Inspection on 10/01/07 for Kirkdale Nursing Home

This inspection was carried out on 10th January 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kirkdale Nursing Home 06/10/09

Kirkdale Nursing Home 11/05/09

Kirkdale Nursing Home 20/05/08

Kirkdale Nursing Home 04/06/07

Kirkdale Nursing Home 04/05/06

Kirkdale Nursing Home 28/11/05

Kirkdale Nursing Home 20/06/05

Kirkdale Nursing Home 29/09/04

Kirkdale Nursing Home 15/04/04

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

CARE HOMES FOR OLDER PEOPLE Kirkdale Nursing Home Radcliffe Crescent Teesdale Estate Thornaby Stockton-on-Tees TS17 6BS Lead Inspector Katherine Acheson Key Unannounced Inspection 09:15 10th and 15th January 2007 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 Nursing Home DS0000000182.V326523.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 Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kirkdale Nursing Home Address Radcliffe Crescent Teesdale Estate Thornaby Stockton-on-Tees TS17 6BS 01642 611199 01642 618899 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) Cleveland Alzheimers Residential Centre Mrs Christine Robinson Care Home 38 Category(ies) of Dementia - over 65 years of age (38) registration, with number of places Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of 8 places can be used for people with dementia aged 50 . 22nd August 2006 Date of last inspection Brief Description of the Service: Kirkdale is a modern, purpose built facility that is registered to provide personal and nursing care to thirty-eight older people with dementia. The home is single storey. The home is divided into two units, Lavender and Rosemary. Each unit has three lounge areas and a link lounge in addition to a dining room. Bathing and toilets are available on each unit. Bedrooms in the home environment are single in nature and meet the required amount of space. Bedrooms do not have en-suite facilities. Externally there are surrounding grounds and a pleasant enclosed garden/seating area for resident use. Car parking is available at the home. The home is on a bus route and close to Stockton town centre The cost of care at the time of the inspection visit ranged from £492 to £541 per week Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection of the home was carried out over two days the 10th and 15th of January 2007. On the first day of the inspection the Inspector arrived unannounced. The Manager of the home was aware of the second day of the inspection. On the 10th January 2007 the Inspector arrived at 09:15 and left at 17:40. On the 15th January 2007 the Inspector arrived at 09:20 and left at 14:45. Discussion with residents was difficult due to their dementia, however three residents were spoken to briefly. During the visits two care staff, one trained nurse, the Deputy Manager, the Cook and the Manager were spoken to. Five relatives were also interviewed Prior to the inspection ten relative comment cards and five resident comment cards were sent out to the home to give to residents and families asking them to complete and comment on the care that is received at the home. Seven relative comment cards and four resident comment cards were received. Comments can be read in the main body of the report. Numerous records including care plans, menus, complaints and staff recruitment and training records were examined. A tour of the premises was carried out. Requirements identified at the last inspection in August 2006 were re-visited. The details of any issues identified at this inspection requiring action are to be found at the back of this report. What the service does well: The Inspector was made to feel welcome by residents, staff and visitors at the home. The home ensures that a good recruitment procedure is followed which provides protection for residents. On the whole relatives spoken to and survey questionnaires returned said they were satisfied with the overall care provided by the home. One relative spoken to said, “The staff are wonderful” another said, “The best thing about the home is the loving care”. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although a plan of refurbishment has commenced many areas of the home still need re-decoration and replacement flooring. One relative said, “The environment is not pleasant and the carpets are dirty” Immediate action must be taken to address the hot temperature of the medication room so that medication is stored at the correct temperature. Plans of care and risk assessments have been developed for residents residing at the home, however further detail is needed. Discussion with relatives, staff, and indirect and direct observation highlighted that the current staffing levels at the home are not sufficient to meet the needs of the residents. The Manager must ensure effective management of the home; regular servicing of appliances, equipment and water must be carried out. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 7 The Manager must ensure all staff must commence and complete induction training. Induction training must contained the required elements. 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 Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Where possible residents do receive an assessment to ensure that the home can meet their needs. EVIDENCE: The Manager said that prospective residents receive an assessment that is carried out by a social worker or other health care professional to ensure that the home can meet their needs. Staff at the home then carry out their own pre-admission assessment to ensure that the needs of the resident can be met at home. Two resident files were examined at random during the inspection, both of which contained an assessment that had been carried out by staff at the home. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 10 One of the assessments was observed to be detailed the other was not. The Manager said that this was because one resident had been admitted as an emergency and as such the majority of required information was gained from the Social Worker assessment and on admission to the home. An up to date Social Worker assessment was on file. The home does not provide intermediate care. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the standard of care planning in the home has improved, care plans and risk assessments are insufficiently detailed and as such could compromise care to be given. In general good procedures are in place to ensure safe practice in respect of the handling of medication, however on occasions the medication room temperature is too hot, this could have an effect on the medication stored within. EVIDENCE: Since the last key inspection in May 2006 it is evident that staff at the home have worked hard to improve the standard of care planning. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 12 The Manager said that all resident files have been updated to contain the new care plan documentation. Two residents plans of care were examined at random during the inspection. Care plans examined gave a detailed physical, mental and social history of the resident. The Manager said that assessments of residents are carried out prior to admission, on admission and reviewed on a regular basis. Following assessments/reviews of residents care plans are developed for problems identified such as pain, pressure damage and isolation. Care notes contained brief care requirements for hygiene and dressing, however were not documented in the form of a plan of care. A discussion took place with the Manager regarding the need to develop a plan of care for each activity of daily living for example hygiene and dressing, continence and eating and drinking if it was identified that assistance or intervention is required by the resident. Risk assessments were evident on files examined during the inspection. One resident file contained a risk assessment as it was identified that they were at risk of falling out of bed. This risk assessment was too general and did not identify specific risk to the resident, if they had fallen out of bed in the past, nor was the risk assessment evaluated to confirm effectiveness. Care plans examined were not evaluated on a monthly basis. Residents files examined during the visit were observed to contain signatures of families to confirm that they had been involved in drawing up the plan of care. Relatives spoken to during the inspection said that they had been part of developing the plan of care. Five relatives were spoken to during the inspection comments made included, “The staff are fine, very loving, friendly and affectionate” “It is not perfect but it is as near as you get it’s home” “The home was initially good, then went down but has improved lately” “I am generally happy with the care” The staff are wonderful, but not enough of them, I have needed to complain recently but things have improved” Resident and relative comment cards received prior to the inspection in respect of care received stated “His treatment and welfare is second to none” Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 13 “On the whole staff are helpful, willing and knowledgeable” “The care received is very good” Relatives spoken to during the visit felt that in general dignity and privacy of residents was respected, however one relative stated that on a number of occasions the resident that they had come to visit had been wearing clothes that were marked with food stains. During the inspection arrangements for receiving, storing, administering, recording and disposing of resident’s medication were observed and examined. The Manager said that it is the responsibility of trained nurses to administer medication to residents. The Manager said that since last inspection they have changed their supplying pharmacy. Records were available to confirm that the home keep a record of all medication coming into the home. Medication was stored securely. During the visit a medication audit of the two residents files sampled at random during the inspection was carried out. Medication administration charts had been completed correctly and the stock balance of medication belonging to the residents was correct, matching up with medication ordered, received, administered and remaining in the home. The home has a system in place for the returning of unused medication for destruction by a licensed company, however, were unable to locate the record that contained medication that had been returned for destruction. It was observed that the temperature of the medication room was very warm. Staff have been recording the temperature of this room and on some occasions the temperature of this room has been recorded as too hot for storage of some medication. This was pointed out to the Manager at the time of the inspection. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 14 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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate and enjoyable activities take place at the home providing residents with stimulation. Visitors are encouraged and made to feel welcome at anytime. Residents enjoy their food and receive a varied diet, however the environment in which they eat is not pleasant EVIDENCE: The home does not employ an Activity Co-ordinator it relies on care staff to provide stimulation through leisure and activities when time permits. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 15 The Manager said that since last inspection she has developed a daily plan of activities for residents. She stated that due to the short attention span of residents activities take place generally twice a day, for half an hour in the morning and an hour in the afternoon. Activities mentioned included reminiscing, ballgames, sing-a-long and pamper sessions. In addition to daily activities the home plans ahead to provide entertainment coming into the home and trips out. Aromatherapy sessions are held twice a month. The Aromatherapist visits the home seeing different residents on each visit. Motivation classes are also held on a monthly basis. The Manager said that Christmas had been a busy time; three residents had gone to see a pantomime, eight residents had visited the local university for a carol concert and that three other residents had been out for Christmas lunch. The home had hosted its annual Christmas party and carol singers had also visited the home. The Manager said that already in the month of January a singer had been booked by the home and that the residents had enjoyed a recent visit from the Fisherman’s Choir. Relatives spoken to during the inspection said that they felt that the home provided sufficient stimulation and entertainment for residents. Comment cards received from residents and relatives in respect of activities stated “ Lots of activities are arranged. Staff are wonderful at ad hock activities like singing as they hand out the tea, showing affection by touching and stroking, making light hearted banter and dancing. The residents have the freedom to walk about” “Occasionally I feel that there are not enough staff, particularly when a large group activity is taking place. The demands of unsettled individuals mean quieter ones are overlooked” “It is pleasing to see so many activities on offer. I have seen residents engaged in the art activities and for one resident winning a game of dominoes gave her an enormous feeling of success” A further two comment cards received said that there were usually enough activities going on. One relative spoken to during the inspection said, “Staff at the home do seasonal activities including crafts with residents” this relative felt that residents did not necessarily benefit from this activity as it was the staff who had to do the majority of craft work. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 16 The home supports residents to practice their religion and that visits from clergy are available to the home, relatives spoken to confirmed that this was the case. Relatives interviewed spoke of flexibility in routine and freedom of choice. Relatives spoken to during the inspection said that contact with family and friends is encouraged and that visitors are made to feel welcome at any time. A relative spoken to during the visit said, “I am always made to feel welcome” another said, “I feel welcome, I think I help staff by visiting on a morning to feed my wife”. On the first day of inspection the mealtime of residents was observed. The lunchtime menu on the day of the visit was roast turkey, carrots, sprouts, mash potato, yorkshire pudding and gravy. Those residents requiring a soft/liquidized diet were served with separate mash potato and turkey, vegetables, Yorkshire pudding and gravy that had been liquidized together. A discussion took place with the cook in respect of liquidizing food separately so that food served looked more appetizing and appealing. Portions of food served appeared adequate. Food is served to residents by kitchen staff. Many of the residents residing at the home require the help of staff to assist with feeding or totally rely on care staff to feed them. Kitchen staff serve food to residents who are able to feed themselves, and also plate up food for those residents requiring feeding. Food is left in the hot lock to keep warm until staff are able to assist with feeding. Concerns have been raised at previous inspections that the temperature of the hot lock is not warm enough. Records were evidenced to confirm that the hot lock had been fixed on the day after the last inspection of the home (August 2006). The Cook said that she is continuing to monitor the hot lock temperature at regular intervals. With so many residents to feed or assist with feeding it was felt that there were insufficient staff on duty at mealtimes. A discussion took place with the Manager in respect of this who agreed that the dependency of residents had increased. There was a plentiful supply of food observed at the home. A discussion with the cook identified that the home use frozen vegetables rather than fresh. It was also identified that there was not any fresh fruit available in the home on the first day of the inspection. The cook said that tangerines had been available over Christmas. The cook also said that frozen vegetables were used as fresh vegetables took so long to prepare. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 17 It was pleasing to see that on the second day of inspection the Cook had prepared a fresh fruit salad for residents. Relatives comments made in respect of food served included “The food is ok my wife had porridge, scrambled egg, beans and tomatoes for her breakfast” “The food is fabulous, however presentation is not always so good for those residents who need it mushed up. There is always plenty of it.” “The meals are fine, I have had meals here. Residents eat different meals. They asked me when my mam was admitted what she likes, she likes finger food”. Two relatives spoken to during the visits said that they had enjoyed Christmas lunch at the home. One said, “I came for Christmas dinner, staff had set up a table in the lounge for me and my wife. It was lovely, the Christmas pudding was lovely”. Another relative said, “I had Christmas dinner in the dining room with my wife. The dinner was lovely”. Both dining rooms in the home environment are in need of re-decoration and replacement flooring. Carpets are badly stained. The Manager said that the dining rooms are to be re-decorated and the flooring replaced in the next six to eight weeks. Kirkdale Nursing Home DS0000000182.V326523.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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives are encouraged and supported to make any complaints they feel necessary, however the complaint policy is not sufficiently detailed to inform residents and relatives of stages of the complaint who to contact and timescales for action. The complaint policy/procedure could be strengthened to include information of residents/relatives rights to complain to commissioning agencies such as Social Services and Primary Care Trusts. Adult protection procedures are in place, which help protect residents from abuse. EVIDENCE: The home has a complaints policy/procedure, however, this does not give clear stages, whom to contact including name address and telephone number and timescale for the process. This policy/procedure should also be updated to inform residents/relatives of their right to complain to any commissioning authorities such as the Primary Care Trust or Social Services. The complaint procedure within the statement of purpose/service user guide should also to be updated to include such information. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 19 The home keeps a record of complaints. In the last twelve months there have been two formal complaints, one of which was made to the home directly and one to the Commission for Social Care Inspection. Relatives spoken to during the inspection said that they would feel comfortable in raising and concern or making a complaint to the staff or the Manager of the home. The home has an adult protection policy and a copy of the Teeswide Guidance regarding the protection of vulnerable adults. Since the last inspection the majority of staff working at the home have received adult protection training. Two adult protection referrals have been made in the last twelve months. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A programme of refurbishment has commenced at the home, however redecoration and replacement carpets are needed in many areas of the home in order to bring the home up to an acceptable standard. EVIDENCE: The Manager accompanied the Inspector on a tour of the home. It was pleasing to see that the home has commenced a programme of re-decoration and replacing carpets. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 21 Corridors on both units had benefited from painting. New carpets have been fitted to the main corridor on Lavender unit. The Manager said that the carpet in Rosemary corridor is expected to be replaced in the next 6-8 weeks. In general lounge areas were warm and homely many benefiting from the purchase of new lounge chairs and settees. A small number of bedrooms have been painted and carpets replaced, however, many of bedrooms in the home environment still require redecoration and replacement flooring. Both dining rooms in the home are in need of re-decoration and replacement flooring, carpets are extremely stained. A tour of the premises highlighted that although re-decoration and the replacing of carpets has commenced there is still a lot to do to bring the environment of Kirkdale up to the required standard. A discussion took place with the Manager and General Manager of the home on the second day of the inspection. The General Manager said that a programme of refurbishment has commenced however due to unforeseen circumstances in December the home had needed to replace two hot water boilers and as such slowed down the programme of refurbishment. It was agreed with the Manager and General Manager that they must be responsible for planning the programme of refurbishment ensuring that priority is given first to the most needy areas. It was also pointed out to both that when budgeting/planning for 2007/2008 consideration must be given to refurbishing communal bathroom areas. One relative spoken to during the inspection said, “I’m pleased with the improvements, the new carpet is beautiful. The home is always kept clean and you can’t smell anything” One relative said, “I don’t like the dirty carpets, the home smells. Over the Christmas period the home was not clean and it smelt a lot” Externally the grounds are generally well maintained. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Good recruitment procedures are followed which helps to protect residents residing at the home. A discussion with relatives, staff, and indirect and direct observation highlighted that the current staffing levels at the home are not sufficient to meet the needs of the residents. A programme of mandatory training is provided to staff, however no records were available to confirm that staff commence or complete induction training. EVIDENCE: Staffing rotas examined informed the inspector that there were generally five or six care staff on duty on a morning, six on an afternoon, seven on an evening and three on night duty. In addition to two trained staff on duty 07:30 until 14:30, one between 14:30 and 21:00 and one on night duty. The Manager of the home works full time, however is not always supernumerary as agreed on registration to the numbers highlighted above. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 23 Five relatives spoken to during the inspection all praised staff working at the home, however all five felt that there were insufficient staff on each shift to meet the needs of residents residing at the home. One relative said, “Staff are rushed off their feet, there is not always enough staff to feed residents” another said, “The home is well under staffed”. One relative said, “I have seen a fair amount of agency care staff lately sometimes there are just as much agency staff as regular staff. With some of the agency staff their English is very limited and although they are pleasant they do not understand the resident nor does the resident understand the agency staff member” As highlighted earlier in the report many of the residents residing at the home are very dependant and as such require feeding. It was felt that there were insufficient staff on duty at mealtimes to assist with feeding. Of the seven relative comment cards received prior to the inspection four relatives thought that there were sufficient staff on duty three did not. Two care staff spoken to during the inspection also felt that there were not enough staff on duty at anyone time. A long discussion took place with the Manager and General Manager regarding the current staffing levels at the home and the concerns raised in respect of agency staff working at the home who speak limited English and as many agency staff being on duty as regular staff. The Manager said that resident occupancy at the home increased prior to Christmas, which resulted in using a fair amount of agency care staff. The Manager said that they have now appointed regular care staff to work at the home, however are awaiting recruitment checks prior to commencement of employment. The Manager acknowledged that some staff supplied by the agency to work at Kirkdale did have limited English. She said that she has spoken to the agency in respect of this. 45 of care staff working at the home have now undertaken an NVQ level 2 in care. The Manager said that there are a further seven care staff who are to commence NVQ level 2 on care in the near future. Two staff files were examined at random during this inspection. Records examined contained two references, appropriate Criminal Record Bureau checks that had been received prior to the commencement of employment and proof of identity. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 24 The Manager said that all newly appointed staff receive induction training, however records were not available of the two staff files sampled at random during the inspection to confirm that this is the case. The Manager said that new staff attend induction training at a training suite. Staff are issued with their induction handbooks and are expected to get each area signed off when they are competent. It was noted that although newly appointed staff are buddied up with experienced staff on commencement of employment there is no formal process of carrying out an internal induction which includes the homes fire procedures, locating emergency exits and fire extinguishers. A blank induction was available for inspection, however this induction did not appear to meet with the current induction standards. A discussion took place with the Manager in respect of this. The Manager has a training matrix, which highlights staff training undertaken and staff training due. The Manager said that the home carry out a rolling programme of mandatory training. Two files of staff who had been employed at the home for some time were examined at random during the visit. Both staff files contained evidence that mandatory training had been undertaken, however when the Inspector tried to link this up with the training matrix it was observed that one of the two staff members names was not listed on the matrix. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 25 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, 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The Manager is appropriately qualified and experienced to run the home, however effective management is not demonstrated at all times. The safety of residents and staff is compromised, testing of the fire alarms, water temperatures, portable appliance testing and fixed electrical installation is not carried out as often as it should be. Resident’s financial interests are safeguarded. The home seeks the views of relatives on an annual basis, however the process is ineffective if the Provider does not take action in respect of concerns raised. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Manager, Christine Robinson, is a Registered Psychiatric Nurse who has worked in the nursing and social care environment for many years. The Manager has a management qualification. Quality assurance and quality monitoring practices are in place. Surveys are sent out to residents on an annual basis to see if they are happy with the home and care that is provided. Surveys are sent out to relatives in February of each year. February 2006 quality assurance records were examined at the last key inspection in May 2006 where it was highlighted that the Provider had not taken any action when a concern was highlighted. The Manager said that as a result of their dementia residents are unable to manage their own finances. Those residents who want a small amount of change in their pocket do so. The home does not handle the personal allowance for residents, relatives/representatives or Social Services maintain control. Three staff records examined at random confirmed that The Manager does not have a system in which to ensure that all care staff receive formal supervision at least six times a year. Records were examined to confirm that the Gas boilers and fire extinguishers had been serviced within the last year. The Manager said that a rolling programme of servicing of appliances and equipment is in place. Records examined highlighted that the servicing for the fixed electrical installation (hard wiring) were out of date having last been serviced in August 2001. Tests carried out by the homes Handyman of the fire alarm system were undertaken on an ad hock basis. Records examined confirmed that fire drills could be as much as two months apart. The Handyman was unable to locate his records to confirm that water temperatures in the home environment are taken on a regular basis. The Handyman said that water temperatures are taken on a monthly basis. A discussion took place with the Manager and Handyman in respect of following Health and Safety Executive Guidelines in which water temperatures particularly baths and showers should be taken and recorded weekly to ensure safety of residents. The Handyman advised that portable appliance testing was also overdue. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 27 A discussion took place with the Manager in respect of the over due servicing who agreed to take immediate action. A discussion took place with the Manager in respect of carrying out audits to ensure that appropriate systems and record keeping are in place to ensure effective management of the home. The Manager advised that this at times was difficult due to the busy home environment and the fact that she is not totally supernumerary. Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 28 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 OP8 Regulation 14, 15 • Requirement Care plans must be developed for those residents that require assistance/intervention with activities of daily living Care plans must be evaluated on a monthly basis or more often if required Risk assessments require further development to ensure that they are specific and individual to the resident Risk assessments must be reviewed/evaluated on a regular basis to confirm effectiveness. The Registered Person must address the problem of the medication room being too warm The Registered Person must ensure that the record of medication returned for destruction to the licensing company is available for inspection Timescale for action 28/02/07 • • • 2 OP9 13 • 15/01/07 • Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 30 3 OP16 22 4 OP19 OP20 16 5 OP27 18 6 OP28 18, 19 7 OP30 18 The complaint policy/procedure must be updated to include clear stages, contact details including name address and telephone number and timescales for the process The Registered Person must continue with their plan of refurbishment. This must include replacing bed linen, towels, furniture, beds and carpets/flooring The refurbishment of bathrooms must be given consideration when planning 2007/2008 budget. A copy of the plan of refurbishment must be available for inspection • The Registered Person must carry an assessment of residents to determine if there are sufficient staff on duty • The Registered Person Must ensure that there are sufficient staff on duty at peak times of activity during the day. Particular attention must be given to mealtimes The Registered Person must continue with their plan of action in which to achieve 50 of care staff qualified to NVQ level 2 in care. • The Registered Person must review the homes induction and ensure it includes all common induction standards as set by Skills for Care. • All newly appointed staff must receive induction training • The Registered Person must ensure that newly appointed staff receive and DS0000000182.V326523.R01.S.doc 28/02/07 15/01/07 15/01/07 15/01/07 28/02/07 Kirkdale Nursing Home Version 5.2 Page 31 8 OP31 OP27 12, 18 9 OP33 24 10 OP38 23 in house induction in respect of areas connected to health and safety Consideration must be given into 28/02/07 ensuring that the Manager has sufficient time to effectively manage the home Following the quality assurance 30/03/07 survey the Registered Person must take the views of residents/representatives into account and act upon concerns raised • The Registered Person 15/01/07 must ensure that the fixed electrical installation (hard wiring is serviced every five years • The Registered Person must ensure that fire drills and testing of the fire alarm system are carried out on a regular basis • The Registered Person must give consideration to the Health and Safety Executive Guidelines to monitor bath and shower water temperatures weekly • The record of testing water temperatures must be available in the home environment for inspection • Portable appliance testing must be carried out on a regular basis RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 32 1 OP36 The Registered Person should make arrangements for the staff to receive formal supervision six times a year. 2 3 4 OP15 OP15 OP16 The cook should ensure that liquidized meals are presented in a manner, which is attractive and appealing. Consideration should be given to providing fresh fruit and vegetables The Complaints policy/procedure should be updated to include information of resident’s rights to complain to commissioning agencies such as Social Services and the Primary Care Trust. The homes statement of purpose and service user guide should also be updated to reflect such information Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX 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. Extracts may not be used or reproduced without the express permission of CSCI Kirkdale Nursing Home DS0000000182.V326523.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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