Inspection on 17/01/06 for Kirkdale Care Centre and Rebecca Posner Unit

This inspection was carried out on 17th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kirkdale Care Centre and Rebecca... 27/09/07

Kirkdale Care Centre and Rebecca... 17/05/06

Kirkdale Care Centre and Rebecca... 19/04/05

Kirkdale Care Centre and Rebecca... 19/10/04

Kirkdale Care Centre and Rebecca... 22/03/04

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Orchard House Nursing Home

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Red Court Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Kirkdale Care Centre and Rebecca Posner Unit Kirkdale Care Centre 258 Kirkdale Sydenham London SE26 4NL Lead Inspector Kate Matson Unannounced Inspection 09:45 17 /18 January 2006 th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 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. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Kirkdale Care Centre and Rebecca Posner Unit Address Kirkdale Care Centre 258 Kirkdale Sydenham London SE26 4NL 020 8659 9004 020 8776 7223 zelina.ramadhan@excelcareholdings.com 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) Rinacrest Limited (T/A Excelcare Holdings plc) Zelina Zarina Ramdhan Care Home 63 Category(ies) of Past or present alcohol dependence (0), registration, with number Dementia (0), Dementia - over 65 years of age of places (0), Mental disorder, excluding learning disability or dementia (0), Old age, not falling within any other category (0), Physical disability (0), Physical disability over 65 years of age (0) Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 1 may have past or present alcohol dependence and 1 may have a physical disability This home is registered for 42 persons of whom up to 42 may be old age, up to 42 have dementia 20 patients (accommodated in the Rebecca Posner Unit at Kirkdale Care Centre) elderly persons aged 60 years and above (female) and 65 years and above (male) with a mental health disorder 42 residents (in Kirkdale Care Centre) persons aged 65 years and above, and persons aged 60 years and above who suffer from a past or present alcohol dependence persons aged 60 years and above who are physically disabled Date of last inspection 19th April 2005 Brief Description of the Service: Kirkdale is a care home with nursing for a maximum of 63 older service users, who are physically frail. The overall stated aim, shared with other homes run by the same provider, is that of offering care in a home from home setting, recognising and meeting individual needs. The underlying philosophy is that of promoting users’ rights to privacy, dignity, security, choice and fulfilment. The registered provider is Rinacrest Limited, a company associated to an organisation called ‘Excelcare’, who run over thirty homes in England. A director, to whom all the staff are ultimately accountable, directs the service. The day-to-day running of the home is delegated to a care manager, who works full time at the home and who leads a team of staff. Accommodation is provided in a large building, divided into three smaller units, one on each floor. The top floor unit provides nursing care. There is a lift. Bathrooms and toilets are located on each floor. None of the bedrooms have en-suite facilities. There is a large back garden. There is provision for parking at the front of the premises. The front and back doors are accessible to people in wheelchairs.The premises are located on a main road close to the centre of Sydenham. The area is served by public transport and has a selection of shops. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This statutory inspection was carried out over 12 hours conducted over 2 days. The inspection included speaking with seven service users, the registered manager, the cook and other staff, a tour of the building, examination of six service users files, staff records and other records. The CSCI pharmacy inspector carried out an inspection on the 2nd day. What the service does well: What has improved since the last inspection? The written information given to service users had been improved and now accurately reflected the services and facilities available. A full time activities coordinator had been appointed and a variety of activities were being offered on a daily basis, based on an assessment of individual needs. Good progress had been made in ensuring staff had training in adult abuse. The provider had made changes in the environment that have significantly improved the quality of life for service users. These included, the reduction in numbers of shared rooms (though surplus furniture must be removed where rooms are used by a single occupant), the provision of a visitors room in the basement, the enlargement of the sitting and dining area on the first floor (though it is recommended that the provider continues to review the furniture arrangement to find the most effective use of the space), the movement of the office spaces on the ground and first floors away from where they impinged on service users space, refurbishment of bathrooms which also ensured service users on each floor have the choice of a bath or a shower and the renewal of furniture in service users bedrooms. An assessment of staff training needs had been developed and a training record completed, however a training plan is still required to evidence a proactive approach to training in the home. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 6 Results of quality assurance surveys had been published and made available to all those taking part. Communication systems within the home and between the manager and the provider had been developed to ensure the health, safety and welfare of service users. Medication handling and recording was good, and improvements noted at the last inspection had been maintained. 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. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 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 the following standard(s): 1 and 3 Information contained in the statement of purpose and service user guide is now accurate. Although the needs of service users are assessed before they are offered a place, some important areas for assessment are not included. EVIDENCE: Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 9 Previous inspections had noted that there were significant inconsistencies between the principles and ethos of care proclaimed in the statement of purpose and the use of the premises that did not consistently support those principles. This was because there were a number of concerns raised about the use of the premises including, among others, the number of shared rooms, lack of private space for visitors and inadequate sitting and dining space. The registered provider was required to clearly state how it is ensured that service users’ rights to privacy, dignity, choice and having their changing needs met are consistently promoted. The registered provider was also required to ensure that the home’s policy on room sharing is based on the principle that double rooms are shared only if two service users have made a positive choice to share together. At this inspection it was found that significant improvements in the use of the building had been made (discussed further under the environmental standards) and the concerns around privacy, dignity and choice were diminished. The statement of purpose now included a statement that when a double room becomes occupied by a single service user the room will convert to a single room, however where service users wish to share they may do so but will be asked to sign a consent form. Six service users files were examined and all included evidence of the service users’ needs being assessed prior to being offered a service. However the format of the needs assessment did not include all areas such as social, cultural and religious needs. This must be addressed to ensure an holistic assessment. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Care planning and review has improved significantly, though more attention to social needs is still required. More effective monitoring of hospital admissions is required in order to ensure that any deficits or improvements in care are identified. Improvements have been made to the environment to ensure that service users’ privacy, dignity and choice are not impeded. The medication at this home is now well managed, ensuring service users’ medication needs are being met. EVIDENCE: Previous inspections had noted that there was much information kept on file, but it was difficult to gain a whole picture of the service user. There needed to be a summary/pen picture and information around what is important to the person, their likes and dislikes. Overall the information related mainly to physical needs rather than giving a holistic picture. Guidelines were to be drawn for staff supporting service users to achieve their goals. Developmental and maintenance objectives were to be clearly defined and separated from tasks, to enable clearer monitoring, evaluation and review. What was learnt from supporting users in activities needed to be recorded. At this inspection much improvement was noted in care planning. Care plans included much more information about how service users were to be supported in achieving Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 11 goals and meaningful reviews were taking place regularly with relatives being invited to these around every six months. Efforts were being made to gather information about service users’ past lives in conjunction with relatives. However, social needs were given less emphasis than physical needs and some files did not include care plans around social needs and activities. The general practitioner visits the home on a weekly basis or when required. The manager described good support from the Care Homes Support Team for the nursing floor in the form of regular visits and training for staff. All other health professionals visit routinely or when needed and these visits were recorded in service users files. Each service user’s file contained an individual risk assessment covering areas such as risk of falls and risk of pressure sores. It was required at a previous inspection that the reasons for hospital admission of service users continue to be monitored. This must include: an assessment of the causes of the accidents resulting in admission to hospital, whether the accidents could have been avoided and any action to be taken to minimise the risk or recurrence. At this inspection it was found that hospital admissions were being monitored and in some cases of accidents an assessment of the reasons for the accident and action taken to minimise the risk were recorded separately; however, this was not done in all cases and an overview of all cases to identify any patterns did not appear to have been taken. As noted under National Minimum Standard one, concerns had been raised at previous inspections of how the use of the building impeded service users’ rights to privacy, dignity and choice being upheld. This related particularly to the numbers of shared rooms, inadequate space for sitting and dining and receiving visitors. At this inspection it was found that significant improvements in the use of the building had been made (discussed further under the environmental standards) and the concerns around privacy, dignity and choice were diminished. Medication Handling Several requirements in relation to medication handling had been made at the last inspection. All of these have now been met, and improvements noted at the last inspection have been maintained. -The ordering and supply systems are robust, there were no out of stock medications. -Medication Administration Record (MAR) charts were inspected for all 3 floors, and recording was good. -There are now Medication Review sheets to document changes to medication regimens, so it is clear when a new item is started, or an item is discontinued or the dose amended. -Staff confirmed that the service provided by the GP is good, the GP visits once a week and has time to visit residents and answer questions. -Compliance is good, residents are supported well to take their medication. -Staff carry out medication audits on each others units three times a week and action is taken on any issues picked up. -Care staff who administer medication on the two residential floors have undertaken medication handling distance learning. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 12 -There is a record of items administered by district nurses. The application of external products and food supplements is also recorded. -Although there have been changes in environmental laws related to returns of medication which have caused problems for nursing homes, the supplying pharmacist is still collecting returns regularly. -Storage facilities for medication are good, room and fridge temperatures are monitored and there are notes on the action taken in the case of temperature excursions. -Controlled drug recording/stocks were checked and were accurate. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The home’s approach to activities is much improved with a full time activities co-ordinator ensuring activities are tailored to meet the needs of individuals. Service users maintain contact with families, friends and others from the community and a visitor’s room has been provided to assist with this. Service users are able to exercise choice in many areas though it was found that decisions had been taken on behalf of two service users without reasons for this being recorded in the notes. Service users are provided with a choice of varied and nutritious meals in much improved surroundings. EVIDENCE: At the last inspection it was noted that most service users were sitting around un-stimulated, suggesting that service users were not given sufficient choices of activity that they wished/were able to engage in. At this inspection it was found that the situation had been much improved. There was a full time activities co-ordinator and a programme of activities was offered on a daily basis and this changed every week. The activities co-ordinator drew up an activities programme for each service user and is also able to spend time with individual service users. Activities offered include armchair exercise, knitting group, card games, dominoes, bingo, hand and nail care, art and craft and visiting musical performers. Some trips out had also been offered in accordance with a previous recommendation. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 14 The inspector was informed that in addition to regular entertainers who visit the home, church ministers visit every week from the Catholic Church and every two weeks from the 7th Day Adventist church. It was noted at previous inspections that although visitors were welcome at any time there was no private space for service users to receive visitors apart from their bedrooms. This was not always appropriate particularly where rooms were shared. At this inspection it was found that a room in the basement had been converted to a visitors room. This was, in the inspector’s view, a very pleasant space. It was yet to be properly advertised within the home as it had only just been completed. There was evidence in service user’s bedrooms that they had been able to exercise choice in bringing some of their own items into the home. Service users spoken to confirmed that they are offered choice in areas such as what time to get up and go to bed and what food they wish to eat at meal times. It was noted at the last inspection that only one of the four baths available in the building was equipped with a suitable and functioning hoist. This meant that on the ground and first floors service users were not able to choose between a bath or a shower. At this inspection the inspector was informed that all of the bathrooms were now fitted with an assisted bath or bath with functioning hoist. It was found that a married couple shared a room and although the manager stated they had been offered the option of a double bed this had not been provided as the family stated they didn’t want their parents to share. It was not clear how this decision had been made on behalf of the service users. Where decisions are made on behalf of others they must be made in conjunction with other interested parties such as advocates, social workers, and psychiatrists and be fully documented in the service users notes. The manager stated she would ensure a review with the social worker took place in the near future to ensure this decision is reviewed. Service users spoken to were happy with the meals provided. Comments included “I like the food”, “You get a good breakfast”, and “The meals are very nice”. The home operates a four-week rolling menu, and the meals offered appeared to be varied and nutritious. They also included meals for vegetarians and people from other cultural backgrounds. Service users are assisted to complete a form every day to indicate their choices of meals. The cook confirmed that hot and cold drinks and snack meals are available as required. Concerns had been raised at previous inspections, as the dining room on the first floor unit was too small for the number of users on that floor. Some service users had to sit in armchairs, away from the tables, with food trays. The space for the users sitting at the tables was cramped and if users on the internal sides wanted to get up, the ones sitting next to them had to do so also, to enable them to pass. The service users who needed support with eating could not sit at the table or were receiving support from staff who stood behind them. Staff said that some relatives had referred to the arrangement as abusive. At this inspection it was found that a bedroom next to the shared space had been knocked through to create a larger space. This was a great improvement and there were sufficient places for all service users to sit at the table. However one staff member stated that assisting service users who Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 15 needed support was still difficult. It is recommended that the provider continue to review the arrangement of the furniture on the first floor to find the solution that utilises the dining and seating space most effectively. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Service users and the complaints record indicated that complaints are taken seriously. Most staff have had training in adult protection in order to protect service users from abuse. EVIDENCE: The complaints procedure is included in the service users guide and located at various points around the building. Service users spoken to stated that they had not had any reason to complain but confirmed they would do so if necessary. There had been a small number of complaints but some of these involved investigations under vulnerable adults procedures. Some were ongoing. The complaints record showed that complaints were clearly summarised with details of investigations recorded in a complaints file. At the last inspection it was found that the provider had not shared the local authority’s report of their adult protection investigation with the home’s manager, despite it making requirements of which she would need to be aware. This raised concerns about the real commitment of the provider to address adult protection issues within the home and a requirement was made that all information relating to the health, safety and welfare of service users at Kirkdale is communicated to the homes manager without delay. At this inspection the manager stated that communication had been improved by a different management strategy and that she is kept updated by fortnightly meetings at head office. It was also required that all staff undergo adult protection training. At this inspection it was found that good progress had been made towards meeting it and the manager was using a variety of resources including external and internal training with an assessment. 25 staff had undergone some training. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26 The home is located close to local facilities and is well maintained. The environment has been significantly refurbished to improve the communal facilities for service users. There are sufficient toilets and washing facilities. The furniture provided has been improved and most service users now have their own rooms; however, surplus furniture has been left in their rooms. EVIDENCE: The home is located in Sydenham, close to shops facilities and good public transport links. It is an older property with bedrooms and communal sitting and dining space arranged in three separate units over three floors. Previous inspections had noted that the way the premises were used impinged on the service users’ rights to privacy, dignity and choice. In particular there was a significant number of rooms that were being used as shared rooms, some rooms were inadequately furnished, there was no private space for service users to receive visitors apart from in their bedrooms (which was not appropriate if they were sharing), the office space on the ground floor impinged on service users sitting space, there was inadequate sitting and dining space on the first floor, and there was inadequate office and clinical Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 18 space on the 1st floor. At this inspection it was found that the provider had made major improvements to the premises, diminishing concerns about service users, privacy, dignity and choice. Rooms were now only shared by a married couple and two service users who had shared for a long time, furniture had been renewed, a room in the basement had been refurbished as a visitors room, the office space on the ground floor had been moved away from where it impinged on the service users’ space, and on the first floor, a bedroom had been knocked through to enlarge the sitting and dining space, office space had been relocated to the landing and clinical space had been relocated to the ground floor and basement. The statement of purpose states that there are two toilets on each floor. At the last inspection it was found that the home had two showers and one bath on the second floor, one shower and two baths on the first floor, though one bath was not equipped with a functioning hoist, and one shower and one bath on the ground floor though the bath was not equipped with a functioning hoist. The provider was required to ensure that there is at least one assisted bath on each floor to allow service users the choice of a bath or shower. At this inspection the inspector was informed that all of the bathrooms were now equipped with an assisted bath or bath with functioning hoist. Previous inspections had noted that a significant number of rooms were shared and that some rooms were furnished inadequately with broken furniture and in some rooms the only chairs available in the rooms for service users or their visitors to sit on were rather old looking commodes. At this inspection it was found that rooms were adequately furnished and broken furniture had been replaced with new. The statement of purpose states that when a single service user occupies a double room, the room will be converted to a single room. However, it was found that although only two rooms were shared, and these were by a married couple and two service users who had shared for a long time, other double rooms were still furnished for two service users. Surplus furniture must be removed from double rooms where they are occupied by a single service user so that the service user can be confident that they have sole use of the room. The home was clean at the time of the inspection, though offensive odours were noted in a couple of areas on the 1st day. These were reported to the homes manager and were resolved by the 2nd day. As a result of a complaint prior to the last inspection a nurse from the health protection unit conducted an infection control audit the recommendations of which were examined at this inspection. Good progress had been made towards implementing the recommendations and the manager stated her intention to continue to do so. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The number and skill mix of staff on the duty rota does not ensure that service users’ needs are met. The home has a good proportion of staff that have been trained or are training to minimum standards. Although in the main the home operates a thorough recruitment procedure, an important check was missing from one staff file. The home’s manager has taken steps to ensure that the home’s training is based on staff need and National Training organisation specifications, though a training plan to indicate a proactive approach to training is still needed. EVIDENCE: Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 20 The current staff level was described as follows: on both the residential floors there was one senior carer and three carers on duty during the day and one senior and one carer on duty at night. On the nursing floor there was one nurse and two carers on duty during the day and one nurse and one carer on duty at night. The previous regulator had set a minimum staffing level above this for the nursing floor and the home must now increase staffing back to those original levels. It was noted at the last inspection that on four out of seven nights there was only one senior carer on duty at night to cover the ground and first floors. The registered provider was required to ensure that staffing numbers and the skill mix of carers and senior carers are appropriate to the assessed needs of the service users, size, layout and purpose of the home at all times. At this inspection the current weeks rota for each floor again showed that four out of seven nights there was only one senior carer to cover ground and first floors. This meant that when the senior was supervising the first floor the carer on the ground floor would be alone to meet the needs of service users. The manager stated that this was because she had a number of staff off sick, however replacement staff must be used from agencies or otherwise to ensure the safety of service users. Continued failure to comply with this requirement will lead to enforcement action being considered. The registered manager stated that 19 of the 39 staff had now completed NVQ qualifications, and a further 9 were currently completing courses. This means that the home will have a good proportion of staff trained to national minimum standards. At a previous inspection the registered provider was required to ensure that all statutory checks are conducted to ensure suitability of staff and inform the decision to appoint. At this inspection the files of three new staff were examined. It was noted that the files were well organised and included evidence of checks with the criminal records bureau (CRB) and list of people considered unsuitable to work with vulnerable people (POVA list), though one of the files contained only one reference. The administrator stated that a verbal reference had been given but a record of this was not available. At the last inspection, it was found that training at the home needed to be better planned and organised in order to ensure that it is based on the needs of the service users and an assessment of the skills/deficits of the whole staff team. The provider was required to ensure that each staff member had a training assessment and profile and that a training plan was developed based on the needs of service users and an assessment of skills and deficits of the whole staff team. In addition it was recommended that the manager contact the London “Skills for Care” office to ensure that the homes training met with National Training Organisation (NTO) specifications. At this inspection it was found that the manager had contacted Skills for Care and obtained induction packs that met with NTO specifications, although this had not been utilised yet as no new staff had started since the packs had been obtained the manager confirmed that they would be used with new staff. A training assessment and profile had been developed and the manager stated these would be updated every six months and more regularly for new staff. The manager had also Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 21 developed a training plan though this was more of a record of training completed as it did not evidence a proactive approach to training for a twelve month period, and state when and where training would be completed. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 The manager is qualified, experienced and competent to run the home. Quality assurance systems are in place to ensure that service users and others are regularly consulted about the service. Although efforts have been made to transfer responsibility for financial matters, the provider still manages service users’ money and their financial interests are not being effectively safeguarded. The home has policies and systems in place to protect the health, safety and welfare of service users. EVIDENCE: The registered manager is a qualified general and mental nurse. She informed the inspector that she has completed the NVQ qualification in Management as required by National Minimum Standards, though had not yet received her certificate. She has over 30yrs experience of in-patient and community settings and has managed the home for five years. She stated she updates her knowledge by attending courses along with her staff and by reading journals and using the Internet. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 23 At the last inspection it was found that customer satisfaction surveys were conducted annually to seek the views of service users, relatives and visiting professionals. The registered provider audits and summarises these surveys and the results are fed back at meetings for staff and relatives. Service user meetings were rarely held, as most of the service users are unable to take part. There was no mechanism for feeding back the results of surveys to service users or visiting professionals. The provider was required to rectify this to ensure that those taking part in surveys have confidence that their views are being taken into account. Meeting minutes evidenced that staff meetings were held monthly and relatives meetings every three to four months. It was recommended that minutes should be recorded more formally to ensure that issues raised are dealt with and carried forward to the next meeting if necessary. At this inspection it was found that results of the latest survey had been published and these were available in the reception area for anyone to take. The minutes of meetings had been formalised to ensure that issues were carried forward. At the last inspection it was found that the home managed the personal allowances for most of the service users and savings were head centrally at head office. Some financial records and service users money were examined and it was noted that although receipts were held and a brief entry of what was purchased was recorded, records did not specify individual items purchased. This system left service users potentially open to abuse and needed to be rectified. In addition, it was noted that the savings of service users were held at head office but service users did not receive statements and they did not accrue any interest on their money. One service user had many thousands of pounds not accruing interest. The registered provider was required to ensure that financial systems are reviewed in order to ensure that service users’ financial interests are safeguarded. At this inspection it was found that fuller details of financial transactions were now being recorded. The provider was still managing some service users money including the service user with a large amount of savings. The administrator stated that statements were issued every three months though a statement for this service user had not been sent for nearly twelve months and interest was still not accruing. However the inspector was informed that the provider was working with this service users social worker and towards local authorities becoming appointees. At the previous inspection it was noted that several of the baths did not have functioning bath hoists and the registered manager stated that she had not been aware that hoists were not working. This raised concern about communication within the home and within the organisation, as carers and the providers maintenance department were aware of the problems. This lack of communication potentially placed service users at risk. The provider was required to ensure that all equipment is in good working order and certificates are available for inspection and the manager was required to develop more effective systems in the home to ensure she is aware of all issues for which she has responsibility. At this inspection it was found that all equipment was functioning and had been serviced appropriately. Certificates for servicing of gas appliances, electrical appliances and the electrical installation of the Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 24 building were up to date. Regular checks of water temperatures, the call system, emergency lighting and fire alarm call points were being made appropriately. Fire drills were conducted at the required intervals and requirements made by a fire inspection in December 2005 to be implemented by March 2006 were being implemented. Communication systems had been developed to ensure that the manager is aware of issues, for example a weekly meeting with senior managers, maintenance book kept in reception and staff are encouraged to note things in the managers diary. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 25 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 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 3 X X 2 X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 1 X X 3 Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 (1) (a) Requirement Timescale for action 30/04/06 2 OP7 15 The registered provider must ensure that the assessment of service users includes all of the areas listed under NMS 3. The registered provider must 30/04/06 audit the way the reviews of care plans are conducted and recorded, to ensure that they are holistic. In particular that:- Care plans give a picture of the person as a whole, with emphasis also given to cultural and other identity issues.Guidelines are developed for staff supporting users with developmental goals. Developmental and maintenance objectives are separated from tasks, to enable clearer monitoring, evaluation, review and update of objectives. - When there are communication issues, (to help establish how the user can best be supported), information is kept around what the person does, what the staff think it means and when it happens. (Timescale of 01/07/05 not met though good progress made towards DS0000007040.V254352.R01.S.doc Version 5.0 Kirkdale Care Centre and Rebecca Posner Unit Page 27 3 OP8 13 4 OP14 12 (3) 5 OP18 13 (6) 6 OP24 23 (2) (f) 7 OP27 18(1)(a) meeting it) The registered provider must ensure that the reasons for hospital admission of service users continue to be monitored. This must include:- An assessment of the causes of the accidents resulting in admission to hospital- Whether the accidents could have been avoided -Any action to be taken to minimise the risk or recurrence. (Previous timescales of Nov 03, Jan 05, and 30/06/05 not met though progress has been made towards meeting it) The registered manager must ensure that where decisions are made on behalf of others they are made in conjunction with other interested parties such as advocates, social workers, and psychiatrists and be fully documented in the service users notes. The registered provider must ensure that all staff undergo adult protection training at a level sufficient to ensure; knowledge of what consitutes abuse, ability to detect signs and symptoms, confidence in action to take if abuse is suspected and knowledge of appropriate local procedures including whistle blowing.(Previous timescale of 30/09/05 not met though good progress has been made towards meeting it) The registered provider must ensure that where double rooms have reverted to singles, surplus furniture is removed from the room. The registered manager must ensure that the staffing notice issued by the previous regulator DS0000007040.V254352.R01.S.doc 30/04/06 30/04/06 30/06/06 30/04/06 10/02/06 Kirkdale Care Centre and Rebecca Posner Unit Version 5.0 Page 28 8 OP27 18 (1) (a) 9 OP29 19 10 OP30 18 (1) (c) 11 OP35 12 is adhered to and that there is at least one nurse on duty on every shift; three support staff during the day and two support staff at night on the nursing floor. The registered provider must ensure that staffing numbers and the skill mix of carers and senior carers are appropriate to the assessed needs of the service users, size, layout and purpose of the home at all times.(Previous timescale of 30/06/05 not met) The registered provider must ensure that all statutory checks are conducted to ensure suitability of staff and inform the decision to appoint. To this end, existing files must be reviewed and appropriate steps taken, if necessary, to ensure that the checks are consistent with the regulations and the home’s own policy. (Previous timescales of 01/02/05 and 30/06/05 not met) The registered provider must ensure that the home has a training and development plan that is based on the needs of the service users and an assessment of the skills and deficits of the whole staff team. (Previous timescale of 31/08/05 not met) The registered provider must ensure, in consultation with advocacy services, that service users financial interests are better promoted and protected and that they are issued with monthly statements of account. (Previous timescale of 31/07/05 not met) 31/03/06 30/04/06 31/05/06 30/04/06 Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 29 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 OP15 Good Practice Recommendations It is recommended that the provider continue to review the arrangement of the furniture on the first floor to find the solution that utilises the dining and seating space most effectively. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V254352.R01.S.doc Version 5.0 Page 30 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 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. 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