Inspection on 27/09/07 for Kirkdale Care Centre and Rebecca Posner Unit

This inspection was carried out on 27th September 2007.

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

The inspector 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... 17/05/06

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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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 27th September 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 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 fiona.lydon@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 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.V332906.R01.S.doc Version 5.2 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 42 persons of whom up to 42 may be old age, up to 42 have dementia 17th May 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: fiona.lydon@excelcareholdings.com Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 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 27th September 2007, the homes fees range from £535- per week for residential care to £631- per week for public or private 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.V332906.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two and a half days on the 27th and 28th September and the 1st October 2007. The inspection ended on the 10/10/07 after receipt of information from various professionals involved. The homes manager and assistant manager facilitated the inspection, and five staff and three residents gave their views of their experiences in the home in an informal interview. Three social care professionals involved in placing people at the home also provided comments for this report. Two 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 report on staffing and stairs carried out by social services was also used in this inspection and the authors of the report were consulted. A range of documents were examined and a tour of the building took place, and the homes project manager who manages maintenance and repairs and is involved in health and safety met with me and toured the building. The inspector observed residents having their meals, being supported by staff and listening to musical entertainment. There are currently five vacancies in the home. What the service does well: What has improved since the last inspection? Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 7 Assessments of care needs have improved and the new system includes activities, ability to self-medicate and food preferences. Care planning has improved but there is a bit more to do to improve these. (See what they could do better below) Exercise routines are now included in care plans and some staff have been trained in carrying out safe exercises with residents. The homes staff and management are now being fully consulted by the registered provider about all issues that affect resident’s care and safety. All of the staff interviewed confirmed this and they say that management are now good at listening to them. All of the repairs requested in the last report have been carried out and the maintenance staff are very quick now in doing necessary repairs. The fire officer has passed the back stairs as safe from the LFEPA and by an Occupational Therapist and the main door keypad mechanism can now be used safely in the event that the electricity is cut off. All health and safety is now well managed with the exception of some important risk assessments, which need to be completed. (See “What they could do better” below) The home now has a new manager whom resident’s relatives and staff have confidence in and they feel she is very active in dealing with problems they may have. There is now an assistant manager and an administrator to provide support for the manager, and to provide some hands on support in emergencies. Residents for whom the home manages finances now receive regular statements of their finances so they can be confident that their money is safely managed. What they could do better: The home has a lot of stairs and steps and residents who have mobility support needs may be at risk of falling. The home needs to do a risk assessment for each person who has a mobility support need about using stairs and show how they will protect anyone who is at risk of falling. The home should also do this for any new people referred to live at the home, and use this to decide whether the home is appropriate for them. Information recorded by staff about residents as part of the daily records needs to be more detailed about things like their mood, activities they’ve been involved in, mental health and dementia related issues, so that this information can be used to review care plans and to decide when the best times are to do activities with residents. Care staff need a better understanding of the medication for the residents for whom they most often provide support so that they can understand how it Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 8 affects them and to help them contribute to medication reviews. The home needs to do a study on staffing to show that there are enough staff available to fully support residents, and also need to make sure that there is a good system for providing additional staff in emergencies so that staffing levels don’t fall short of the minimum number on each floor of the home. Staff had not always been CRB checked before starting work at the home. New management is aware of this and has now more support to do this properly but the provider must make sure that staff are always safely recruited. The training for staff needs to be at least 3 paid days every year and this had not been happening properly. The new management are working on doing this but need to be able to show that it is happening. There should be a training plan for the home to help decide what training is most important for nursing and care staff. Staff need to be supervised more regularly to make sure they have the support they need to do their jobs. The homes management have started to work on improving this support for staff. The residents bedroom windows need to be examined to make sure the window restrictors are correct and that the windows can be opened by residents or their visitors without having to ask staff to do it. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 9 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.V332906.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 6 Quality in this outcome area is good. 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. Residents are provided with statements of terms and conditions or contracts on admission. The needs of residents are assessed before they are offered a place. The home does not provide intermediate care. EVIDENCE: The home has a Statement of Purpose of Service User Guide, which has been revised in 2007. These documents accurately described the services and accommodation to be provided by the home. There have been some issues, which have arisen regarding the safety in using the various stairs, and steps in the home for residents have mobility problems. Is recommended that a comment is made in the homes Statement of Purpose which highlights this issue, and emphasises the need to risk assess all individual referrals who have been assessed as having mobility support issues. (Refer to Recommendation OP1) Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 11 Examination of six residents files showed that not all residents had up-to-date contracts or statements of terms and conditions on file. This was also commented on by a number of residents who responded to inspection surveys. However the new manager had already almost completely resolve this issue and had drafted up complete new contracts for all residents and was in the process of distributing them. Examination of a selection of these contracts showed them to contain all of the required information. There was a requirement at the last inspection for the provider to ensure that care assessments include all of the areas required by the Care Standards Act National Minimum Standards. This has been done and a requirement is now met. Examination of six residents files showed that a new care assessment system has been introduced by the home, which contains information on all aspects of care, needed. This new system includes: Social and leisure interests, self-medication assessment, and preferences regarding diet and food, as well as a range of information on personal care and health care support needs. As commented on above where residents have assessed mobility support needs it is important that the assessment is accompanied by a risk assessment for these residents in relation to the use of stairs and steps in the home. This risk assessment should be done before the admission stage and be used to make a judgment as to the appropriateness of the referral. This is to ensure that any new residents will be better protected from falls. (Refer to Recommendation OP3) The home does not provide intermediate care for residents. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 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 is happening consistently but social and religious needs still need to be included for some residents and risk assessments need some improvement. Health Care needs are being fully met, but care staff need a fuller understanding of residents medication. Resident’s privacy and dignity needs are respected by the home. EVIDENCE: Six residents care plans were inspected and three residents and two relatives made comments about their involvement in the care planning process. Resident’s files examined had care plans in place, and there was evidence to show that these had been reviewed monthly, with involvement from the resident or their family whenever possible. There was a requirement at the last inspection for the provider to include social, cultural, religious and leisure care needs in care plans for all residents. At that time a newly appointed activities coordinator had commenced work at the home, and work had been done on up to 25 residents care plans to include these issues. Since that time there has been a change of activities coordinator, and progress has been made on improving these care plans with involvement from other staff, residents and Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 13 their families. However not all of the files examined showed enough specific information on social leisure and religious support needs. Therefore this requirement is repeated and is partially met. (Refer to Repeated Requirement OP7) Two of the resident’s files examined did not adequately reflect social and leisure interests and one of these did not have adequate information regarding medical history and medication support needs. However it is understood that resident’s medication needs are specified separately in a medication administration system used in the home. The current management have begun addressing shortcomings in these care plans and together with the activities coordinator are making significant improvements to care planning system in these areas. Generally risk assessments are being fully addressed in care plans, with areas such as mobility, self-harm, exploitation and fire risk being included in risk assessments. One residents risk assessment said that she must use handrails or use the back of chairs to assist with mobilisation, however there was not adequate guidance in place for staff to follow to direct them in how to avoid falls. There is a need to improve the specific written guidance for staff to follow where significant mobility support is needed, and to ensure that this guidance is available in the place where the support is provided. There was a recommendation made by social services, following a study carried out at the home, regarding increasing staffing levels. There was another recommendation made in relation the use of stairs stating that the stairs be made inaccessible to all residents unless accompanied by a staff member, or failing this proof should be provided to show how risk of falling while using the stairs or steps is safely managed. Following discussion with the manager and staff, and a tour of the home to observe the stairs the steps, it would seem inappropriate to further prevent access to stairs by residents without seriously impinging on their freedom of movement throughout the home. Access to one stairs has already been closed off, and preventing some service users who do not have any problem in use of stairs from freely using the stairs does not seem a reasonable option. However it is necessary to risk assess the use of stairs and steps in the home on an individual basis for each residents who is currently assessed as having a mobility support need, and ensure that on an individual basis measures are put in place to safely manage and support these residents in using the stairs. It has been separately recommended that the issue of using stairs be included in the assessment process prior to admission to the home. (Refer to Recommendation OP3) The home’s management must ensure that all residents assessed as having a mobility support need, have a risk assessment in place regarding the use of stairs and steps, supported by clear written guidance staff describing how to manage the risk and how to support a resident in using stairs when needed. In Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 14 addition all residents who have significant support needs with mobility must have a risk assessment, which includes guidance for staff on how to minimise risk of falls. (Refer to Requirement OP7& OP18) Examination of handover notes for a number of residents showed that notes were consistently written and dated, but given the high level of support regarding issues such as mobility, mental health and dementia the notes were not sufficiently detailed regarding the resident’s participation in activities, social contact, mood, and dementia related issues such as memory absence or distress. These notes form an important part of the information system to aid in the review of care plans and in improving the service provided, and it is important that these issues be included in daily notes to assist in reviews and to improve the quality of these reviews. (Refer to Requirement OP7) There was a requirement made at the last inspection for the home to ensure that exercise routines for residents be specified in the care plans. This has now been met and care plans for residents were seen to include details of how to provide support in exercise routines for all residents who need it. In addition the Care Home Support Team has also been involved in providing training and guidance for staff, and there is now a member of staff who is a trained coordinator available on each floor in the home. There are range of health care professionals involved in providing health care support to the home with GPs, district nurses, dentists, chiropody and tissue viability nurses attending the home regularly. The GP 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. 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 each 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 items administered by district nurses. The application of external products and food supplements is also recorded. The homes medication policy is detailed and has been reviewed in 2006 and prescribes how staff should behave regarding medication management issues. Given the level medication used in the home as part of residents health care management, it is important that care staff have a good understanding medication issues relating to the residents they provide support for. However interviews with a number of care Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 15 staff showed a poor level of understanding about the prescribed medication for the residents for whom they provide support. This may be in part caused by the fact that one member of staff is seen as responsible for medication management. There is a keyworker system in operation in the home, which gives responsibility to some staff to co-ordinate the service for a specified resident. Some staff interviewed did not have a working knowledge of the medication their key resident was on and in some cases had little knowledge at all of the medication prescribed. It is important that all staff have a good knowledge of such issues in order to monitor the condition of residents and to prompt a review of medication where concerns are noted. The homes management must ensure that care staff have an adequate working knowledge about medication in relation to the residents for whom they most commonly provide support. (Refer to Requirements OP9) There was a requirement made at the last inspection for the home to ensure that all residents care plans reflect their wishes regarding self-medication and this requirement has now been met. All residents are now being assessed on admission regarding their ability to self-medication and this is seen as very good practice. 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. Two relatives commented that staff and the management are very respectful and that a dignified and sensitive approach is used in providing personal care support and in communicating with and about residents. Seven residents or their family members made similar comments in response to inspection questioners. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 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. 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 co-ordinator ensuring activities are tailored to meet the needs of individuals. Residents 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 EVIDENCE: The home is a member of National Association of providers of Activities for older people in Care Homes (NAPPA). 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 residents. He is also able to spend time with individual service users finding out first hand whether things are improving for them. All residents and/or their families complete a life review and social care diary,often with a member of staff. All residents have an individual activity plan,a leaflet is available detailing planned major activities, celebrations, and planned outings for the year. 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 Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 17 Day Adventist church. On the days of the inspection about 12 residents took part in a music entertainment session put on by two visiting musicians who visit the home regularly. All seemed to enjoy this and three residents said they really liked it. There is a private and pleasant space for residents 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, residents I spoke 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. Two relatives said that they are very happy with the approach of the new management in getting to know residents, saying that the manager regularly is out amongst the residents and has a very sensitive approach in helping their parent to get involved in activities. At last inspection a married couple who shared a room, wished to have a double bed provided for them. There were some reasons put forward as to why this should not be provided for them, but the social worker concerned has now resolved this problem and the new manager has purchased the bed for them. This was a recommendation of the last inspection and is now met. All residents have their own room where they can receive visitors in private,a family room is also available. Residents are encouraged to bring personal possessions into the home,including furniture and bed linen. 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. Residents are assisted to complete a form every day to indicate their choices of meals. Residents I spoke to were happy with the meals provided. Comments included “the food is good”, when speaking with residents. At the last inspection some comments suggested that although some residents have stated that there is some food they do not like, it often is given to them. It was recommended that as part of the homes consultation with residents and families, that this issue is explored further and any appropriate action be taken. This has now been done and the cooks are well aware of any cultural needs of the service user. Every resident is enabled to make choices from the menu every day and can have an alternative if they wish. Menus reflect their wishes and they are consulted about their choices. Three cooked meals are provided daily, and a cooked or continental breakfast is available. There are always two cooked options available for lunch and salads are provided even if they are not on the menu. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 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’s policies, procedures and action in relation to incidents, show that residents are generally protected from abuse, but may not as yet be adequately protected by the home’s reporting procedures or from falls. EVIDENCE: The complaints procedure is included in the service users guide and located at various points around the building. There have been four complaints since last inspection and of these one was upheld. Two residents family members spoken to say that they know how to complain if they needed to and that the homes new manager is always available to speak to. The complaints record showed that complaints were clearly summarised with details of investigations recorded in a complaints file. Complaints issues were: 1. There was not enough money available at the home for one resident’s day-to-day spending although the home had responsibility for this resident’s bank account. This was upheld and was resolved 2. A relative complained about not enough staff being available to provide support for her relative, there was also a concern within this about the level of information recorded about this residents care needs. The homes view was that there were enough staff available. This was also reported to social services who followed up on these concerns and included the Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 19 issues in a monitoring study and a report. They concluded that staffing needed to be increased on one floor. 3. Complaint by relative in November 2006 that a resident had an unexplained bruise to her eye, and had a fall that did not receive prompt response from staff. This was also reported as an adult protection issue to social services and investigated by them. This was not reported appropriately reported to CSCI or to social services at the time. (See Standard 18 requirement) 4. Relative complained in June 2006 that not enough staff were available to provide support to a resident when she visited the home. Staff had to respond to a resident needing support on another floor and the home’s manager at that time expressed concerns that staffing levels were less than adequate in such emergencies. It is noted that a new manager is in post for the past seven months approx. and that measures are being taken to provide a consistent quick response to situations where residents need urgent attention, without impacting too much on the staff availability. This takes the form of the assistant manager being more available to be involved in providing hands on support when needed. The home’s Adult Protection policy is up to date, and the staff have received appropriate training in the protection of vulnerable adults. There have been three Adult Protection investigations involving the Adult Protection team in Lewisham since June 2006. These cases have now been investigated and closed and there are no current adult protection cases in progress. The adult protection concerns investigated were as follows: 1. A relative complained that a resident was not receiving enough care and monitoring. This was not upheld 2. An anonymous allegation was made and specific details were not provided by the anonymous person making a proper investigation difficult. 3. A resident had a fall and there was unexplained bruising to the residents eye. This was not reported properly to social services or to CSCI. Some of the complaints and Adult protection issues prompted an intensive monitoring visit by social services over a number of days to examine whether there were enough staff available on the first floor to provide the level of care provided. Recommendations were made to increase the level of staff by one during daytime hours and to bring the level of support offered from 2 care staff and one senior staff to three care staff and one senior staff. The report stressed that not increasing the staffing to this level places residents at increased risk of injury or neglect. Although the home has introduced a new post of assistant manager who will work hands on across three floors, this has not provided an increase of staffing to the levels recommended in the social services report. In September 2007 one of the main service commissioners for the home carried out a monitoring visit and said that he had found Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 20 improvements in how the home managed the care, and that he found the staffing levels to be at best adequate. There are other factors that from time to time further impact on the staffing levels. (See Standard 27 of this report) Clearly there is more work to be done by the provider to demonstrate that staffing levels adequately provide for the day-to-day needs of the residents while also being robust enough to cater for emergency situations. (See Requirement OP27) The social services report also identified potential risk to residents who have mobility problems in using the many stairs and steps in the home, and asked that the registered provider provide proof as to how the risk to residents is to be removed. To date no further work has been done by the provider to meet this request, however the manager agreed that this work would now be given priority. It was noted that since the new manager has been in post there have been no concerns regarding reporting of adult protection issues and the manager shows a commitment to dealing with updating the risk assessments to better protect residents in using stairs and steps in the home. This work will take a number of months and is therefore a requirement of this report (Refer to Requirement OP7 & OP18) (Also refer to Recommendation OP3 regarding risk assessment of new referrals) At the last inspection there were some concerns that the homes manager was not always fully involved in all action taken by the registered provider, in deciding on the best approaches to protect residents. A social care professional who visits the home also expressed this view. A requirement was made for the registered provider to ensure that the homes manager and staff be always consulted regarding the protection of residents. The new manager and all of the staff interviewed confirmed that this is now happening and therefore this requirement is now met. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 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 some repairs needed to make it comfortable for residents. The home is generally 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. A main sitting room/dining room space was also recently enlarged to provide better comfort and privacy for residents. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 22 There was a requirement made at the last inspection for the home to carry out a list of repairs to the fabric of the home and to bring maintenance of hoists up to date. This work has now been done and the requirement is now met. Following today’s inspection the following repairs/replacements and consultation should be carried out to make the home more homely and safe and accessible for residents: 1. The opening space on restricted windows in residents bedrooms above the ground floor vary in size, and in one room inspected the opening was considerably larger, which could allow a resident to exit. This window opening was dealt with to reduce the size by the homes maintenance staff before the inspection ended. It is necessary to check all residents’ bedrooms above the ground floor to ensure that the space safely restricts exiting from these windows. 2. Some resident’s bedroom windows were found to be very difficult to open and could not be conceivably opened by the resident of visitors independently. The home must ensure that they can open all residents’ bedroom windows. (Refer to Requirements OP19) The provider has declared an intention to extend the living room on the first floor to improve this facility for residents, but while this is a positive development for residents doing it may also involve residents losing a separate quiet room which they currently have use of. It is recommended that the provider consult residents and their families about their intentions and fully include their views on this issue when making this decision. (Refer to Recommendations OP20) The home was clean is maintained to a high level of cleanliness and hygiene. It was noted that the homes maintenance team are very quick and efficient to respond when repairs are required. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate 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 not yet adequately 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 has a thorough recruitment procedure, but this has not been consistently implemented which may pose a risk for residents. EVIDENCE: Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 24 The home has a recently appointed manager who is a qualified nurse, who is supported by an assistant manager and administrator. Both of these posts were created since the last inspection to provide additional support for the manager with some emergency support for staff provided by the assistant manager. 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. (Prior to the 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 is one nurse and three carers on duty during the day and one nurse and two carers on duty at night. Some of the complaints and Adult protection issues prompted an intensive monitoring visit by social services over a number of days in February 2007, to examine whether there were enough staff available on the first floor to provide the level of care provided. Recommendations were made regarding the staffing on the first floor, where up to 18 residents with high levels of support reside, to increase the level of staff by one staff during daytime hours which would the level of support offered from 2 care staff and one senior staff to three care staff and one senior staff. The report stressed that not increasing the staffing to this level places residents at increased risk of injury or neglect. Although the home has introduced a new post of assistant manager who will work hands on across three floors, this has not provided an increase of staffing to the levels recommended in the social services report. In September 2007 one of the main service commissioners for the home carried out a monitoring visit and said that he had found improvements in how the home managed the care, and that he found the staffing levels to be at best adequate. (Report pending) There are other factors that from time to time further impact on the staffing levels. In some cases it has been suggested that staffing levels fall below the minimum levels described above. For example when staff are off sick, or there is an emergency in the home requiring staff in one area such as the first floor to provide support for sometimes hours, there is an almost non existent availability of bank staff to be used to provide extra support and agency staff are not used at all. Senior staff in charge clarified that on one floor, the 1st floor, there are at least two to three shifts monthly where whole shifts cannot be covered due to emergencies and in addition there are also shifts that cannot be covered due to staff sickness. On Another floor the monthly staff sickness is estimated at an average of four shifts per month. The only means currently of filling these gaps is for staff to be asked to stay on when they are due to go home, or for the assistant manager to provide some Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 25 cover. Given the high levels of support and monitoring required for most of the residents on the first and second floor, and the already very tight staffing levels, this situation is at best barely manageable and places staff under a great deal of strain during these periods. Clearly there is more work to be done by the provider to demonstrate that staffing levels adequately provide for the day-to-day needs of the residents, while also being robust enough to cater for emergency situations. Suggestions were made during the inspection by a number of people that often some resident’s personal care and monitoring and activities are affected when any of the situations described above arise. The provider must carry out a full staff analysis exercise on all three floors to and produce a comprehensive analytical report which demonstrates that the current staffing levels are adequate to provide for the care and safety of residents or identify the areas where care and safety needs are not being met and how these will be addressed by the home. (Refer to Requirements OP27) The provider must ensure that the system for providing staff support during emergencies and staff sickness is such that these situations do not allow the staffing levels to fall below the agreed minimum staffing levels. (Refer to Requirements OP27) More than 50 of the homes care staff have achieved the required NVQ level 2/3 in care. Five staff files were examined and showed that the home does have a good system for safely and fairly recruiting and employing staff but that it has not been consistently applied when doing CRB checks. Three of the five files showed that the staff in question started employment before CRB checks had been completed, in one case the staff had worked in the home for five months before the CRB was received back. The last known occurrence of this was February 2006. The registered manager for the home holds the responsibility for all recruitment activity together with the extensive role of staff and care management. It has become clear that the manager needs good support in the management of administrative tasks and to this end the home has now employed an administrator to provide this support. There is evidence to show that the home has begun addressing the shortcomings in recruitment administration and the new manager shows a commitment to resolving these problems. However the lack of attention to carrying out the necessary checks prior to the arrival of the new manager is a concern and the provider must have adequate auditory systems in place to ensure that such shortcomings are identified and quickly addressed. (Refer to Requirement OP29) There was a recommendation at the last inspection for the home to include diversity training in the homes training programme for care staff. This has now been done. Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 26 New staff undergo an induction, which is now being consistently applied. Examination of five staff files showed that one did not have an induction schedule completed, but discussion with five staff and showed the home does consistently carry out induction of new staff. It may be that the absence of this induction record was an administration or filing error. The home is not registered with Skills for Care induction but the induction is an adequate system. A staff-training plan is now in place for all care staff, but recording of individual training that staff have had is not complete and up to date with some staff records showing no training for over two years. Training needs are picked up During supervision but are not linked to any training plan for the home, or to a development plan or business plan. There is no functioning Annual Appraisal for staff currently to review training needs or proactively set the training schedule for the home in a planned manner. Staff have said that training has improved and the new management have started to address some of these issues. The home must ensure that staff training records reflect that each member of staff has had at least 3 paid training days annually. (Refer to Requirement OP30) There are residents and staff training issues, which are not currently included in the homes training schedule. The following are some examples: 1. Senior care staff and nurses: Staff supervision, specialised feeding techniques 2. Care staff: Medication in relation to the residents they support, specialised feeding techniques, dealing with complaints It is recommended that the home develop an training plan for the home based on the needs of the residents and ensure that all care staff receive training in the key areas specified in the plan. (Refer to Recommendation OP30) Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33,35 36 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 good quality assurance systems are in place, which ensure that the home is run in the best interests of the residents. Resident’s financial interests are being effectively safeguarded. Staff have not been consistently supervised. The home has adequate health and safety policies and systems in place, but more work is needed to fully protect residents from potential falls. EVIDENCE: The registered manager is a qualified nurse, has completed the NVQ Level 4 qualification in Management. The manager started in post seven months ago and has submitted an application for registration with CSCI. She has made some positive changes in how the home is managed and two visiting relatives commented that she is always available to listen to them and that they feel Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 28 very confident that she takes action quickly to resolve problems. Residents whom I spoke to said that they feel they can easily speak with her and see her regularly helping residents. The manager is now supported by an assistant manager and an administrator, which greatly strengthens the management in the home. There was a requirement made at the last inspection for the home to develop an annual quality audit system seeek the views of residents families and other interested parties as to how the home is run and to identify where improvements can be made. This has now been done. The company has a quality department that provides questionaires which are sent out to the home twice a year. One is a food survey and one is a general questionaire seeking views on more general issues around the home the quality department collate the results and send them back to the home which the manager then incorporates into the homes action plan which is reviewed monthly. Residents are asked for their views on the entertainment that is provided compliments and complaint forms are available and these are evaluated to see how they can be incorporated improvements in the services that are provided. At the last three 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 be reviewed in order to ensure that this residents financial interests are safeguarded. In doing this provider was to ensure the resident received regular statements about the money held on his behalf by the provider. This requirement is now met and all residents for who the home manages money receive regular written statements. The staff records on supervision show that supervision has been inconsistent. Examination of five files sowed that one staff had no recorded supervision for a 12 month period and another for a nine month period. The new management have begun addressing this problem and have introduced a scheduling system for supervision. However given the importance of staff having support from a good supervision system especially given the intensity of support provided it is a requirement that the provider ensure that all nursing and care staff are formally supervised at least six times a year and that a clear written record is maintained for each supervision. (Refer to Requirement OP36) At the last inspection there were four Health and safety requirements made asking the provider to: 1. Involve the fire officer in assessing the back stairway to ensure the newly installed gate and keypad system meet fire regulations. This was Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 29 an immediate requirement and was met as required. The gate and keypad system were deemed as safe 2. Engage an Occupational Therapist to assess the safety and appropriateness of the floor covering, handrail stair gate and doorway in relation to residents and staff who use them. This has now been done and the stairs was deemed as safe and appropriate 3. 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. This has now been done 4. Ensure that a copy of the five-year electrical wiring certificate is kept at the home and copied to CSCI. This has now been done. 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 the home meets all fire safety requirements. There is a requirement for the home to carry out risk assessments for all residents assessed as having mobility support needs in relation to the use of stairs and steps in the home. (Refer to Requirement OP7 and OP18) Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes one outstanding requirement partially met. 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 OP7 Regulation 15 Requirement Timescale for action 31/12/07 2 OP7 and OP18 13.4 (a, b & c) 3 OP7 15.2 The registered provider and manager 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. This was a requirement from the last inspection Timescale of 31/08/06 partially met and now revised The registered provider must 29/02/08 ensure that residents are safeguarded from risk of harm or negligence by ensuring that all vulnerable residents as described in this report Standard 7, are risk assessed in the use of steps and stairs, and have in place appropriate guidance to minimise risk of falls in accordance with the homes written policies. The registered provider and 29/02/08 manager must ensure that the quality of written handover DS0000007040.V332906.R01.S.doc Version 5.2 Kirkdale Care Centre and Rebecca Posner Unit Page 32 4 OP9 12.1 and 18.1 5 OP9 23.2 6 OP27 18.1 7 OP27 18.1 8 OP29 19.4 c information be improved to better inform the planning and review process as discussed in this report Standard 7. a&b The registered provider and manager must ensure that care c (i) staff at the home have adequate knowledge of the prescribed medication taken by residents for whom they provide support b&c 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 a The registered provider and manager must ensure that the staffing numbers and skill mix of staff are appropriate to the assessed need of the residents, and the size, layout and purpose of the home at all times. In so doing the provider and manager must carry out a comprehensive staff analysis for the first and second floor and apply this to ensure that there is evidence to show that residents are adequately supported and cared for. a The registered provider and manager must ensure that in the event of staff absence or emergency as discussed in this report, that there is a robust system in place to ensure that staffing levels on any single floor do not fall below those set out in this report Standard 27 for an unreasonable period of time. a,b & The registered provider must ensure that there is on file proof of a suitable enhanced CRB check for all care staff and DS0000007040.V332906.R01.S.doc 31/03/08 29/02/08 31/03/08 29/02/08 31/12/07 Kirkdale Care Centre and Rebecca Posner Unit Version 5.2 Page 33 9 OP30 18.1 c (i) & (ii) 10 OP36 18.2 nursing staff, prior to commencement of employment The registered provider and manager must ensure that there is written evidence at the home to show that all nursing and care staff receive a minimum of three paid training days annually The registered provider and manager must ensure that all care staff receive formal supervision at least six times annually, and that there is a written record of these supervisions available for inspection 29/02/08 29/02/08 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 OP1 Good Practice Recommendations The registered provider should include mention in the homes Statement of Purpose of the importance of risk assessment regarding the use of stairs in the home for any potential residents who have a mobility support need The registered provider should include risk assessment of all potential residents in the use of stairs in the homes assessment and admission procedures The registered provider and manager should develop an overarching training plan for the home based on the assessed needs of the residents and use this to plan training for all care staff 2 3 OP3 OP30 Kirkdale Care Centre and Rebecca Posner Unit DS0000007040.V332906.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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