CARE HOMES FOR OLDER PEOPLE
Kirkby House Residential Care Home James Holt Avenue Kirkby Knowsley Merseyside L32 5TU Lead Inspector
Mrs Trish Thomas Key Unannounced Inspection 14th August 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 Kirkby House Residential Care Home DS0000062026.V348230.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. Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kirkby House Residential Care Home Address James Holt Avenue Kirkby Knowsley Merseyside L32 5TU 0151 2899202 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) kirkbyhouse@meridiancare.co.uk Meridian Healthcare Ltd Ms Madeleine Ward Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (14) of places Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Services to be provided for one Service User of 55 years or over. The home is registered for a maximum of 40 service users to include:*Up to 40 service users in the category of DE (E) (Dementia over 65 years of age) *Up to 14 service users in the category of OP (Old age not falling within any other category). 13th November 2006 Date of last inspection Brief Description of the Service: Kirkby House is a care home for 40 older people. The manager of Kirkby House is Mrs. Madeleine Ward and the home is owned by Meridian Healthcare Ltd. Kirkby House is a single storey building surrounded by well-maintained grassed areas and secluded gardens. The home is situated in a residential area of Kirkby, close to bus routes and a train station. Care and accommodation in Kirkby House is provided in three units. General administration, laundry and cooking are carried out centrally, and the manager has over all responsibility. Individual Units are otherwise self-contained, having designated staff, toilet and bathing facilities and lounge/dining areas. The building is suitable for people who have a physical disability, providing level access, mobility aids. Further communal spaces are available to all residents for joint social gatherings. All Service Users are registered with local doctors when admitted to Kirkby House on a permanent basis. Kirkby House has recently been completely refurbished. The range of weekly charges for Kirkby House is £343.07 - £399.91 with extra charges for hairdressing and chiropody. Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit was un-announced and the methods used to assess standards in Kirkby House were, discussion and spending time with residents, discussion with the manager, Ms. Madeleine Ward, and staff on duty. Records compiled in Kirkby House regarding health & safety and staffing were read and a tour of the premises was carried out. The care of four residents was tracked through reading their initial assessments of need, their care plans and their risk assessments and by meeting them and discussing their care. What the service does well:
Prospective residents have had their needs assessed before they move in to Kirkby House and the statement of purpose and service user guide have been reviewed to accommodate residents who have dementia. All residents have a care plan, which is based on the outcomes of each individual assessment of needs, and there are systems in place to review care plans and carry out risk assessments to address any identified change in need. Residents’ diversity is respected in care giving through involving them (and their families) in the planning of their care and by recording their religious beliefs and personal preferences. Kirkby House has been recently refurbished to very high standards, and provides a pleasant and comfortable home for the residents. Those who commented said they approved of the changes and said their home is very comfortable. To ensure that complaints are taken seriously, Kirkby House has a complaints procedure, which is available to residents and their families. The training and vetting procedures followed for staff in this home, protect residents’ best interests and welfare. Because Kirkby House is a purpose built care home, the environment is suitable for residents who have poor mobility and a range of adaptations is in place to ensure their comfort and safety. The service is provided on three units to give a more homely and personalised service. Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
To ensure that medication is stored safely, a recommendation is given that the temperature of the medication room is maintained at a safe level. As a development measure and to ensure that the lifestyle in the home is meeting the needs of all residents, including those who have dementia, a recommendation is given. Residents’ participation in activities or one to ones with staff, (or their refusal to take part in activities) should be monitored and activities on offer should be reviewed accordingly. To ensure proof of gas safety compliance, a recommendation is given. A copy of Kirkby House updated gas certificate to be provided to CSCI, when work on the ventilation system in the kitchen is complete. Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 7 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. Kirkby House Residential Care Home DS0000062026.V348230.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 Kirkby House Residential Care Home DS0000062026.V348230.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): Quality in this outcome area is good. Prospective residents have had their needs assessed and are given the information they need about Kirkby House before moving in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standard 1, 3. Kirkby House has a Service User Guide and Statement of Purpose, which give prospective residents and or/ their representatives a broad range of information about the organisation, staff, fees, accommodation and aims and objectives of the service. This is aimed at helping people to make an informed choice as to whether Kirkby House will make a suitable home. Residents have had their needs assessed by social workers, before they move in to Kirkby House and the admissions process is set out in the service user
Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 10 guide. Senior staff who work in Kirkby House, also carry out an assessment of need to ensure that the services and facilities can meet each prospective resident’s needs. The outcomes of assessments form the basis of each person’s care plan. Kirkby House Residential Care Home DS0000062026.V348230.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): Quality in this outcome area is good. Residents’ health and personal care is addressed in their care plans to ensure their needs will be met in Kirkby House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7.8.9,10. Four care plans were tracked to assess the levels of support received by each person. Care plans were compared with outcomes of assessments to ensure that each area of need has been addressed. Care plans cover a range of health, social and personal care needs. Care plans in general were satisfactory and reviews and risk assessments had been carried out. All residents are registered with local doctors and there is evidence in care files that they also have access to mental health services, paramedical and community health services, according to their need. Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 12 There are policies and procedures for managing residents’ prescribed medication and staff who give out medication have received training. The medication for three residents was tracked and was in order. Medication is stored in a secure area and there are arrangements for the safekeeping of keys. There is a recorded system for returning unwanted medication to the pharmacy each month. To ensure that medication is suitably stored, it is recommended that the medication storage room be maintained at a safe temperature. Kirkby House statement of purpose supports each resident’s right to be left alone and undisturbed when they wish. Residents’ privacy and is respected in their daily lives through provision of single accommodation and there are privacy and confidentiality policies for staff guidance. A resident said, “I like to stay in my bedroom, staff bring my meals and they are here when I need them. I have all I want.” Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. The lifestyle in Kirkby House was meeting residents’ expectations and their meals are appetising and served in a congenial setting. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. There is a written programme of improved social activities (stated as being available to residents in the service user guide), and their social preferences are stated in their care plans. To ensure that there are activities on offer to suit every person’s preference, it is recommended that participation in activities (and one to ones) is monitored and activities reviewed accordingly. Residents in the main lounge were watching a film on the afternoon of the visit. Others were moving freely around the lounges and some were in their bedrooms. There was a pleasant and relaxed atmosphere throughout this home. Residents’ visitors are made welcome and those who were seen during the visit were spending time with their relatives without interruption from staff. One resident said, “I prefer to stay in my bedroom and this is where I like to see
Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 14 my family.” There are arrangements for ministers and priests to visit Kirkby House regularly to attend those residents who wish to follow their religious beliefs. The manager said that some of the residents have attended weekly coffee afternoons arranged by a local voluntary group. Residents’ diversity is respected through respect for their rights and independence in care giving and in the range of choices available to them. Residents’ preferences are recorded and respected, and this was in evidence (for example), in a care plan, which records where the resident wants to take meals, her rising and retiring times, and her wish not to take part in arranged activities. Many of the residents no longer have capacity to state their opinions and preferences and to ensure they have independent representation there is ongoing communication with relatives and advocates during initial assessments and ongoing reviews in Kirkby House. The main meal on the day of this visit was pork, vegetables and mash with a milk pudding to follow. Three residents who were seated in the dining room said they enjoyed their meal and the food is very good. The cook was spoken with and she confirmed that there are choices and alternatives available to residents for their meals, and the menu is taken round daily to consult with them. Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents’ complaints are listened to and they are protected through the training and procedures in Kirkby House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16 and 18. Kirkby House has a complaints procedure, which is provided to residents and their representatives. A record of complaints is maintained, recording the investigation findings and any remedial action taken. There has been one concern raised to CSCI about Kirkby House since the last visit, regarding shortfalls in medication administration. Action has been taken to ensure that areas of concern have been rectified. Procedures have been amended in relation to adhering to pharmacy instructions when giving out medicines. There are procedures in Kirkby House for protection of vulnerable adults, and “whistle blowing”. Staff, who were on duty, had received relevant training and showed awareness of the indicators of abuse and the procedures to be followed if abuse is suspected.
Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 16 Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is excellent. Kirkby House is in very good condition, clean and suitable for its purpose. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19, 26. Kirkby House is a purpose built one-storey home and the grounds are well maintained with colourful planting and lawns. There is a secure courtyard garden, which is also well planted and attractive. There are forty-four single bedrooms, all having call buttons to summon assistance from staff. The majority of bedrooms have en-suite facilities. There are arrangements also for residents to have private phone lines in their bedrooms or make use of the home’s phone line. A resident said, “I like to
Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 18 stay in my bedroom and I have my own bathroom, I am very comfortable.” There are three lounges and two dining areas in Kirkby House. The building has been completely refurbished to very high standards giving a relaxed and homely environment for residents. Kirkby House provides a range of aids such as hoists and assisted baths and showers for those who are frail and whose mobility may have deteriorated. There is level access throughout the interior of Kirkby House and to the exterior grounds. Domestic staff are employed in Kirkby House and the building was very clean in the areas which were visited. Residents who commented were satisfied with standards of hygiene in their home. There are procedures for staff to follow in controlling infection and the control of substances hazardous to health and safe working practices in this were observed during the visit. (Cleaning materials were locked away when not in use and staff were wearing protective clothing). Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 19 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 good. Training and staffing arrangements in Kirkby House support the service aims and objectives and the job descriptions of those who work there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27,28, 29, 30. A staff roster is maintained in Kirkby House, which provides a record of the names of staff on duty on each shift. In addition to the manager and care assistants, staff are employed for cleaning, cooking and maintenance. The registered providers, Meridian Care Limited, have a management structure in the wider organisation, which provides senior management support, training, human resource management, and estates management. There has been low staff turnover in Kirkby House in the past twelve months and there were no staff vacancies at the time of the visit. Over 50 of care staff have achieved NVQ and a range of mandatory and service specific training is available. Members of staff who were spoken with, said that the training was in keeping with their job roles. A record of training undertaken and planned is maintained on staff training schedules, and this gave evidence that a satisfactory level of training is provided in Kirkby House.
Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 20 To protect residents, there is a recruitment procedure in place in Kirkby House, which includes the vetting of prospective job candidates and taking up criminal records bureau clearances and references before they take up their posts. A sample of staff files was read and these had been well maintained giving evidence of that the recruitment procedure is being followed. Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good. Kirkby House is managed in a way, which protects the health, safety and welfare of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 31,33,35 and 38. The manager, Ms. Madeleine Ward, has many years managerial experience in Kirkby House and has achieved the Registered Managers Award. Residents said that Ms. Ward is kind and helpful and staff said she supports them well. There is a quality assurance system in Kirkby House, which is based on seeking the views of residents and their representatives by distributing quality
Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 22 questionnaires twice a year. The outcomes are monitored, strengths are built upon and remedial action carried out to address any negative comments. The manager and two of the residents who commented, confirmed that staff do not involve themselves in residents’ financial affairs. Personal allowances held in safe keeping on residents’ behalf are held secure and audited regularly. A sample of these records was seen and was in order. A record of accidents to residents is maintained which is regularly monitored with risk assessments reviewed as necessary. Accident records for two residents were seen and these had been recorded to a satisfactory standard and appropriate action taken to avoid future occurrences. There are procedures in place for the promotion of health & safety and fire safety in Kirkby House. Supporting documentation was well maintained. Work was being carried out on the kitchen ventilation system, to ensure compliance with gas safety. To ensure that there is evidence of compliance on completion of the work, it is recommended that a copy of Kirkby House up to date gas safety certificate is supplied to CSCI. Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 23 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X 3 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 3 X 3 X 3 X X 2 Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 24 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. 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 OP9 OP12 Good Practice Recommendations To ensure that medication is suitably stored, it is recommended that the medication storage room be maintained at a safe temperature. It is recommended that participation in activities and individual support (one to ones) for residents, who have dementia, is monitored and reviewed, to ensure that there are activities on offer to suit every person’s need. To ensure that there is evidence of compliance with gas safety, it is recommended that a copy of Kirkby House up to date gas safety certificate is supplied to CSCI when work on ventilation is complete. 3. OP38 Kirkby House Residential Care Home DS0000062026.V348230.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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
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