Inspection on 17/05/06 for Kirkdale Care Centre and Rebecca Posner Unit

This inspection was carried out on 17th May 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... 17/01/06

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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Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Henry Nihill House

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The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Herbert Street

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 Sean Healy Unannounced Inspection 17th May 2006 09:30 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.V291973.R01.S.doc Version 5.1 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.V291973.R01.S.doc Version 5.1 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 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.V291973.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 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 1 may have past or present alcohol dependence and 1 may have a physical disability This home is registered for 63 persons of whom up to 63 may be old age, up to 63 have dementia 17th January 2006 Date of last inspection Brief Description of the Service: Kirkdale Care Centre and Rebecca Posner Unit, is a care home with nursing for a maximum of 63 older service users, who are physically frail or have dementia. 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. The provider’s email address is: zelina.ramadhan@excelcareholdings.com Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 5 Information about the service provided is made available to current and potential service users in the homes Statement of Purpose and Service Users Guide. The recent CSCI report is kept on display in a bookrack on each floor of the building, and is discussed in meetings with relatives. At 24th April 2006, the homes fees range from £435 per week for residential care, to £610 per week for nursing care, which covers all of the homes charges including food. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days on the 17th and 19th May 2006. The Registered Manager and three staff were involved in the inspection, and five residents gave their views of their experience of living in the home. Three social care professionals involved in placing people at the home also provided comments for this report. Three relatives of residents gave their opinion of the care provided. The organisation’s Head of Care and Operations was also involved in the inspection. A range of documents were examined and a tour of the building took place. The inspector met five residents and also observed residents having their meals, listening to musical entertainment, and having their hair done by a visiting hairdresser in facilities provided by the home. There is currently one nursing care bed vacancy. What the service does well: What has improved since the last inspection? Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 7 The home has introduced a new pre-admission assessment form to collect much more information on all areas of support needed, including social, religious and leisure needs. These are being currently completed for new residents. There is also a great deal of work being done by the activities coordinator to now include activities and religious needs of individual residents in care plans. In doing this life histories have been compiled for 25 residents, and their care plans now include weekly activity plans. The reason for admission of residents to hospital is now being more closely monitored by the home’s management, with a view to identifying areas where care could be improved. The home now provides access to advocacy via social services as and when necessary. Most staff have now had Adult Protection training and understand the process for reporting abuse if suspected. This training is now part of the homes core training for staff. Surplus furniture has been removed from double rooms as requested. The home has agreed to maintain the staffing levels agreed with the previous regulator, and staffing numbers are adequate to provide the care needed. Staff recruitment checks are being well conducted and good records are being kept to show that staff are suitable to work at the home. There is now a training and development plan for staff to help them to have the necessary skills to provide support to residents. What they could do better: The home needs to complete the review of assessments in relation to social, religious and leisure activities for all residents. At the moment 25 out of 49 residents have had this done. Residents who have had it done said they were very pleased that this was happening for them. These activities need to be reflected in all residents care plans. There should be more structured exercise routines included in care plans for those residents who need it. Comments were received which suggest that this improvement is necessary to help some residents maintain and improve their mobility. It’s recommended that more routine regular visits from the relevant local churches representatives, to the home are encouraged and supported. Some residents commented that would be glad to see this happen. Religious needs of all residents must be included fully in care plans, and arrangements made with the resident, family or others to ensure that residents have the necessary support to practice their chosen faith. The staff should be offered training in understanding the support needs of those of the Muslim faith, as part of the diversity training offered by the home. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 8 It is also recommended that the new weekly plans for resident’s activities are regularly reviewed with the residents and their families to see that activities on offer remain relevant to residents expressed wishes. Care plans must have more specific information about what activities individual residents like to do. For example what TV programmes they like, what papers or books they like, and they need to be supported to do these activities. Individual residents abilities and wishes regarding self medication must also be included in care planning, and where residents ask the home to manage their medication their consent must be included. As a Nursing Home the home needs to make contractual arrangements for the disposal of unwanted medication instead of returning this medication to the local pharmacist. Some comments received suggest that although good food is provided to residents and they have been asked about their preferences, that some are being served food that they have said they do not like. The home should look into this and make whatever changes seem appropriate. The following repairs or replacements should be carried out to make the home more homely and safe for residents: 1. Top floor bathroom needs upgrading as it is worn and old 2. Carpet is some residents bedrooms need replacing as there are signs of significant wear and tear 3. The wall and door to room 46 needs repairing 4. The hospital bed in room 39 needs to be repaired and the footboard to the bed replaced 5. Room 27 needs a proper restrictor fitted to the window instead of the existing screws, and it should also be draught proofed. The resident and family must also be able to easily open this window when they want to. 6. The home needs to involve an Occupational therapist in assessing the flooring, handrails and restrictive gates, which have been fitted on the back stairs to make sure that individual residents are safe in using them. The fire officer needs to be involved in formally approving this work also. 7. The bathroom sink in first floor dining area is not the kind normally found in dining areas and consideration should be given to replacing or removing it. 8. Hoists in bathrooms are a bit overdue for their annual maintenance check and this should be done soon Some changes are recommended in how staff training is decided to help ensure that all staff have a fair approach to planning their training and development. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 9 The organisation’s senior management need to check that the home’s manager is being fully involved in important decision making about issues affecting the service provided to residents and staff of the home. The home needs to develop a good annual system for checking the quality of the service provided to residents, and put a development plan in place for making any improvements needed. The home needs to make sure that all residents’ financial interests are protected and that they receive clear statements when the home is in charge of their finances. For one resident work needs to be done by the home to show that this is properly happening. The key to the front door of the home must always be available in the reception area to ensure that residents are able to quickly leave the building should the electrical system fail in the event of a fire. A copy of the home’s five-year electrical wiring certificate must be kept at the home to show that the electrical wiring is safe. When the need arises staff should be offered support to deal with traumatic experiences, which may have implications for them at work. 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.V291973.R01.S.doc Version 5.1 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents have complete information about the home contained in the Statement of Purpose. Although the needs of residents 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.V291973.R01.S.doc Version 5.1 Page 12 At the last 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 had been revised to include 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. As a result of this process the home has now reduced the bed-spaces offered from 63 to 49 beds. The homes business plan clarifies the intention for this to remain as the spaces offered for the foreseeable future. Six service users files were examined and all included evidence of the service users’ needs being assessed prior to being offered a service. At last inspection the format of the needs assessment did not include all areas such as social, cultural and religious needs. The home has in the past year appointed an activities co-ordinator to address this issue. The co-ordinator is an experienced care worker who has done some training with the Care Homes Support Team and has become a member of NAPA, the National Activities Provider Association. In consultation with families, residents and other staff she has compiled Life Histories on 25 residents and introduced a system for assessment of residents social, leisure and religious support needs for these residents. This system includes a means of reflecting these assessed care needs in new format care plans and weekly activity plans. There is a new organisational post of “Activities Manager”, whom the homes activities coordinator will report to and receive more specialist support from in developing these activities. This new system sounds very promising and if successful will prove very beneficial for residents. There is a need however to complete these assessments for the remaining 24 residents. The home does not currently provide intermediate care. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care planning and review continues to improve, though social and religious needs still to be included for up to 24 residents. Health Care needs are now being fully met, but all residents have not been fully assessed regarding their ability to self medicate. Improvements have been made to the environment to assure resident’s privacy and dignity. EVIDENCE: At the last inspection much improvement was noted in care planning. Care plans had started to include much more information about how residents were to be supported in achieving goals, and meaningful reviews were taking place regularly with relatives being invited to these around every six months. This improvement has continued, with now 25 residents now having a written historical profile, which they have contributed to, which provides good information for care plans. Residents commented that they are happy that this is happening. Social care needs such as leisure activities and other social activities are now included in care plans for these residents and these include activities such as Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 14 reading, watching TV, listening to music, and some outings in the local community. The activities co-ordinator is well informed about this group of residents. However, these care plans need to be more specific as to what is meant by such activities as “read paper”, “watch TV”, “exercise”, and other similar activities. It needs to be made clear what papers/books people will like to read, and what they will like to watch on TV, and such activities need to be supported by some guidance for staff to follow explaining whether the resident’s level of independence, and what support they will need. For example whether they can read or will need to be read to for short periods, whether they can select TV channels independently or not. Care plans will also need to be completed for the remaining 24 residents who currently have not yet benefited from the new care planning assessments. It was noted that while exercise is referred to in care plans, there are not as yet detailed structured guidance describing the exercise routines for those residents who need it. The home needs to include details of who should support residents in such routines, how often they should be scheduled, and a brief description of how the support should be provided. This needs to be included in care plans and weekly plans. It is recommended that weekly activity plans for residents be reviewed regularly, at least every two months. It is also recommended that the need for more regular visits to the church of residents choice, or more regular visits to the home by the relevant church representatives is explored by the home and facilitated as appropriate. As at last inspection it was noted that 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. All residents have now had risk assessments carried out about their support needs in using stairs, in response to an incident in December 2005. It was required at the last two inspections that the reasons for hospital admission of service users continue to be monitored. This was to 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. This is now being done and hospital admissions are now being monitored and an overview of all cases of hospital admissions, to identify any patterns is now being carried out by the home. Medication Administration Record (MAR) charts are being used on all 3 floors, and recording is good. Medication is being safely stored, and administration is allocated to the nurse in charge on one floor. Care staff who administer medication on the two residential floors have undertaken medication handling distance learning. Staff carry out medication audits on each other’s units three times a week and action is taken on any issues picked up. There is a record of Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 15 items administered by district nurses. The application of external products and food supplements is also recorded. Although there have been changes in laws related to returns of medication for nursing homes, the supplying pharmacist is still collecting returns regularly. However, it is a requirement that the home reviews this practice, with a view to setting up a separate contractual arrangement for the disposal of medication, as has been the case for other similar homes in this care sector. The abilities of residents to self-administer their own medication has not being fully assessed for all residents, and where medication is being administered by the home on behalf of residents, this has not been formally agreed with residents or relatives in individual care plans for all residents who fall into this category. This issue must be addressed by the home. All residents with the exception of two residents now have a single room. The two residents who share a room do so out of choice and this has been properly recorded. This shows a good commitment by the home in facilitating greater privacy and comfort for its residents. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s approach to activities has improved with a full time activities coordinator ensuring activities are tailored to meet the needs of individuals. Residents do maintain contact with families, friends and others from the community, and are supported to exercise choice and control in their lives. Residents are provided with a choice of varied and nutritious meals in much improved surroundings. EVIDENCE: There is a full time activities co-ordinator employed, and a programme of activities is offered on a daily basis. The activities co-ordinator has drawn up an assessment and activities programme for 25 residents, and is carrying on developing these for the remaining 24 residents. She is also able to spend time with individual service users finding out first hand whether things are improving for them. 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. Regular entertainers visit the home, and church ministers visit from the Catholic Church and from the 7th Day Adventist church. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 17 There is now a private and pleasant space for service users to receive visitors in addition to their bedrooms, situated in the basement. Residents are able to choose items of their own to bring 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. At last inspection a married couple who shared a room, had been offered the option of having a double bed in their room, but this had not been provided as there was an objection to this being provided by close family members. It was stated in the report that as there was a question as to whether the couple could ably speak up for themselves, that decisions making 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 today said that a review involving a social worker, and family members has taken place, and the decision reached remains that a double bed should not be provided. One of the married couple involved remains very upset that the double bed is not being provided, and has expressed to the home’s management, and to the inspector, that this decision be looked at again. Clearly there is great upset about this decision and the home would be happy to provide the bed if the decision to do so was approved. It is recommended that this issue is again raised in accordance with the residents wishes, and that independent advocacy be offered to the residents in question in reaching a decision. 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. Service users spoken to were happy with the meals provided. Comments included “the food is good”, when speaking with residents. Some comments also suggested that although some residents have stated that there is some food they do not like, it often is given to them. It is recommended that as part of the homes consultation with residents and families, this issue be explored further and any appropriate action be taken. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and the complaints record show that complaints are taken seriously. The home policies and procedures, and action in relation to incidents, show that residents are protected from abuse. EVIDENCE: The complaints procedure is included in the service users guide and located at various points around the building. There has been one complaint since last inspection and this wasn’t upheld. Residents and family members spoken to say that they knew how to complain if they needed to and that the homes manager is always available to speak to. One relative described having had some problems in the past about the quality of care being provided, but that she was able to discuss these with the manager and have them resolved informally. The complaints record showed that complaints were clearly summarised with details of investigations recorded in a complaints file. The provider has appointed an adult protection manager to take a lead in all adult protection issues for the organisation. There have been three active Adult Protection investigations involving the Adult Protection team in Lewisham. Two of these were still ongoing, and discussion with relevant professionals involved, and the records held by the home, showed that in two cases these had been appropriately reported to Adult Protection, and investigations had been carried out. In the third case there was some delay in reporting to the Adult Protection team and they are awaiting information from the provider before reaching a Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 19 conclusion. The home’s policy is up to date, and the staff have received appropriate training in the protection of vulnerable adults. There remains some concern that the homes manager is not always fully involved in all action taken by the registered provider, in deciding on the best approaches to protect residents. This view was also expressed by a social care professional who visits the home. This does not suggest that responsible action is not being taken by the provider to protect residents, but it does suggest that the Registered Manager’s views may not be fully taken into account in the early stages of decision-making, which may prevent the best outcome for the protection of residents being reached. An example of this is that a decision was taken to install a handrail and gate to the backstairs of the home to prevent residents who may be prone to falling from using these stairs. The manager felt at the start of the inspection that it was appropriate to involve an Occupational Therapist in deciding on the best type of handrail, flooring and gate to best support and protect residents who would be most likely to use these stairs. The manager also suggested that should the gate to be installed not be high enough that some residents may put themselves at risk by climbing over it. The handrail and gate were installed within 24 hours of this discussion taking place, without resolving these concerns, and within two weeks it was reported to a visiting professional that staff too shared these concerns, and that two residents had already tried to climb over the gate. From this it is evident that it is best practice that the registered manager and staff be consulted in decision making in the protection of residents, but that this is not consistently being done. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 20 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is safe and generally well maintained, but there are repairs and replacements needed to make some areas comfortable for residents. Bedrooms are generally safe and comfortable, and the home is clean pleasant and hygienic. 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. The provider has reduced the number of rooms being used as shared rooms to only one room shared by a married couple. With also having recently introduced a visitor’s room in the home, this has very much improved the private space for service users. This has improved the homes ability to best provide for the residents privacy, dignity and choice. Unwanted furniture has been removed from rooms previously used as double rooms. A main sitting room/dining room Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 21 space was also recently enlarged to provide better comfort and privacy for residents. The home was clean is maintained to a high level of cleanliness and hygiene. The following repairs or replacements should be carried out to make the home more homely and safe for residents: 1. Top floor bathroom needs upgrading, as it is worn and old. This should be included in the homes development plan. 2. Carpet is some resident’s bedrooms need replacing, as there are signs of significant wear and tear. 3.The wall and door to room 46 needs repairing. 4.The hospital bed in room 39 needs to be repaired and the footboard to the bed replaced. 5. Room 27 needs a proper restrictor fitted to the window instead of the existing screws, and it should also be draught proofed. The resident and family must also be able to easily open this window when they want to. 6. The home needs to involve an Occupational therapist in assessing the flooring, handrails and restrictive gates, which have been fitted on the back stairs to make sure that individual residents are safe in using them. The fire officer needs to be involved in formally approving this work also. (Refer to requirement OP standard 38) 7. The bathroom sink in first floor dining area is not the kind normally found in dining areas and consideration should be given to replacing or removing it. 8. Hoists in bathrooms are a bit overdue for their annual maintenance check and this should be done soon. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 22 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number and skill mix of staff on the duty rota does ensure that service users’ needs are met. A good proportion of the home’s staff have been trained ensuring that residents are in safe hands. The home operates a thorough recruitment procedure, which protects residents. EVIDENCE: Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 23 The home has a registered care manager who is a qualified nurse, who is supported by seven qualified nursing staff and seven senior care staff. There are 32 care assistants providing care and support for residents. The current staff level on each shift is as follows: (in brackets showing the levels recorded at the last inspection) 1. On each of the two residential floors there are one senior carer and two carers on duty during the day, and one senior and one carer on duty at night.(Last inspection levels were one senior carer and three carers during daytime and one senior and one carer at night) 2. On the nursing floor there was one nurse and three carers on duty during the day and one nurse and two carers on duty at night. (At last inspection levels were one nurse and two carers daytime, and one nurse and one carer at night) The previous regulator had set a minimum staffing level for the nursing floor, and the home has now increased staffing back to those original levels for the nursing floor. At last inspection it was noted at the last inspection that 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 had 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 registered provider has taken steps to ensure that, the daytime and nighttime cover for the nursing unit have increased and on today’s inspection the rota showed the staffing levels listed above are being adhered to. However there seems to have been a reduction in daytime cover on the residential floors as a result of doing this. It is recommended that this change be formally agreed by the homes commissioning authorities. As the issue of ensuring that staffing levels are adequate was stated as a requirement at last inspection, this is now repeated. More than 50 of the homes care staff have achieved the required NVQ level 2/3 in care. Three staff files were examined and showed that adequate recruitment checks were being carried out by the homes management. Requirements to update some staff files had been met. A closer examination of recruitment records will be carried out at the next inspection. A staff-training plan is now in place showing planned training for staff from January to December 2006. This is comprehensive and reflects appropriate training is being scheduled. It is recommended that training is included for care staff in supporting the cultural diversity, including support needs of residents from the Muslim faith, which is a relatively new support issue for this home. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified, experienced and competent to run the home. Some quality assurance systems are in place, but more work is needed to ensure that the home is run in the best interests of the residents. Although efforts have been made to transfer responsibility for financial matters, the provider still manages a resident’s money and their financial interests are not being effectively safeguarded. The home has adequate health and safety policies and systems in place, but more work is needed to fully protect the health safety and welfare of service users and staff. 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 Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 25 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. Customer satisfaction surveys are conducted a few times a year, to seek the views of residents, relatives and visiting professionals. The registered provider audits and summarises these surveys and the results are fed back at meetings for staff and relatives. The results of the latest survey had been published and these were available in the reception area for anyone to take. Monthly audits of care plans are done by the manager, and monthly inspection visits are being done consistently by the organisations head of care and support, with good clearly written reports being produced and acted on by the homes manager. Service user meetings are rarely held, as most of the service users are unable to take part. Relatives meetings are held every three to four months to keep them updated and hear their views on how the home in run. The home does not carry out annual quality audits or produce an annual development plan. At the last two inspections one resident had many thousands of pounds held by the provider not accruing interest. The provider was acting as appointee for the resident with the knowledge of social services as the resident could not be responsible for his own finances and did not have a relative to fulfil this role for him. The registered provider was required to ensure that financial systems are reviewed in order to ensure that this residents financial interests are safeguarded. Details of financial transactions are now being recorded, but the provider is still managing this resident’s money, including a large amount of savings. At last inspection 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. This is still the case, and the manager now explained that social services have formally requested that the provider engage the services of a solicitor to act on this resident’ behalf. To this end the services of a financial advocacy service, “Care Asset Management” have been engaged. Health and safety is generally given due care and attention by the homes management. There is a health and safety policy and appropriate systems being used for training staff, checking fire equipment, storing dangerous liquids and substances, carrying out risk assessments, and doing regular health and safety checks within the home. The fire officer for the LFEPA, has been involved in inspecting the home and reports that after making a number of requirements in December 2005, these have now been met. Some work has been carried out on the back stairs during the inspection, which involved replacing the carpet, removal of rubber edging to the steps, installation of a handrail and installation of a quick release gate to the bottom of this stairs to protect vulnerable residents from risk of falling. Before this work took place the inspector asked that the services of a relevant Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 26 professional, such as an Occupational Therapist, be engaged to assess the work prior to commencement, to ensure that the most suitable flooring, edgings to step, handrail and gate be installed. However the work went ahead without involvement of such expert advice. Given the significant and varied mobility support needs of the residents of the home, it is very important for their ongoing safety that an Occupational Therapist is engaged to assess the stairs and gate in relation to residents abilities to use them. The quick release gate now installed, was being linked to the fire alarm system as a means to ensuring that the gate would not prevent residents from escaping safely in the event of a fire. (Refer also to Standard 18 of this report) On testing the work on completion it was found that the gate was not in fact linked to the fire alarm system. An immediate requirement was made to: “ Contact the Fire Officer today (19/5/06) to arrange for the assessment of the stairwell described, to ensure that the gate, and keypad system, installed at the bottom of the stairs, fully meet fire safety requirements.” This requirement was met on the 19th May 2006. The fire officer has since confirmed that the work was satisfactory to meet fire regulations. (Subject to receipt of a certificate from the installation electrician) The homes bathroom hoists were due for their annual maintenance on the 10th May 2006. One of these hoists was noticed not to be working during the inspection, but was made operable again during the inspection. There was no date yet set for the maintenance to take place. A date for this work to happen needs to be agreed as soon as possible. A copy of the homes five-year electrical and wiring certificate was not available at the home for inspection. Due to the risk of quite a few residents exiting the building without support, the front door to the building is locked using a keypad lock. This is linked to the electrical system and does not appear to operate when the electricity supply is off, which renders the front door locked. This issue must be risk assessed, and appropriately addressed, and in the meantime a key to the front door must be kept at the main reception, and all staff must be notified as to where it’s kept. Staff in the home have been subject to some challenging experiences in the workplace, including experiencing service user bereavement on a regular basis. Recently this situation occurred as a result of an accident and there are stress and trauma implications for staff, which would benefit from the support of a counselling or de-briefing service. Staff are unaware of this type of service currently being available to them. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 2 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 1 X X 2 Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 28 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 31/08/06 2 OP7 15 4 OP8 15 The registered provider must ensure that the assessment of service users includes all of the areas listed under NMS 3. (Refer to contents discussed in this report standard 3) This was a requirement made at the last inspection, Timescale 30/04/06, partially met and now revised 31/08/06 The registered provider must complete care plans for all residents, to include social, cultural, religious and leisure care needs, and ensure that these plans are supported by more specific information regarding each residents individual support needs as discussed in this report Standard OP7. The registered manager must 30/09/06 ensure that exercise routines are specified in care plans for those residents who need it. There must be detailed structured guidance describing the exercise routines for those residents. The home needs to include details of who should support residents in DS0000007040.V291973.R01.S.doc Version 5.1 Kirkdale Care Centre and Rebecca Posner Unit Page 29 5 OP9 15 6 OP9 13.2 7 OP18 12.1 a 8 OP19 23.2 b c 9 OP27 18 (1) (a) such routines, how often they should be scheduled, and a brief description of how the support should be provided. The registered manager and provider must ensure that all residents care plans reflect their abilities and wishes regarding self medication, and that where the home is responsible for the management and administration of residents medication, that the residents consent, or that of an appropriate relative or advocate, is included in the care plan. The registered provider and manager must review the home current arrangements for the disposal of medication, with a view to setting up a separate contractual arrangement for the disposal of medication, as is the prescribed practice for Nursing Homes. The registered provider must ensure that the home is conducted so as make proper provision for the health and welfare of the homes residents. In doing so that the registered manager and staff must be consulted regarding the protection of residents. The registered provider and manager must ensure that the home is safe and well maintained and meets residents’ individual and collective needs in a comfortable and homely way. In doing so the issues identified under Standard 19 of this report must be addressed 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 DS0000007040.V291973.R01.S.doc 30/09/06 31/08/06 30/06/07 30/09/06 31/08/06 Kirkdale Care Centre and Rebecca Posner Unit Version 5.1 Page 30 10 OP33 24 11. OP35 12 12 OP38 13.4 a b c of the home at all times. The provider must ensure that the changes made in staffing levels on the residential floors have been agreed as appropriate with relevant commissioning authorities. This is a repeat of a requirement made at the last two inspections (Previous timescale of 30/06/05 and 31/03/06 partially met) Continued failure to fully meet this requirement may result in enforcement action. The home must develop an annual quality audit system use the quality assurance information collected to produce an annual development plan for the home. 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. This is a repeat of a requirement made at the last two inspections. (Previous timescale of 31/07/05, and 30/04/06 partially met now revised). Continued failure to fully meet this requirement may result in enforcement action. An immediate requirement was made to: “ Contact the Fire Officer today (19/5/06) to arrange for the assessment of the stairwell described, to ensure that the gate, and keypad system, installed at the bottom of the stairs, fully meet fire safety requirements.” This requirement was met on the DS0000007040.V291973.R01.S.doc 30/09/06 30/09/06 19/05/06 Kirkdale Care Centre and Rebecca Posner Unit Version 5.1 Page 31 13 OP38 13.4 a b c 14 OP38 13.4 a b c 15 OP38 13.4 a b c 19th May 2006. The registered provider, in the 31/07/06 interests of ensuring residents ongoing safety, must ensure that an Occupational Therapist is engaged to assess the safety and appropriateness of the back stairs; floor covering, handrail and stair-gate and door to stairs, in relation to residents and staff abilities to use them in emergency conditions. The registered provider and 30/06/06 manager must ensure that the use of the electrical keypad lock to the front door of the premises is risk assessed, as described in this report standard 38, and any issues arising are appropriately addressed. In the meantime a key to the front door must be kept at the main reception, and all staff must be notified as to where it’s kept. The registered manager must 31/07/06 ensure that a copy of the five year electrical wiring certificate is kept at the home and copied to CSCI 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 OP7 Good Practice Recommendations The registered care manager should ensure that that the possible need for more regular visits to the church of residents choice, or more regular visits to the home by the relevant church representatives is explored by the home and facilitated as appropriate. The registered manager should consider reviewing resident’s weekly activity plans at least every two months DS0000007040.V291973.R01.S.doc Version 5.1 Page 32 2 OP7 Kirkdale Care Centre and Rebecca Posner Unit 3 OP14 4 OP15 5 6 OP30 OP38 to ensure that they remain relevant to individual residents. It is recommended that the concerns raised by a resident regarding the provision of a double bed as discussed in this report, are again raised with social services, in accordance with the residents wishes, and that independent advocacy be offered to the residents in question in reaching a decision. It is recommended that as part of the homes consultation with residents and families, the issue raised as to whether preferred food is always provided, be explored and any appropriate action be taken. The registered manager should consider inclusion of diversity training for staff in the homes training programme The registered provider should consider the provision of a counselling service for staff and inform them of the most confidential means of accessing this service Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 33 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. Extracts may not be used or reproduced without the express permission of CSCI Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V291973.R01.S.doc Version 5.1 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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