CARE HOMES FOR OLDER PEOPLE
Kirkby House Residential Care Home James Holt Avenue Kirkby, Knowsley Merseyside L32 5TU Lead Inspector
Lynn Paterson Unannounced 9 August 2005
th 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 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 F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Kirkby House Address James Holt Avenue Kirkby Knowsley Merseyside L32 5TU 0151 289 9202 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Meridian Healthcare Ltd Ms Madeleine Ward Care Home 30 Category(ies) of DE - Dementia registration, with number OP - Old Age of places PD(E) - Physical disability over 65 Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should employ a suitably qualified and experienced manager who is registered with the CSCI. 2. Day staff levels for 10 service users with dementia to be on duty in the ratio of 1:5, in accordance with the Notice of 9/3/04 3. Service to be provided for one service user of 55 years or over, within the registered number of 10 DE. 4. The service is registered to provide personal care to a maximum of 30 Service Users. 5. The service is registered to provide personal care to a maximum of 20 Older People (OP) 6. The service is registered to provide personal care to a maximum of 10 Older People with Dementia DE(E) Date of last inspection 7th October 2004 Brief Description of the Service: Kirkby House is a residential care home registered to provide accomodation for 30 older people and is owned and manged by Meridan Care. The premsies is a single storey buidling situated on the outskirts of Kirkby with acces to shops and local amenities. Accomodation is provided in three small 10 bed units which are`self contained in respect of lounge/dining room,bath and toilet facilities.A large central dining rrom provides accomodtaion for meetings and entertainment. The home has 2 enclosed gardens for theb use of the residents and parking facilty to the front and side of the property. . Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Kirkby House took place over a 4- hour period and was carried out on an unannounced basis. For the purpose of this report a tour of the premises was undertaken, care files and other documentation was examined 17 residents, 3 care staff and the manager and her deputy were spoken with. The manager Mrs Madeline Ward represented the home and all areas of the inspection process and inspection findings were discussed. What the service does well: What has improved since the last inspection?
New furnishings have been provided in the EMI unit and the home is benefiting from general refurbishment. Staff training is ongoing. New policies and procedures have been implemented as a consequence of the home being owned and managed by Meridian Care Limited. Updated brochures and statements of purpose have been provided for all residents to reflect the change of ownership of the home. Staff advised that they felt valued and included by the Meridian Care Group. Provider visit reports are clear and purposeful. Quality assurance systems are in place to ensure all service users views are recorded and addressed. Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 6 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. Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Pre- admission assessments are not carried out by staff of Kirkby House therefore staff cannot identify that the home can meet assessed need. EVIDENCE: Examination of care files showed that pre admission assessment documentation was not in place. Staff spoken with revealed that they were not responsible for pre admission assessments as placements were requested by social workers. The home manager agreed that pre assessment should be carried out by people who had full knowledge and understanding of the service provision of Kirkby House and that information gained at this assessment should be recorded and transferred to the care plan if admission was agreed upon. Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7.8.9. Care plans held some information about health and personal care needs. However more details are necessary to ensure that the care planning process includes full information about health, personal and social care needs and of the agreement of all concerned for these practices to be carried out. EVIDENCE: Care plans examined held some detail about care need and care planning and record showed that they were monitored and reviewed on a monthly basis. None of the 5 care plans viewed had background information about past medical history. None of the 5 care plans viewed held information about activities or interests. However the home manager was able to show that this information had been recorded for previous residents and it was agreed that this information should be obtained and held on file to ensure that all information was in place to fully meet needs, choices and preferences. Only one of the care plans viewed had signatures of all concerned in the plan preparation. All plans looked at had risk assessment details and weights and tissue viability were recorded as appropriate. Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 10 General recording systems of daily records appeared well managed and consistent with cross -referencing between care files, daily recordings and professional visiting records. Mediation policies and procedures were clear and medication records and storage systems seen at the time of the inspection appeared to be managed as per the policies and procedures in the home. Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12. Service users are not provided with social or recreational interests to match their expectations and preferences. The company need to review and plan to evidence that action has been taken to meet this standard. EVIDENCE: Residents spoken with said that whilst they were generally happy in the home they were not offered many activities or interests, and as a consequence did not have the stimulation they required. They said that staff did their best to arrange Bingo or Dominoes and sometimes they had a “little sing a long”, but they felt that staff had so much to do that activities could not be arranged very often. Staff revealed that they did their best to arrange activities but agreed that it was not always possible due to the pressure of work. Residents were observed sitting in the corridors, chatting or sleeping during the time of the inspection visit and it was noted that no activities were taking place in any of the three units. Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16.18 The home has a complaints policy, which is known to residents and staff. Staff, are provided with training in abuse awareness and have knowledge and understanding of all aspects of adult protection. EVIDENCE: Residents spoken with said that they knew what they should do if they had reason to complain and they had received a copy of the homes complaints procedures. All residents spoken with said that they had been given no reason at all to make a complaint but “ they knew what to do if they had”. The homes complaint book was visible and accessible at the time of the visit. Staff advised that they had received training in all aspects of adult protection and were able to advise of the steps they would follow in the event of abuse allegations. Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19.24.26.. The company has devised an upgrading and refurbishment programme to ensure that residents live in a safe, well-maintained environment. EVIDENCE: A tour of the premises identified that the home was clean and tidy and free from unpleasant smells. Resident’s rooms were personalised, homely and comfortable at the time of the inspection visit and residents spoken with revealed that they were happy with their accommodation in the home. Risk assessments were also seen and it was noted that they held detailed information about identified risk and of the preventative measures used to minimise risk and provide a safe environment wherever possible. The home had a maintenance, refurbishment and decorating plan in place that identified the companies commitment to upgrading and improving Kirkby House .It was noted that plans included improvements being made to the facilities, décor and overall standard of accommodation over the next 12 months. Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.30 Staff, receive relevant training and are supplied in sufficient numbers and skill mix to meet the needs of the residents of Kirkby House. EVIDENCE: Residents spoken with revealed that they were happy with the care provided by staff of the home and comments included “staff are `wonderful to us all”, ”staff are kind and helpful”, “they are always there when you need them”. Staffing rotas were clear and identified that staff were provided in adequate numbers to carry out their duties however it was noted that staff are not provided to organise or carry out activities and this is currently provided through “the goodwill” of care staff. Staff interviewed were enthusiastic and appeared motivated to carry out their remit. Staff revealed that they felt valued and supported by the line management structure and by the company who employed them. Records showed that the staff turnover was low and that training was ongoing. Staff spoken with said they had received training both in house and externally to include all mandatory training and training in dementia care. Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31.33. The manager is respected by staff and residents and is fit to be in charge of the home . Quality assurance systems are in place to make sure that the home is run ion the best interests of the residents. EVIDENCE: Staff and residents spoken with said that the manager was “good at her job” and had an open style of management with which everyone felt comfortable. Staff said that the manager had an open door policy and was approachable at any time. Quality assurance systems viewed revealed that the provider visit reports focused on residents views and this was followed up by questionnaires to ascertain what the residents felt was good about the home and what they felt needed changing. The manager advised that the company policy was to pursue excellence and promote quality in all service provision ,an attitude which she stated had been cascaded through to all the staff of the home.
Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 4 x x x x x Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 17 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 3 Regulation 15 Requirement The registered perosn must ensure that a pre admission assessment is carried out by suitably qualified persons who have full knowledge of the service provison of the home. The regsitered perosn is required to provide a care plan which details all personal,social and health care needs and which holds the singatures to ensure that the care delivery is acceptable to the residents and representative. The registered perosn must ensure that all health needs are identified and met. The registered perosn must consult residnets about the activities programae to ensure that residnets are provided with activites and interests to mmet preferneces ,choices and capabilities. Timescale for action 1.10.05 2. 7 15 1.10.05 3. 4. 8 12 12 16 1.10.05 1.10.05 Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Kirkby House Residential Care Home F53 F03 S62026 Kirkby House V228210 090805 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Burlington House Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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