Inspection on 08/10/07 for Kirk House Nursing Home

This inspection was carried out on 8th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Kirk House Nursing Home 24/10/06

Kirk House Nursing Home 11/10/05

Kirk House Nursing Home 15/04/05

Kirk House Nursing Home 12/10/04

Kirk House Nursing Home 20/04/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Kirk House Nursing Home Balance Street Uttoxeter Staffordshire ST14 8JE Lead Inspector Sue Jordan Unannounced Inspection 8th October 2007 10:00 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 Kirk House Nursing Home DS0000022345.V345032.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. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kirk House Nursing Home Address Balance Street Uttoxeter Staffordshire ST14 8JE 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) 01889 562628 01889 564976 kirk.house@tesco.net Uttoxeter & District Old People`s Housing Society Limited Amanda Anne Clayton Care Home 26 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (2), Physical of places disability (10), Physical disability over 65 years of age (26), Terminally ill (4) Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. PD(E) Minimum aged 60 yrs Date of last inspection 24th October 2006 Brief Description of the Service: Kirk House is a Care home providing personal care and nursing care to twentysix older people over the age of 60 years with physical disabilities, terminal illness, or dementia. The Home is owned and operated by the Uttoxeter and District Old People’s Housing Society Limited, which is a voluntary organisation. The manager, Amanda Clayton was registered with the Commission for Social Care Inspection in October 2006. She is a registered general nurse and has the Registered Managers Award. A team of thirty-five staff supports her, including nurses, care workers, cook, handyman, cleaning and laundry personnel. Kirk House presently has fourteen single bedrooms, some of which have ensuite facilities. There are five double bedrooms and screening is provided to afford the residents privacy. There are three communal bathrooms, one of which is being refurbished. There are also two walk-in showers. Three lounges and one dining room are available and there is a visitors’ room, two small kitchenette areas, a hairdressing salon, a nursing station and a treatment room. The staff have their own room and the management and administration team have the use of two offices. The main meals come from a central kitchen and there is a laundry and two separate sluice areas. The Home charges from £359 to £460 per week. The residents pay extra for hairdressing, dry cleaning, private chiropody, private phone installation and the subsequent calls. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over a total of seven hours, twenty minutes. This was a ‘key inspection’ and the core standards were assessed. The methodologies used were: A day of pre-inspection preparation, including scrutiny of the Commission for Social Care Inspection Annual Quality Assurance Assessment completed and returned by the manager, and of the six questionnaires completed by staff and eight completed by residents and/or their relatives. During the visit, a number of residents were chatted to and informal discussions were held with three of the staff on duty. Three residents and a visiting relative were also interviewed. Lunch was shared with the residents and informal discussions took place with two visitors from the local church and two of the Home’s committee members. Discussion and feedback was held with the manager The medication systems were examined and a tour of the environment undertaken. Three residents’ care records were checked and the recruitment records of four new staff members employed since the last inspection. Fire safety and maintenance records were also checked. What the service does well: The manager does not admit anyone into the Home unless his or her needs have been assessed. In the case of Local Authority or Health Authority referrals people are assessed by external professionals and copies received before agreeing admission. The manager or a member of the nursing team also undertakes an assessment of any potential resident. The Home can take people in an emergency, but they make sure that they receive the required information as soon as possible. The residents and/or their families say that the manager gave them enough information about the Home to enable them to make an informed choice as to whether they wanted to live there. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 6 The residents have access to a range of medical professionals to maintain their health and wellbeing. There is a registered general nurse on duty at all times. Families and visitors are made welcome at any time. All of the people involved in this inspection were positive about the manager and the staff and their caring attitudes to the residents. Generally the medication systems are safe. Safe storage and recording safeguard the residents. Staff are provided with training appropriate to their role and to meet the needs of the residents. 66 of the care staff have National Vocational Qualification 2 or above. The residents surveyed and spoken to during this visit confirmed that they generally enjoyed the food. The environment is clean and well maintained. There is an on-going programme of redecoration and refurbishment. The procedures for holding, storing and recording residents’ finances and transactions are safe and secure. There are opportunities for the residents and relatives to give their views about the Home. Most of the residents surveyed said that they knew how to complain and who to speak to if they had concerns. The Commission for Social Care Inspection has not received any complaints about the Home. There is a waiting list of people wishing to live in Kirk House, which is an indicator of the Home’s reputation in the local area. What has improved since the last inspection? What they could do better: Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 7 Care plans are in place for all of the residents, which cover all aspects of daily living. However, it is recommended that the information in the care plans be expanded, especially where there is an element of risk in order that the staff know exactly how to care for the people using the service safely. When a resident’s care needs change the care plans should be amended as soon as possible so that the staff have access to current information. The care plans must be reviewed monthly. Recruitment procedures are poor and do not safe guard the people using the service. Staff must not start work until a Protection of Vulnerable Adults check is complete and the results received. The management must obtain all the required information about the prospective staff member. The manager was asked to keep the staffing levels under review, particularly at night. Staff levels should be set according to the layout of the building and the dependency of the residents to ensure that their safety is maintained at all times. A fire evacuation plan, based on individual need will aid this review. The residents must be only be given medication which is prescribed for them specifically. The manager is approachable and senior staff are always available, however staff supervision needs to be more regular to ensure that the staff know what is expected of them. The manager should also receive regular formal supervision. Fire safety arrangements must be strengthened. This includes the checks amd tests made by the Home and compliance with the requirements made by the Fire Safety Officer in August 2007. The manager could consider developing residents’ information in alternative formats to enable more people access and understanding of the relevant procedures. 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. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 8 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 Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed before they move into the home affording them confidence that the Home can meet their needs. Prospective residents and their families are given the information they need to help them make a choice as to whether they wish to live in Kirk House. EVIDENCE: A combined Statement of Purpose and Service Users Guide is available to the residents and their families. It was revised in May 2007 and is in a brochure format with photographs of the Home and user-friendly language. It is a welcoming document and paints a clear picture of life in Kirk House. The information is also available in a smaller handheld booklet. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 10 The manager was asked to consider developing these documents in alternative formats, to enable people with more complex needs access to important information. Seven out of the eight surveys completed by residents or their relatives stated that they had received a contract and received enough information before choosing to live in the Home. Information is provided to prospective residents and/or their families about the fees and any extras they may have to pay for. The needs of prospective residents are assessed by a member of the nursing staff or the manager and care plans and assessments are also received by the referring authority. As a result the Home can ensure that they are able to meet the person’s needs before offering them a place. There were thirteen people on the Home’s waiting list at the time of this inspection. The manager was asked to remind the nursing staff that the assessments must be dated and signed. The Home also provides intermediate care and has suitable facilities to support two people at a time. Two single bedrooms with en-suite facilities are available solely for this purpose. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is evidence in the Care Plan of health care treatment and intervention, and a record of general health care information. There are some gaps in information but staff are able to think in a person centred way and are able to give a verbal update. Health needs are monitored and appropriate action and intervention taken. Medication systems do not always follow good practice or safe practice guidelines and need action to ensure that the residents are fully safeguarded. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 12 EVIDENCE: An initial care plan is developed at admission and this is written by hand. This information is then transferred to a computer system, to which the staff are given access. This covers all areas of a person’s life. Some of the information in the care plans is very brief and although the staff member demonstrating the computer system could explain the residents’ needs, this was not always clear from their records. This also applied to the risk assessments, including mobility assessments. The manager was advised to expand the information to ensure that the staff know exactly what they need to do to meet the resident’s needs and whether there are any risks involved. This also needs to apply to people receiving respite or intermediate care. The manager reported that all of the nursing staff are to attend risk assessment training. Each resident is allocated a named nurse, who is responsible for reviewing the care plan information and keeping it up to date. The care plans should be reviewed monthly, however on inspection of the care plans this seems to vary. It was noted that changes in need had occurred but these were not recorded. Changes to the support needed should be recorded as soon after the event as possible. All six staff completing the surveys said that they are given up to date information about the needs of the residents. As well as access to the computer, there is also a handover at the beginning of every shift. All medical intervention is recorded on the care records, including appointments with other health professionals. There was evidence of people seeing general practitioners, chiropodists, opticians and dentists. A district nurse currently attends one of the residents. There is a nurse on duty at all times. There is evidence that people are regularly weighed and that their susceptibility to pressure sores is assessed. Pressure relieving equipment is provided if applicable. Four out of the eight surveys completed by residents or their families state that the service users always get the care and support they need, three say usually and one says they sometimes do. Seven out of the eight surveys completed by residents or their families say that the service users always get the medical support they need. One says they usually do. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 13 The staff were observed treating the residents with respect, this included knocking on bedroom and bathroom doors before entering and in their interactions. There are five double bedrooms in Kirk House and screening is provided to afford the residents privacy. The Home is asked to consider providing an additional wash hand basin so that the residents can have their own, affording them further privacy. The medication systems were checked including observation of the lunchtime administration. This was conducted in a sensitive and hygienic manner. The administration records are signed immediately after administration and there are no gaps on the records. Medication is stored securely and the stock is checked every night to ensure that there is an audit trail of the medication in the Home. Controlled drugs are stored, administered and recorded safely. The manager conducts a check of the medication administration records every twelve months and checks the continuing competency of staff. Only the nursing staff administer medication. The Home has held a stock of paracetomol to administer to those residents not prescribed for it and to staff. The manager was informed that the residents must only be given medication prescribed directly for them and from the original container with their name on. Therefore if a resident needs this painkiller, the general practitioner must be contacted for a prescription. She was also advised that she should not be responsible for administering medication to staff. The manager said that she would put a stop to this practice straight away. The residents and/or their families are asked to explain their wishes in the event of dying and death. These are recorded in the initial care plans to ensure that people’s wishes are fulfilled at this very difficult time. The staff are trained to use a care pathways approach to palliative care. These focus on the patient and their family, set standards for how things should be done and involve all professionals caring for the patient and their family Some of the staff have been trained in palliative care. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. They also have the opportunity to maintain important personal and family relationships. The service promotes, and fosters good relationships with neighbours and other members of the community. The residents are provided with a choice of well balanced, home cooked, healthy meals. EVIDENCE: An activities co-ordinator was employed at the end of December 2006 and this has improved the provision of activities and stimuli for the residents. At the start of her employment she completed a life history for each resident and Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 15 spent time getting to know them and gleaning important information from them and their families. From this she was able to develop an activities plan. Daily activities are arranged which include reminiscence sessions, physical exercises and quizzes. The activities co-ordinator will also do one to one activities, especially for the residents with dementia. These include hand massage, story telling and colouring. A relative comes into the Home to help with arts and crafts. ‘Theme’ days are also arranged; Easter bonnets were made and a competition held, a Chinese auction was successful and on the day of this inspection a harvest festival and lunch was taking place. Most of the residents were able to take part. Two ladies from a local church came to encourage the residents in harvest hymns and poems. Two of the residents read poems. A ‘harvest’ lunch was provided and a special menu devised with the help of the residents. The dining room and tables were decorated in a harvest theme. Staff and management joined the residents and a pleasant atmosphere observed. The two church visitors said that they visited the Home once a month to offer the residents communion and that it was better arranged since the employment of the activities co-ordinator. The Home has a fundraising committee who have raised funds for various activities and events and are currently raising money for a mini bus. The Home is part of the local community and encourages community participation. The Home is situated within a few minutes walk of the town centre and staff take the residents. A bingo night is held every two months, to which families and members of the local area are invited. The day before the inspection some of the residents went to the local Roman Catholic Church. A member of the local Methodist Church also comes into the Home. None of the present residents have alternative religions or faiths, although some are nonpractising and therefore they do not have to attend Christian services. The activities co-ordinator is currently attending training to supplement her role. One of the relatives commented: “We welcome the efforts made to include our relative in activities and ensure that she has someone to call in and read to her on a regular basis”. The hairdresser visits two days a week. Relatives are welcomed into the Home and the Service Users Guide says that they can visit at any time. There are separate visitors’ facilities including two small kitchens for making drinks. Following discussions with the residents the relatives can now visit with them in the communal lounges. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 16 Three residents were spoken to during this inspection and all said that they could choose when they went to bed or got up. The residents can bring personal possessions into the Home. Three out of the eight residents and/or relatives completing a survey said that the service users always enjoyed the meals, four said they usually did and one did not receive a conventional diet. All of the residents spoken to during this inspection praised the food provided. There are three cooks employed at Kirk House working a variety of shifts. The residents are provided with four meals a day; breakfast, lunch, high tea and supper. Choices are available at all meal times and the residents confirmed that they could have an alternative to the menu. The Home also caters for people requiring a soft diet and diabetes. One of the residents is a vegetarian and commented: “Whilst at Kirk House, I changed to become a vegetarian and the cooks catered for me very well indeed”. Discussions with the cook confirmed that the residents are provided with a variety of fresh fruit and vegetables, delivered regularly by local suppliers. Some of the residents require assistance to eat. This was seen to be provided in a sensitive manner that did not draw attention to the resident. The residents’ nutritional needs are recorded on the care records and they are regularly weighed. Food and hygiene training is planned for the very near future. The environmental health officer visited the Home in December 2006. One minor issue has been rectified. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. The residents know who to speak to if they are unhappy and their complaints are taken seriously and addressed accordingly. The staff are trained to understand and recognise adult abuse and how to respond, ensuring the safety of the residents. The Home’s recruitment procedures must be more thorough to fully safeguard the residents. EVIDENCE: Seven of the eight residents or their relatives completing a survey said that they always know who to speak to if unhappy and one said they usually do. Six of the eight surveys say that the service users or family know how to complain, two said that they do not. The manager was informed of the above and as a result decided to place the complaints procedure in more areas of the Home. She may want to consider producing this document in other formats. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 18 Two residents were asked whether they knew how to complain and who to speak to and both confirmed that they did. One relative commented: “We are very grateful for the efforts made for our relative. Although we had problems with communication in the past these now seem to be resolved and we feel more relaxed about approaching senior staff with any worries that we have”. All of the six staff completing a survey said that they know what to do if a service user or relative has concerns about the Home. The manager received a complaint from a resident in May 2007, which she promptly addressed. The Commission for Social Care Inspection has not received any complaints about the Home. The manager covers the area of adult abuse and protection at induction and staff will also study this subject during completion of the National Vocational Qualifications. The Home has not had to make any referrals to the Safe Guarding Adults team. The Home’s recruitment procedures must be more thorough to fully safeguard the residents. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 19 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): 21, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. EVIDENCE: All of the eight people filling in the surveys said that the Home is always fresh and clean. One relative said, “Kirk House maintains a fantastic environment, it is always pleasant to visit”. Another relative was interviewed during the inspection and specifically commented on the cleanliness of the Home. This was confirmed during a tour of the environment. There is evidence of continuing maintenance, redecoration and refurbishment. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 20 Major work is being undertaken to build an extension to the Home, which will provide nine extra bedrooms. The Home is liaising with the Commission for Social Care Inspection registration team. There are no unpleasant odours and there are facilities available to maintain a high standard of infection control. Kirk House presently has fourteen single bedrooms, some of which have ensuite facilities. There are five double bedrooms and screening is provided to afford the residents privacy. The Home is asked to consider providing an additional wash hand basin so that the residents can have their own, affording them further privacy. There are three communal bathrooms, one of which is being refurbished. Equipment is provided to assist the residents to get in and out of the bath. This is checked every six months. There are also two walk-in showers. Three lounges and one dining room are available and there is a visitors’ room, two small kitchenette areas, a hairdressing salon, a nursing station and a treatment room. The staff have their own room and the management and administration team have the use of two offices. The main meals come from a central kitchen and there is a laundry and two separate sluice areas. The fire officer visited on 15/08/07 and left a number of requirements. These are gradually being addressed. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff recruitment must be improved to ensure that the residents are fully safeguarded. The staffing levels must be kept under review to ensure that there are enough to meet the needs of the residents and keep them safe. The staff are kept up to date with relevant training, which helps them to support the residents. EVIDENCE: At the time of this inspection there were twenty-six people living in the Home. There is always one Registered General Nurse on duty and in the morning there are four care workers, three in the afternoon and one at night. The manager, administrator, activities co-ordinator, laundry, maintenance, cleaning and catering staff are supplementary to this. The residents were asked in surveys whether there are staff available when needed and three said there always are, four said usually and one said sometimes. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 22 Four of the six staff completing the surveys made comment about the staffing levels and expressed concerns. Comments included: “In my opinion the service would do better if there were enough staff on every shift. Sometimes we lack staff on a shift and we can’t meet the needs of the residents”. One of the staff was asked whether there were enough staff on duty and she said that difficulties only arose when staff went off sick. In particular, the night staff ratios were discussed at this inspection, as two members of staff would appear to be low, particularly as many of the residents have poor mobility and some are permanently cared for in bed. The manager has to complete a fire risk assessment and individual fire evacuation plan and this may well flag up the need for additional staff. The manager was asked to review the staffing levels, particularly at night, taking into account the layout of the building and the dependency of the residents, to ensure that their safety is maintained. The residents spoke positively about the staff and this was also confirmed in the surveys. All of the eight people completing a survey said that the staff listen and act on what they say. A visitor said that the staff had done a ‘marvellous job’ supporting his relative. New staff are informed at interview that they will be expected to undertake National Vocational Qualifications in care and 66 of the present staff team have level 2 or above. A member of staff interviewed during this inspection said that she had been reluctant at first but had gone on to complete level 3, which she really enjoyed. Four staff have been employed since the last Key Inspection and their recruitment files were checked during this visit. All had completed an application form. Two references had been obtained for two members of staff, but there were none at all for one staff member and only one for a fourth. “To whom it may concern” references are not suitable. Proof of identity had been obtained for all staff members. There was no evidence of Protection of Vulnerable Adults and Criminal Records Bureau checks for one member of staff and the checks had been completed some time after the other three started work in the Home. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 23 The manager must follow Protection of Vulnerable Adults, Criminal Records Bureau and Care Homes Regulations and legislation. Staff must not work in the Home until the results of a Protection of Vulnerable Adults check have been obtained. They can start work once this is obtained and whilst waiting for the results of the Criminal Records Bureau disclosure. The present recruitment procedures do not indicate that prospective staff are thoroughly vetted and therefore do not fully safe guard the residents. There is no evidence that residents are involved in the recruitment process. The manager reports that all nurses employed at Kirk House are checked with the Nursing and Midwifery Council before employment to prevent putting the residents at risk. New staff undergo an induction day, in which they learn about infection control, fire safety, Control of Substances Hazardous to Health, adult abuse, policies and procedures and Health and Safety. For two weeks they are supernumerary to the rota so that they can get to know the residents and the routines. Manual handling and fire training is provided by an external trainer annually. Food and hygiene and Protection of Vulnerable Adults training courses are planned for the near future. Five of the six staff completing the surveys say that they are given training relevant to their role, which helps them meet the needs of the people using the service and keeps them up to date with new ways of working. Supplementary training courses have included, challenging behaviour, incontinence, palliative care, peg feeding and syringe drivers. The activities co-ordinator is completing a relevant course and the senior nurse is completing the Registered Managers Award. One of the staff interviewed said, “Kirk House is a nice place to work”. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home, although more work is needed in this area. EVIDENCE: The manager, Amanda Clayton was registered with the Commission for Social Care Inspection in October 2006, although she has worked at Kirk House for many years. She is a registered general nurse and has completed the Registered Managers Award. She is considered to be very approachable by the staff and the residents and their families. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 25 Comments included: “Mandy has been great, she’s so supportive”. “We have staff meetings often, but senior staff are on hand at all times to give me any help I need”. Another member of staff commented that the Home had improved since Amanda became manager and that the atmosphere had improved. The home is a Registered Charity run by a committee of volunteers from the local community, who visit regularly and are actively involved in fundraising. They meet approximately ten times per year. The Home has a Quality Assurance system in place. Monthly meetings are held with relatives and volunteers within the ‘Friends of Kirk House Social and Welfare of Service Users’ group. A member of the committee is also involved in the ‘Friends of Kirk House’ so that the residents and relatives have access to them in an informal manner. Members of the committee visit the home on a regular basis to talk to the residents, relatives and visitors. Questionnaires are sent out on a six monthly basis to those residents able to express their views and opinions. If the resident is unable to give their views the relatives/next of kin are asked to give their opinions. All questionnaires are collated and an action plan on improvements is formulated and action carried out if appropriate. Meetings are held with the residents to discuss daily activities, diet, menus and other issues that come to light. Positive changes have been made as a result of these meetings and discussions. The manager keeps the Commission for Social Care Inspection informed of significant events. She needs to keep up to date with current legislation for example, Protection of Vulnerable Adults and recruitment, to ensure that the residents are fully safeguarded. The Home holds small amounts of monies for the residents. Records are kept of all transactions and two people witness them at all times. The records are audited annually. Discussions with the staff, manager and reading of staff surveys indicate that although the manager is very approachable there is a need for more regular, formalised supervision. Two of the six staff completing a survey said that they meet with the manager regularly to discuss how they are working; two said they often did and two said sometimes. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 26 Three of the six staff completing a survey felt they always have the right support, experience and knowledge to meet the needs of the service users and three said that they usually do. The written evidence at this inspection indicated that staff supervision has not been kept up to date The staff should attend a mixture of individual and team meetings. The manager should also receive support and supervision and this was discussed with a member of the committee. Some of the issues identified at this inspection confirm the need for more regular supervision. Staff are allocated various responsibilities and their completion needs to be checked. This includes the review and amendment of care plans and risk assessments and fire safety checks and testing. A random selection of the maintenance records were checked and they confirmed that the Home is well maintained, Health and Safety given appropriate priority and equipment serviced regularly. Control of Substances Hazardous to Health items are safely locked away and good infection control measures are in place. The Fire Safety Officer visited the Home in August 2007 and made a number of requirements, which the manager is gradually working through. The manager reports that she has nearly completed a full risk assessment, an electrician has been contacted to make improvements to the fire alarm systems and work is being planned to make sure that all fire doors are fully self closing and fit properly. The manager also needs to complete an evacuation plan, based on the individual needs of the residents. The fire safety records were checked during this inspection and the weekly fire alarm testing and monthly emergency lighting checks are not being done at the required frequencies. The water temperatures have not been checked since the beginning of August 2007. Accidents are recorded and evaluated three monthly to establish any trends, which can be eliminated. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 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 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 X 2 Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 13 (4) © Requirement The information in the care plans should be expanded upon to ensure that needs are fully identified, particularly complex needs, which pose a risk to the people using the service. This will ensure that all staff have the information needed to assist the people using the service and keep them safe. This information must be reviewed monthly and changes to care needs documented as soon as possible. The residents must be only be given medication which is prescribed for them specifically. The manager must keep the staffing levels under review to ensure that there is enough staff to meet the needs of the current residents and maintain their safety. The manager must make sure that the required checks are made on prospective staff members before they are employed and obtain all of the elements listed in Schedule 2 of DS0000022345.V345032.R01.S.doc Timescale for action 01/12/07 2. 3. OP9 OP27 13 (2) 18 (1) 12 (1) 13 (4) 23 (4) (iii) (a) (b) © © 01/11/07 01/12/07 4. OP29 19 Schedule 2 01/11/07 Kirk House Nursing Home Version 5.2 Page 29 5. OP31 21 A 6. 7. OP36 18 (2) 23(4)(c) (iii) OP38 8. OP38 23(4)(a) The Care Homes Regulations 2001. The Registered Person shall produce an improvement plan setting out the methods by which, and the timetable to which, the registered person intends to improve the recruitment procedures and provide evidence that that the results of a Protection of Vulnerable Adults check have been obtained and a Criminal Records Bureau applied for or received. The manager must evidence that staff are being appropriately supervised. To complete the evacuation plan to ensure that all residents are included, including their specific needs and provide enough detail for safe evacuation in the event of an emergency. To ensure that a fire assessment is completed. The fire safety systems must fully safeguard the residents. This includes compliance with the Fire Safety Officer’s requirements and ensuring that the Home’s checks are completed at the correct frequencies. 15/12/07 01/12/07 01/12/07 01/12/07 9. OP38 23 (4) (a) (b) (c) 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 30 1 OP1 2 3 OP7 OP9 The manager should consider developing the Statement of Purpose, Service Users Guide and contract in alternative formats, to enable people with more complex needs access to important information. The care plan information should be expanded to make sure that the staff know the assistance required to meet the needs of the people using the service. The manager should not be responsible for administering medication to staff. Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-46 Stephenson Street BIRMINGHAM B2 4UZ 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 Kirk House Nursing Home DS0000022345.V345032.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!