Inspection on 11/05/09 for Kirkdale Nursing Home

This inspection was carried out on 11th May 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kirkdale Nursing Home 06/10/09

Kirkdale Nursing Home 20/05/08

Kirkdale Nursing Home 04/06/07

Kirkdale Nursing Home 10/01/07

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 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kirkdale Nursing Home Radcliffe Crescent Teesdale Estate Thornaby Stockton-on-Tees TS17 6BS     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Katherine Acheson     Date: 1 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Kirkdale Nursing Home Radcliffe Crescent Teesdale Estate Thornaby Stockton-on-Tees TS17 6BS 01642611199 01642618899 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cleveland Alzheimers Residential Centre care home 38 Number of places (if applicable): Under 65 Over 65 38 dementia Additional conditions: 0 A maximum of 8 places can be used for people with dementia aged 50 . Date of last inspection Brief description of the care home 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 people that use the service. Car parking is available at the home. The home is on a Care Homes for Older People Page 4 of 31 Brief description of the care home bus route and close to Stockton town centre Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 0 stars. This means that people who use the service experience poor quality outcomes. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous inspections reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. This unannounced key inspection took place on the 11th May 2009. A pharmacy inspection of the service also took place on the same day and looked at the homes Care Homes for Older People Page 6 of 31 systems and procedures for receipt, recording, storage, handling, administration and disposal of medicines. The Manager completed and returned an Annual Quality Assurance Assessment, (AQAA). The AQAA is the services self assessment of how they think they are meeting national minimum standards. This information was received before the inspection and was used as part of the inspection process. The reason for the inspection was to see how good a job the home does in meeting the national minimum standards set by the Government for care homes. Numerous records were examined including care records of people living at the home, medication records, risk assessments, complaints and staff records. It was not possible to have in depth discussion with people that use the service due to their dementia, however brief chats did take place. Some relatives visiting the home on the day of the inspection were spoken to and expressed their views. The Manager was not present for the inspection, however the homes Deputy Manager was. Brief discussion took place with nurses and care staff working at the home. Before the inspection surveys for people that use the service and surveys for staff were sent out to the home for the Manager to distribute accordingly. Surveys sent to people that use the service were asked to comment on care received. Surveys sent to staff were asked to comment on what it was like working at the home and training. We received eleven surveys from people that use the service, relatives had helped to complete the surveys. We received three surveys from staff. Comments in surveys received can be read in the main body of the report. The cost of care at the time of the inspection visit was five hundred and fifty two pounds and thirty pence a week. What the care home does well: What has improved since the last inspection? What they could do better: Medication administration and recording practices in the home are not robust enough to ensure that people will always receive their medicines accurately as prescribed. Record keeping was poor. Hand written entries on Medication Administration Charts are Care Homes for Older People Page 8 of 31 not always checked or signed and on some occasions were incorrect. Some people were not receiving their creams as prescribed. Medication required for some people was unavailable on the day of the visit. An example of this was that one person needed medication to control their epilepsy. The home did not have this medication. An antihistamine for another person was also not available within the home on the day of the visit. An Immediate Requirement Notice was left at the home on the day of the inspection for the Provider to attend to this urgently. The Care Quality Commission made a safeguarding alert to the Local Authority regarding concerns in relation to medication. It was highlighted at the last inspection in May 2008 that care plans needed to be developed to include more detailed information. Three plans of care were picked at random and looked at during this visit. Two of the three files looked at during the visit did not show any improvement from last inspection in May 2008. One file contained a plan of care for a person who had lost weight. This plan of care contained basic information and did not detail any specific individual intervention required to manage the problem. Anther person had a diagnosis of epilepsy yet there was no plan of care in respect of how to manage this health problem. The lunch time of people that use the service was observed. There are two dining room areas, one for those people who reside on Lavender unit the other for those people who reside on Rosemary unit. The lunchtime of those people who reside on Rosemary unit was observed. People were dependant on staff and needed feeding, supervision and prompting. Lunchtime on this unit was not well managed. People who use the service were not being given the help and support that they needed. One staff member was seen to be feeding three people on two different tables. Some staff were standing up whilst feeding people and as such not making meal time as pleasant as it could be. One staff member who was supporting a person who required one to one attention finished their shift at PM, which resulted in another staff member who was assisting/prompting four people to eat being left alone. One of the four did not eat their food until twenty five minutes later when a staff member came over to offer assistance. Other people were left unsupported and as such compromised their dignity. The last inspection highlighted that testing of the fire alarm system needed to be carried out more frequently to ensure safety of all, this had not been addressed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Care Homes for Older People Page 10 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments of people who are to use the service are carried out before they move into the home to ensure all needs can be met Evidence: Before going into Kirkdale people who are to use the service have a care management assessment from Social Services and/or Health. This assessment is forwarded to the home for the Manager to look at to determine if the needs of the person can be met. Once this assessment has been reviewed, a nurse from the home visits the person at home or in hospital to do a further assessment and answer any questions about the home. The AQAA advises that, A service user guide is provided to relatives. This guide gives people the information they need about the home to make an informed choice about Kirkdale. Evidence of assessments were available on the files of people that use the service that Care Homes for Older People Page 12 of 31 Evidence: were looked at during the visit. People who are to use the service and their relatives are welcome to visit the home, have a look round and meet the staff. People spoken to and surveys received advised that they received enough information about the home before moving in. One person spoken to during the visit said, I visited in March last year, had a look round and thought no way. I came back in May 2008 because I was told that there was a new Manager and the atmosphere had entirely changed One survey received stated, I was shown round and had all of my questions answered. The home does not provide intermediate care. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some care plans for people who use the service do not set out in detail action which needs to be taken to ensure all aspects of health, personal and social care needs are met. Some files of people who use the service do not contain a plan of care in relation to health and personal care. Medication administration and recording practices in the home are not robust enough to ensure that people will always receive their medicines accurately as prescribed and as such treatment to their medical condition could be affected. Evidence: The care files of three people were looked at during the visit. Files contained a detailed assessment of needs for each person, evidence of nutritional screening and moving and handling assessments. One file was that of a person who had been in the home for two weeks and contained a detailed history that the family had put together. This contained important and interesting information about the person including childhood, marriage, family holidays, likes, dislikes and medical history. This is particularly useful when looking after a person with dementia. Following assessment of the person staff Care Homes for Older People Page 14 of 31 Evidence: at the home had developed some plans of care based on their needs however not for all. Plans of care that had been developed for this person contained good detail. An example of this was in respect of a plan of care for eating and drinking. The plan of care clearly identified the risk of choking and detailed how to help to prevent this. The plan of care also detailed how the person liked black tea and buffet food and how fruit needed to be peeled. The two other care files looked at during the visit did not contain the same detail and did not show any improvement from last inspection in May 2008. One file contained a plan of care for a person who had lost weight. This plan of care contained basic information and did not detail any specific individual intervention required to manage the problem. Another plan of care in respect of a person who had an infection had not been updated to reflect if the infection had cleared . Plans of care for this person had only been updated on a three monthly basis. The last file looked at during the visit was that of a person who was epileptic, needed assistance with attending to hygiene and dressing and toileting yet no plans of care had been developed. There was clear evidence of the involvement of GPs, District Nurses and other health care professionals such as chiropodists. Relatives of people living at the home confirmed that if they were feeling unwell, the GP would be called. People spoken to during the visit and surveys received were generally complimentary about life in the home and care received. Comments made included, My mum has received fantastic care and attention from all staff members since she came here in May 2008. In addition I have also received great support from everyone. I am extremely happy with the care my mum receives. Dementia is a terribly cruel disease, but I do take some comfort in knowing she is in the best place possible I always find the staff to be very friendly and helpful and feel that he is being looked after to the best of their ability The care is good and staff acted promptly when he was ill and needed to be admitted to hospital I thought that we would get a personal plan and discuss this regularly, but this does not seem to happen. Rather I am told what the home wants which is not always what I want Its lovely, absolutely marvellous, I cant complain about anything During the inspection arrangements for receiving, storing, administering, recording Care Homes for Older People Page 15 of 31 Evidence: and disposing of medication were observed and examined. Medication administration and recording practices in the home are not robust enough to ensure that people will always receive their medicines accurately as prescribed. There is inconsistency in the recording of the quantity of medication from one monthly cycle to another and the date received. Handwritten entries are not always checked or signed and on some occasions were incorrect. Medication Administration Record charts were incomplete with gaps and some entries were difficult to read. Records of the use of creams were poor. Some people were not receiving their creams as prescribed. On the morning of the inspection a Medication Administration Chart had been signed for that day confirming that cream had been applied. Discussion with a nurse who worked at the home identified that the chart had been signed but the cream had not been applied. Medication required for some people was unavailable on the day of the visit. An example of this was that one person needed medication to control their epilepsy. The home did not have this medication. An antihistamine for another person was also not available within the home on the day of the visit. An Immediate Requirement Notice was left at the home on the day of the inspection for the provider to attend to this urgently. The Care Quality Commission made a safeguarding alert to the Local Authority regarding concerns in relation to medication. The room used for storage of medication was untidy and prescription only creams were stored on open shelves.The room was cool with an air conditioning unit in use but no record of room temperature was kept. The fridge was unlocked and there were inappropriate items stored in the fridge which could have resulted in cross infection. Records kept of fridge temperatures showed a maximum temperature of ten degrees centigrade and a minimum of minus eleven degrees centigrade.(manufacturers recommend that storage is between 2-8c) Medication policies were comprehensive but contained some references to a previous pharmacy supplier and need updating. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate and enjoyable activities do take place at the home. Some people who use the service are not given the support that they need at mealtime and as such their dignity, health and wellbeing is compromised Evidence: The Deputy Manager advised that the home have a monthly schedule of activities that care staff at the home organise. Activities detailed within the schedule included, dominoes, sing a longs, baking and aromatherapy. A company called Movement and Motivation visit the home every two weeks to do gentle exercises and games with people that use the service. On the day of the inspection Movement and Motivation visited the home. A number of people who use the service were observed to be enjoying participating in the exercise session . Staff go through news papers with people to inform them of current affairs. Once a month a singer guitarist visits the home to entertain everyone. A pie and pea supper has been organised as has a trip out Preston Park. People that use the service have the use of a minibus. The Deputy said that people enjoy visiting to a Cafe in Stockton for cream teas. The home have just ordered greenhouse and hope to encourage and support those people who are able to do some potting of plants. The Deputy Manager said that people that use the Care Homes for Older People Page 17 of 31 Evidence: service, relatives and staff celebrated St Georges Day. Staff dressed in England shirts, lounge areas in the home were decorated with flags and bunting and people enjoyed an afternoon entertainer and afternoon tea. The Deputy Manager said that she has just arranged for Church of England service to take place at the home on the 24th May 2009 and that there is to be service every four weeks thereafter. A Special Minister visits the home on a weekly basis to give those people who are Roman Catholics communion or a blessing. People that use the service were unable to comment on the activities and outings planned by the home due to their dementia, however, relatives spoken to and surveys received made the following comments, My husband is very limited with in house activities due to his disability, but there is music and trips out that he can take part in Activities are sometimes difficult for my mum due to dementia some things are more suitable and appropriate than others We have recently been asked to sign for my mother to take part in aromatherapy sessions My husband wouldnt sit still long enough to engage in activities, but he will walk in the garden and go on visits to pubs for lunch. Enjoyed a visit to Redcar last summer The lunch time of people that use the service was observed. There are two dining room areas, one for those people who reside on Lavender unit the other for those people who reside on Rosemary unit. The lunchtime menu of the day was braised sausage, Yorkshire pudding, creamed potato, swede and carrot mashed together and gravy. Dessert was rhubarb tart and cream. Initially the lunchtime of people who reside on Lavender unit was observed. Food served looked presentable. One person was having an alternative of jacket potato and salad and another was having a quorn burger. For those people who required soft or liquidised diet each item of food had been liquidised separately giving the food more colour and looking more appetising. Staff were giving help to those people who needed it. The lunchtime of those people who reside on Rosemary unit was then observed. People were more dependant on staff and needed feeding, supervision and prompting. Lunchtime on this unit was not well managed. People who use the service were not being given the help and support that they needed. One staff member was seen to be feeding three people on two different tables. Some staff were standing up whilst feeding people and as such not making meal time as pleasant as it could be. One staff Care Homes for Older People Page 18 of 31 Evidence: member who was supporting a person who required one to one attention finished their shift at 1 PM, which resulted in another staff member who was assisting/prompting four people to eat being left alone. One of the four did not eat their food until twenty five minutes later when a staff member came over to offer assistance. Other people were left unsupported and as such compromised their dignity. Comments made in respect of the food provided included, The kitchen staff have been fantastic in devising a vegetarian diet for my mum. The homemade cakes and biscuits are delicious too A new menu has been introduced recently which got rid of angel delight types of pudding and more substantial puddings are offered There is a varied menu which is quite good For tea the other evening he/she was given a small bowl of mashed potato, kidney bread torn into small pieces and gravy , which I sent back as it was tasteless and disgusting Food, lovely show, he always comes back for seconds Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported to make any complaint they feel necessary. Adult protection procedures are in place which helps to protect people from abuse. Evidence: The home has a complaint procedure which informs people of who to contact and timescales for action. People spoken to during the inspection said that they would have no hesitation in approaching the Manager or any member of staff to raise any concern that they may have. The home has received one complaint in the last twelve months. The home has an adult protection procedure which informs staff of who to contact if abuse is suspected. The Deputy Manager said that staff receive adult protection training when they start working at the home and on a regular basis there after. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment is good providing people that live there with an attractive, homely and comfortable place to live. Evidence: The home 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 but they do contain a sink. Externally there is a pleasant enclosed garden/seating area for people that use the service. Since last inspection improvements to the environment have been made. Some bathrooms have been painted and some bedrooms have benefited from new furniture, bedding and curtains. In one lounge area the television has been replaced with a large fish tank ,which the Deputy said that many people that use the service enjoy looking at. The home are in the process of putting up recessed picture frames outside each bedroom. The picture frames are then to be filled with photographs and belongings that will help people to find their bedroom. Care Homes for Older People Page 21 of 31 Evidence: On the day of the inspection the home was clean and tidy. One survey received stated, The housekeeping staff are always working hard to keep the home clean and tidy. Appropriate laundry facilities were in place. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes recruitment procedure is good, which helps to ensure that people are protected. Mandatory training and other training relevant to the job staff do is provided ensuring that staff are knowledgeable and experienced to meet the needs of people using the service. Evidence: Duty rotas looked at during the visit informed that Lavender unit , which accommodates up to nineteen people, and was fully occupied on the day of the inspection had five care staff on duty during the day one of which was allocated to one person requiring one to one support. There were seven care staff on an evening, two of which were allocated to people who require one to one support. Rosemary unit which can accommodate nineteen people and was fully occupied at the time of the visit had five care staff on duty on a morning and six on an evening, one of which is allocated during the day and evening to a person who requires one to one support. On night duty there are four care staff on duty one of which is allocated to a person who requires one to one support. During the day there are two nurses on duty, on an evening one nurse and for night shift one nurse. The Deputy Manager said that the home continue to need to use agency care staff, Care Homes for Older People Page 23 of 31 Evidence: however the amount used has decreased and that they use the same agency who supply the same care staff and as such consistency is maintained. Comments made in respect of staff employed at the home and staff supplied by the agency included, I can always find staff if needed. There now appears to be less bank staff and more regular staff Sometimes there are agency staff who although they are caring dont know the residents well enough to know what they need There is a a lot af agency staff, but the same faces The staff are brilliant, patient and kind Sixty four percent of care staff working at the home have achieved a minimum qualification of NVQ level 2 in care. Records were available to confirm that good recruitment procedures are followed. Three files of staff working at the home were examined. Appropriate references were on file as was evidence of Criminal Record Bureau checks. Two of the three application forms looked at during the visit had only been completed by the employee to inform of the year that they were employed from and to. It was pointed out to the Deputy Manager that application forms should detail the month and the year to enable the exploration of any gaps in employment. Records were available to confirm that staff working at the home receive induction training. Staff files examined during the visit contained certificates to confirm that staff had recently attended training in Moving and handling, fire, dementia and adult protection. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Testing of the fire alarm system and testing of water temperatures is not carried out as often as it should be and as such could compromise the safety of people that use the service. Evidence: The Manager is a Registered Mental Nurse who has many years of experience working with dementia and people who have mental health problems. The Manager advised in a meeting after the inspection that she has forwarded her application for registration to the Care Quality Commission. The Manager of the service has been in post for just over a year now. People spoken to and surveys received spoke positively about the Manager, Deputy Manager and other staff working at the home. A number of people advised that there had been lots of improvements in the last twelve months. Comments made included, The Manager and Deputy Manager are very approachable nothing is too much Care Homes for Older People Page 25 of 31 Evidence: trouble I have a lot of faith in the new Manager and commend her on the improvements she has implemented. I cant praise her and the staff enough for the improvement in my husband since moving to Kirkdale after a long stay in hospital The Manager has worked hard to improve the home with limited resources. Also has boosted staff moral and motivation All of the staff team are very good Appropriate quality assurance monitoring systems are in place. Surveys are sent out to relatives on a yearly basis to make sure that they are happy with the home and the care that is receive. Regular meetings are held for people who use the service and their relatives. The home looks after small amounts of money for some people that use the service, for others family manage their money. Appropriate systems were in place for dealing with money with records of transactions being kept. A sample of health and safety records were examined. Records were available to confirm that the homes fire alarm, emergency lighting and gas boilers had been serviced in the last twelve months. Maintenance records for the home showed that water temperatures of baths/showers were taken on a monthly basis. Water temperatures should be taken and recorded weekly in line with health and safety guidance. The last inspection of the service highlighted the need for weekly testing of the fire alarm system to ensure that this was in good working order. Records examined during the visit showed that weekly testing of the fire alarm system was not happening. Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 14, 15 Care plans require further 30/09/2008 development to ensure that they are individual to the person using the service. Care plans must include limitations, preferences and assistance required to help to ensure that care needs are met. To help to ensure that care is delivered in a way that is accetable to the person and promote wellbeing. 2 38 23 The Registered Person must 20/05/2008 ensure that tests of the fire alarm system are carried out on a regular basis to ensure safety of all. Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 9 12 The registered person must ensure that there is an effective system in place to request, obtain and retain adequate supplies of prescribed medication for people who use the service To ensure that treatment to their medical condition is not affected 11/05/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The registered person must 30/07/2009 develop for each person a plan of care that details how the persons needs in respect of health and welfare are to be met. To help to ensure that care is delivered in a way that is acceptable to the person and maintain wellbeing 2 9 13 Medication must be stored securely and safely at the correct temperature recommended by the manufacturer. A system must be in place to check expiry dates of medicines 30/06/2009 Care Homes for Older People Page 28 of 31 and add the date of opening when necessary. This makes sure that medicine is safe to administer when needed 3 9 13 Arrangements must be in 30/06/2009 place to ensure that medication records are accurately maintained; that the reason for nonadministration of medication are recorded by the timely entry of an appropriate code or entry on the medication record; that the meaning of any such codes are clearly explained on each record; and that the person administering the medication completes the Medication Administration Record in respect of each individual person at the time of administration. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected The registered person must ensure that people that use the service receive the help they need at mealtime To ensure wellbeing 5 38 23 The registered person must 10/06/2009 ensure that tests of the fire alarm system are carried out on a regular basis 30/06/2009 4 15 12 Care Homes for Older People Page 29 of 31 To ensure safety of all Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans for people who us the service should be evaluated on a monthly basis to inform of any deteriorations or improvements made Handwritten entries and changes to Medication Administration Records must be accurately recorded and detailed. This makes sure that the correct information is recorded so a person receives their medication as prescribed. The prescriber or community pharmacist should be asked to provide further information when a medicine is labelled as directed or when required. This makes sure that medication is given correctly The medicine policy and procedures should be updated in line with current best practice guidance and to reflect changes to the new supplying pharmacy so that staff follow correct procedures and handle and administer medicines safely The Manager should continue with her application to be Manager of Kirkdale. This will enable the Care Quality Commission to determine fitness and register. Water temperatures should be taken and recorded on a weekly basis to help to ensure safety of people that use the service 2 9 3 9 4 9 5 31 6 38 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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