seen. All checks had been carried out by the home including a Criminal Records Bureau check prior to appointment. Discussion with care staff and their staff training files confirmed they have received training about safeguarding people. Staff were clear of the action they would take if they suspected any abuse. The requirement made following the previous key inspection of the service has been met. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.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. 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 home is well maintained and systems are now in place to ensure equipment is serviced at appropriate intervals to ensure the safety of residents and staff. Infection control practice & procedures have improved protecting residents from the risk of cross infection. EVIDENCE: The home is a modern purpose built building and the accommodation for the care home is situated on the first floor of a health and social care centre. It is situated in the small market town of Kington within walking distance of the shops and amenities of the town. The home is clean, bright, and the décor and furniture is of a good standard. The home provides accommodation for male and female residents and is Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 22 suitable for people with physical disabilities. All bedrooms except one are single occupancy and they all have a walk in en-suite shower and toilet. Rooms seen were personalised. A resident told us the staff clean their room every day. Three lounge and dining areas are provided within the home on the same level. Assisted bathrooms are available and these have facilities for lifting residents in and out of the bath. There appeared to be plenty of aprons and gloves provided and staff were seen using them to prevent cross infection. Blue aprons are used for the service of meals. One bedroom seen had a strong smell of urine and this was pointed out to the manager designate at the time of the inspection. Residents’ laundry is laundered on site. Clothes were well cared for by the laundry staff. An identified resident and the relative of another resident case tracked have chosen not to have their clothes laundered by the home. Laundry staff spoken with were aware of this. Staff files seen and staff spoken with have received training about the management of infection control. Staff were clear about the procedures to use if a resident has an infection. The communal flannels that were in use in the home have now been replaced with disposable wipes. This is good practice. The lifting equipment in the home had been serviced in April 2008 and the passenger lifts serviced in May 2008. The fire risk assessment had been reviewed in February 2008 (see management section). Systems for recording maintenance checks for bedrails are now in use. The requirement made following the previous key inspection of the service has been met. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are in sufficient numbers to support the people who use the service. Staff have received the training required to ensure they can meet the needs of the people living in the home. Robust recruitment procedures are in place to ensure residents are protected from harm. EVIDENCE: At the time of the inspection there were 22 residents in the home. There were three trained nurses on duty this includes the manager designate whose hours were supernumerary to the staff rota that day. There were two care staff on duty and an activity co-ordinator. Another care assistant was rostered on duty but had called in sick that morning. Other staff covered these hours. The night shift were just leaving as we arrived. There was a trained nurse and one care assistant on duty on the night shift with another care assistant covering the twilight hours of 7-10pm. Discussion with staff confirmed these are the normal current staffing levels in the home. These staffing levels are satisfactory for the numbers of residents in the home at the time of the inspection. The information in the home’s statement of purpose and service user guide shows that five of the 10 care staff employed have NVQ level two. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 24 Competency assessments for the trained staff were re-assessed in April 2008. These were seen and all staff who are currently working in the home scored satisfactory or above in all areas of the competency assessments. The manager designate and the deputy manager have undertaken recent syringe driver training. One trained nurse has not yet had this training although at the time of the inspection there was not a syringe driver in use and procedures were in place to rotate this trained nurse with someone who had received the training in the event of a syringe driver being used. Two new care staff have recently been employed. Their recruitment files were seen. They showed all checks required through regulation had been carried out by the home prior to appointment. The enhanced Criminal Records Bureau checks were seen. There was evidence of induction training for these staff carried out in the home and further induction and training which took place at the organisations head office. Staff spoken with confirmed they had received this training and did not work alone until they had received the 3-day induction course at the head office. The homes induction paperwork for these staff was not fully completed, but the manager designate rectified this at the time of the inspection. The requirements made following the previous key inspection of the service have been met. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management arrangements ensure that people using the service can be confident the home is managed in their best interests. The quality monitoring systems and management of this service has improved to ensure any areas of potential risk are identified and an action plan put into place to protect residents and staff from harm. EVIDENCE: The manager resigned following the last Key Inspection in September 2007. Interim management cover was put into place and the Director of Nursing for Blanchworth Care Ltd has been spending a considerable amount of time at the service. A manager new to Kington Court who was working elsewhere within the organisation has been appointed as manager designate for this service. We have received an application for registration from the manager designate; Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 26 although this has been returned as, the application was incomplete. The manager designate is a registered mental nurse and has experience of working in care homes. A new deputy manager who is also a registered mental nurse has recently been appointed. Following the findings at the last key inspection and the subsequent random inspections of this service, more robust systems have been put into place to enable the home to audit the quality of the service provided and to ensure action plans are put into place and carried out where needed. Weekly internal audits/reviews are carried out for medication and nutrition. The format for the unannounced monthly visits by a representative of the organisation has been changed so they are in line with the national minimum standards for older people. The Director of Care normally carries out these visits. The daily handover sheets are audited to make sure where any acute changes are identified the relevant care plans are reviewed and updated. Monthly audits are carried out for a random selection of care plans, medication and accidents. Findings are given to the manager designate who creates an action plan to address any shortfalls. A recent action plan was seen. The action plan stated all staff had received moving and handling training. The Director of Care confirmed this included all grades of staff. Discussion with catering staff and the training files showed that two catering staff had not received any practical moving and handling training since July 2004. The Director of Care and manager designate were advised of this during the inspection and have confirmed these ancillary staff will receive this training on the 10th June 2008. Questionnaires have been sent to residents and relatives since the last Key Inspection. These were seen and overall they were generally very positive. The Director of Care stated any areas of concern were addressed with these individuals, a letter to a relative was seen dated April 2008. Following this audit changes were made to the homes management of laundry and to communication systems in the home. A random audit was undertaken of money held by the home for an identified resident. This was checked and correct and receipts for any purchases were seen. The Director of Care had recently audited these records. She advised that they were revising the format of the form used for recording monies held. It is recommended receipts be issued by the home for all money received from residents or their relatives. Since the last Key Inspection in September 2007 and the identified concerns an action plan was put into place by Blanchworth Care to ensure staff receive training appropriate to the needs of the residents and in relation to health and safety. We have monitored this through our random inspection visits to the service. Other than the shortfall identified above this has been actioned. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 27 Systems are in place for the recording of bedrail maintenance checks. The home’s fire risk assessment was updated in February 2008, although this needs to be reviewed to update the manager details, the Dorguard schedule and the use of evacuation chairs. Fire training records has training recorded for April 2008, which took place in the home and staff were able to practise using the evacuation equipment. Weekly and monthly fire system checks were recorded. The requirements made following the previous key inspection of the service have been met. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.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 X 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 29 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard OP14 OP22 Good Practice Recommendations Resident’s choice and preferences written in their care records should be carried out by staff to ensure they are receiving person centred care at all times. Residents should have access to a call bell at all times to ensure they are able to call for assistance when needed. Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Kington Court Health and Social Care Centre DS0000066097.V365703.R01.S.doc Version 5.2 Page 31 - 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. 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