Inspection on 20/05/08 for Kirkdale Nursing Home

This inspection was carried out on 20th May 2008.

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 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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Kirkdale Nursing Home Radcliffe Crescent Teesdale Estate Thornaby Stockton-on-Tees TS17 6BS Lead Inspector Katherine Acheson Unannounced Inspection 10:00 20th May, 2nd June and 6th June 2008 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.V363499.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.V363499.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 Alzheimer’s Residential Centre Care Home 38 Category(ies) of Dementia - over 65 years of age (38) registration, with number of places Kirkdale Nursing Home DS0000000182.V363499.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 . 4th June 2007 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 people that use the service. 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 was £535 per week. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. The key inspection of the home was carried out over three days, the 20th May, 2nd June and 6th June 2008. On the 20th May 2008 the Inspector arrived unannounced. On the 2nd June 2008 an unannounced pharmacy inspection was carried out. The manager was aware of the inspection visit on 6th June 2008. 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 including care plans, complaints and staff recruitment and training records were examined. Discussion with people that use the service was difficult due to their dementia, however four people that use the service were spoken to briefly. During the visits one care staff member, the training officer, the handyman, the housekeeper, the deputy manager, and the Manager were spoken to. Three relatives were also interviewed. At the end of the first day of the inspection discussions also took place with the general manger of the service. A new manager has recently been appointed and had only been in post for six days by the first visit to the home. The Inspector walked around the home with the manager. Before the inspection five surveys for people who use the service and fifteen surveys for relatives, carers and advocates were sent to the home for the manager to distribute accordingly. Surveys requested feedback on the service and staff provided. We did not receive any surveys back from people that use the service, but received two surveys from relatives, carers and advocates. Comments received can be read within the report. The deputy 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. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 6 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: What has improved since the last inspection? What they could do better: There are a number of improvements that need to be made as a result of this inspection. Assessments and care plans of people that use the service need to include more detail to ensure that care needs are met. Activities and outings do not take place on a regular basis and the food provided and mealtime needs to improve. Medication administration and recording practices in the home are not robust enough to ensure that people will always receive their medicines accurately as prescribed. The dependency of people using the service needs to be reviewed to ensure that there is sufficient staff on duty and the management team need to review the high number of agency staff that are being used to meet the needs of people using the service. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 7 Checks of the fire alarm system are not carried out often enough. 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.V363499.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.V363499.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): Standards assessed 3 and 6 People who use 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. Assessments of people who are to use the service are carried out, however, some are insufficiently detailed and as such do not help to ensure that the needs of people using the service can be met. EVIDENCE: The manager said that before going into the home people who are to use the service are first assessed by a social worker or health care professional and that this assessment is forwarded to the home before admission. Staff at the home then carry out their own pre-admission assessment either visiting the person in their own home or at hospital to ensure that the needs Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 10 can be met at Kirkdale. The manager said that once in the home more detailed assessments are carried out. If people are self-funding then an assessment is usually only carried out by experienced staff working at the home. Three files of people that use the service were looked at during the visit. Files contained a basic assessment but this did not include enough information about the person. An example being an assessment for one person identified that they needed help with eating and drinking, but did not include likes/dislikes, what they could do for themselves or where help was needed. The home does not provide intermediate care and as such standard 6 does not apply. Kirkdale Nursing Home DS0000000182.V363499.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): Standards assessed 7, 8, 9 and 10 People who use 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. Improvements are needed in respect of care planning to help to ensure that the needs of people that use the service are met. Medication administration and recording practices in the home are not robust enough to ensure that people will always receive their medicines accurately as prescribed. EVIDENCE: Three plans of care for people who use the service were examined at random on the first day of the inspection. Files examined contained a basic assessment of the person. Plans of care developed following the assessment contained limited information, an example being one person that uses the service was identified as needing help with attending to their personal hygiene. This plan of care did not include any personal preferences or describe the help that was needed. Another plan of care highlighted that a person that used the Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 12 service had lost weight. This plan of care had not been updated to include intervention and treatment prescribed by the GP or show that there had been any involvement from the dietician. Staff at the home had started to fill in a nutritional screening tool but had not completed this. The person had been recently weighed, but the plan of care had not been updated since February 2008. Moving and handling assessments were on file for people that use the service, however they were meaningless. Moving and handling assessments contained limited information and were worked out using a scoring system. Although assessments contained a score there was no written information to explain what the score given meant. Care plans examined were not evaluated on a monthly basis, nor did they include a baseline observation/evaluation of person’s limitations, abilities or assistance required. Files examined were not signed by the person who used the service, relative, carer or advocate to confirm that they had been involved in drawing up the plan of care. A discussion took place with the manager and general manager in respect of care plans examined. The manager acknowledged that care plans required further development and said that she would take immediate action to address the situation. On return to the home on 6th June 2008, the manager advised that an audit of all care plans of people that use the service had been carried out. The manager said that this audit had concentrated on bringing all of the information within the plan of care up to date and then once this had been achieved a further audit would be carried out concentrating on the quality of information contained within the plan of care to ensure that care plans are person centred. One relative spoken to during the visit raised concerns that his wife was going to be bathed by two male care staff until he said that this was unacceptable. This was pointed out to the manager on the first inspection day who advised that she would take immediate action to ensure that this would not happen again to any person using the service. She said that she would consult with people that use the service and their representatives to ask if they had any objections to a care staff member of the opposite sex providing personal care and ensure that a person using the service never receives personal care from two staff of the opposite sex. People who use the service, relatives spoken to during the inspection and surveys received said, Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 13 “I am very impressed with the home and staff” “We find that communication in the home is poor, for example when he/she was diagnosed with a chest infection and urine infection (on two separate occasions) we were only made aware of this when we attended meal times and medication was handed out” “Some of the staff are worth their weight in gold” “Staff do try to help” “The home has improved since the new manager has been appointed” All relatives spoken to during the visit referred to themselves as “We”, when asked what they meant by this all said that they are made to feel part of a family. The home’s system for ordering medicines includes a process for receiving a copy of the regular monthly prescriptions before the pharmacy supply is made. This is good practice as it enables the home to check for any medication changes or discrepancies with their order. Controlled drugs are stored securely and appropriate records are kept reflecting the usage of these medicines. However, some improvements in other medication processes are still required. Medication administration and recording practices in the home are not robust enough to ensure that people will always receive their medicines accurately as prescribed. The recording of the receipt, administration and disposal of medication is inconsistent. Working conditions for staff handling medicines is somewhat cramped and cluttered. Further training should be given to staff to update them about current professional best practice guidance. Regular checks should then be made to ensure all staff consistently follow the home’s updated medication procedures. Kirkdale Nursing Home DS0000000182.V363499.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): Standards assessed 12, 13, 14 and 15 People who use 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. Visitors are encouraged and made to feel welcome at anytime, however, the lack of activities and outings provided by the home does not help to ensure that people using the service are fulfilled. Improvements could be made to the food provided and mealtime of people using the service, which will help to ensure wellbeing. EVIDENCE: The home relies on care staff to plan and take part in activities when time permits. On the first day of the inspection the manager acknowledged that activities happened on an ad hoc basis as much of the care staff time was spent providing personal care. The deputy manager and manager advised that people using the service liked to listen to music, and when the weather was Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 15 good go out into the enclosed garden area. There have been no recent trips out for people that use the service. The deputy and manager of the home advised that they were aware of the need to improve on activities and outings provided. On return to the home on 6th June 2008 the manager advised that the provider of care was looking at the possibility of employing an activity co-ordinator who could devote their time and attention to planning activities with people that used the service. The manager had developed a plan of activities that included hand massages, sing a longs and individual time with those people who are unable to join in any activities due to their dementia. The home had also taken delivery of mobile sensory equipment, which can be therapeutic to some people with dementia. Although initial improvements have been made to providing a varied plan of activities the manager is aware that this needs to continue. The home shares a minibus with another home that is operated by the same provider, however the minibus has not been used over recent months. The manager said that she intends to make full use of the mini bus over the summer months and plan some trips out for people that use the service, relatives and representatives. The deputy manager said that people who use the service are encouraged and supported to practice their religion. Ministers from the local Church of England and Methodist church visit regularly as does a representative from the local Roman Catholic Church. Relatives spoken to during the inspection visits said that they were made to feel welcome and could visit at any time. One relative said, “I spend lots of time at the home and I feel welcome on each one of my visits”. On the first day of the visit the lunchtime of people using the service was observed. There are two dining areas, both of which have benefited from painting and new flooring since the last inspection. Tables were appropriately set and some people that use the service were observed to be enjoying their cold drinks from new, bright glasses that had been purchased. The lunchtime menu of the day was pork casserole with vegetables and creamed potato. Some people were having cheese sandwiches. The home has a two-week menu plan with alternatives of scrambled egg, sandwiches, baked beans, sausages, soup and hotdogs available at each mealtime. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 16 It was noticed that a lot of people using the service needed assistance at mealtime with a large number needing to be fed. Food was served from a hot trolley by the homes cook and put in front of the person using the service. Due to the large number of people needing feeding food was left for too long and would almost certainly be cold by the time it was given to the person using the service. The manager of the home was with the Inspector to witness that food was left for too long before being given to people. One relative spoken to during the visit said, “When I came in last week my wife hadn’t been given her tea, it was cold and still in front of her. I went to the kitchen and asked staff for some soup. My wife really enjoyed the soup”. Comments received from relatives spoken to during the visit and surveys were not favourable about the food provided. Comments made included, “With the exception of breakfast, the meals are quite bland. More fruit and vegetables would be better, smoothies for those who require their food to be soft” “Some of the food is alright but they keep putting what I called kids food on the menu like spaghetti hoops and beans. People want traditional corned beef stews and potatoes” “I would like to see more fruit and smoothies for those people on soft diets ” The manager said that bowls of fruit are available in lounge areas for people that use the service. On walking around the home fruit bowls were seen. Meals served to those people requiring soft/liquidized food did not look appetizing. Meat, vegetables and potatoes are all mixed together rather than providing separately. It was pointed out at the time of the visit that it was totally unacceptable that people using the service were receiving cold food and that immediate action must be taken to improve the situation. The Manager said that she was aware of the need for improvement in relation to menus, food provided and presentation, however only having been in post for a short period of time had not been able to address all areas as requiring improvement at the same time. The manager said that she is to meet with the cook and address all concerns. On the inspection visit to the home on 6th June 2008 the manager said that food is no longer left in front of people until staff are able to feed them, it is left in the hot trolley so that it does not go cold. The Inspector was informed at the last inspection that the lunchtime of people that use the service had been reviewed with an additional member of staff coming on at lunchtime to help feed those people who are unable to feed themselves. Staffing at lunchtime and the dependency of people that use the service must be reviewed again to ensure that there is sufficient staff on duty. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 17 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): Standards assessed 16 and 18 People who use 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 confident that their complaints would be listened to, taken seriously and acted upon. Adult protection procedures are in place, which helps to protect residents from abuse. EVIDENCE: The home has a complaint procedure, which informs people who use the service and relatives of their right to complain, timescales for action and who to contact. The home keeps a record of complaints. There has been one complaint made in the last twelve months. The home has an adult protection policy that details action that staff should take if abuse is suspected. The homes adult protection procedure needs to be updated to include new contact details for the Commission for Social Care Inspection at Newcastle. The training officer said that staff receive adult protection training on a regular basis, staff spoken to during the visit confirmed that this was the case. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 18 Staff spoken to during the visit were aware of action to take if abuse is suspected. There have been five adult protection referrals made in the last twelve months, all of which have been dealt appropriately by the home. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 19 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): Standards assessed 19 and 26 People who use 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 within the home is continually improving providing the people who live there with and attractive, homely and comfortable place to live. EVIDENCE: Kirkdale is a modern, purpose built facility. The home is single storey and 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. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 20 The Inspector walked around the home with the manager. Communal lounge areas were pleasantly decorated and homely, some of the furniture like tables and sideboards was looking a little shabby, however, the manager said that they were soon to be replaced. New flooring had been fitted to dining room areas which has made them look much more attractive. A number of bedrooms had been decorated and fitted with new carpets. The home had taken delivery of three new divan beds with more to be ordered over a period of time. The manager spoke of a refurbishment plan, which is to continue over the next twelve months this included decorating all communal areas, and bedrooms. Bathrooms in the home are also to benefit from an upgrade. On the inspection visit on 6th June 2008 curtain and bedding samples had been delivered to the home, the Manager said that it is the intention to upgrade all bedrooms with new curtains and bedding. The home also has a training suite, which is used by both staff working at the home and members of the public. It was identified at the last inspection that security arrangements needed to improve in respect of the main entrance of the home to help to ensure safety of people using the service. Since last inspection a keypad locking system has been fitted to the main internal door into the home. The manager said that only relatives who have been given the code can gain access other visitors would need to knock on the door. Screening has also been provided so that people using the training suite cannot look onto the main corridor area of the home. Externally there are surrounding grounds and a pleasant enclosed garden/seating area for people that use the service. The manager said that people that use the area need to be accompanied when they go outside, as there are some raised areas, which might cause people to fall. Car parking is available at the home. The home is on a bus route and close to Stockton town centre. The home has a policy in respect of control of infection. Staff spoken to during the inspection said that there was always a plentiful supply of protective clothing. On the day of the inspection the home was clean and odour free. It is evident following discussion with the homes housekeeper that he takes great pride in his work. Relatives spoken to during the visit all said how hard the housekeeper works to keep the home clean and tidy. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 21 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): Standards assessed 27, 28, 29 and 30 People who use 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. The homes recruitment procedure is robust which helps to ensure that people are protected. Insufficient staff at busy times and the large amount of agency staff being used could impact on safety and the care given to people that use the service. EVIDENCE: At the time of the inspection there were thirty-eight people living at the home, nineteen on Lavender unit and nineteen on Rosemary unit. On the first day of the inspection the Inspector looked at the home’s duty rota. The home’s duty rota showed that between the units there are seven care staff on a morning/afternoon, eight on an evening and three on night duty. In addition there are three people that use the service that require one to one staffing either all day or for some part of the day, additional staff are put on in for these people. Also on duty during the morning and afternoon are two trained nurses one of who is a Registered Mental Nurse. On an evening or night there is one trained nurse. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 22 In addition the manager of the home works full time, with four out of five days a week being supernumerary. The homes duty rota did not highlight which staff work on which unit, the manager said that she would take action to address and had done so by the visit to the service on 6th June 2008. Off duty rotas looked at during the inspection identified a high number of agency staff. An example being on one particular evening there were eleven staff on duty, the usual eight plus three additional staff for those people that have been assessed as needing one to one care. Of the eleven staff five were from an agency. The manager and general manager of the home said that they try to use the same agency staff to ensure continuity. The general manager said that the reason that they don’t recruit more staff is that the funding for one to ones could be taken away at any time. Relatives spoken to during the visit said, “On one occasion two agency staff did not know how to use the hoist and I had to go and get a regular member of staff” and, “We use a lot of agency, Saturday and Sunday is the worst days. Agency nurses just sit and do paperwork and as such other staff lack supervision”. On the first day of the inspection a detailed discussion took place with the manager and general manager regarding the high amount of agency usage and concerns that had been raised following discussion with relatives. The Manager and General Manager said that they would review the situation immediately, speak to Primary Care Trusts that fund the one to one of people that use the service to see if they could agree set time contracts for people that use the service. This would mean that they could recruit staff to the position, which would help to ensure continuity. As highlighted earlier in the report staffing numbers should be reviewed for busy times in the home an example being lunchtime. On return to the home on 6th June 2008, the amount of agency staff used and booked for future shifts had reduced however talks with the primary care trusts who fund the care were still to take place. The manager said that 52 of care staff working at the home have achieved a minimum qualification of NVQ level 2 in care. The home’s recruitment procedure is robust. The files of three newly appointed staff contained evidence to confirm that an appropriate Criminal Record Bureau checks are carried out before staff start working at the home. Files examined contained all of the required information including, proof of identity and two references. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 23 A discussion with the training officer identified that an induction training booklet has now been developed that meets with the required standards. The training officer said that on commencement of employment staff receive the required mandatory training and go on to do the induction booklet with their mentor. It was identified that there is no monitoring or record kept to ensure induction training is completed, the manager said that she would address this. The training officer keeps a training matrix that lists all staff, training they have completed and when they’re next training is due. Records were available to confirm that staff receive mandatory training on a regular basis and other training specific to the job that they do. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards assessed 31, 33, 35 and 38 People who use 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. Quality assurance monitoring systems are in place to help to ensure that the home is run in the best interest of people who use the service. The management of pocket money accounts for people that use the service are not robust and as such does not ensure protection of people that use the service and staff. EVIDENCE: A new manager has just started working at the home. The new manager is a Registered Mental Nurse who has many years of experience of working with people who have dementia and mental health problems. The manager of the Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 25 home has worked at Kirkdale previously. The Manager is aware of the need to apply to register with the Commission for Social Care Inspection. The home has quality assurance monitoring systems in place. Surveys are sent out to people that use the service and relatives on a yearly basis to see if they are happy with the home and care received. Meetings for people that use the service, relatives and representatives have taken place. The new manager said that she intends to set up an introductory meeting within the next few weeks. The Manager said that the trustees of the home visit on a monthly basis to carry out an audit of systems in place and to ensure that good practice is being followed. She said that the visit has not happened this month as they are allowing her some time to settle in. The home looks after small amounts of money for five people that use the service with the relatives of other people looking after their money. During the inspection the pocket money accounts of people that use the service were looked at. Money given to staff to purchase items was not always signed out by two staff and change from the purchase was not always returned quickly enough. This was pointed out at the time of the visit; the Manager said that with immediate effect she would take responsibility for monitoring peoples money. A random sample of health and safety records were examined. Records were examined to confirm that fire alarms and the electrical hard wiring had been serviced within the last year. The handyman said that he had chased up the service due on the fire extinguishers and that the homes gas boilers were going to be serviced on 12th June 2008. Water temperatures were taken on average every ten days, however tests of the fire alarm system were only taking place on average monthly. Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 26 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 2 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 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 27 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 OP3 Regulation 14 Requirement The Registered Person must ensure that assessments of people who use the service are sufficiently detailed to help to ensure that all needs are met. • Care plans require further development to ensure that they are individual to the person using the service. Care plans must include limitations, preferences and assistance required to meet the needs • Care plans must be evaluated on a monthly basis • Care plans must contain signatures to confirm that they have been drawn up with the person using the service or their representative • Moving and handling assessments of people that use the service must be clear to ensure safe practice Nutritional assessments/screening for those people using the service must be DS0000000182.V363499.R01.S.doc Timescale for action 30/07/08 2 OP7 14, 15 30/09/08 3 OP7 OP8 14, 15 20/05/08 Kirkdale Nursing Home Version 5.2 Page 28 4 OP10 OP14 12 5 OP9 13(2) 6 OP9 13(2) 18(1) carried out and reviewed on a regular basis to help to ensure the well being of the person using the service The Registered Person must 20/05/08 respect the privacy and dignity of people that use the service. The registered person must take into account the wishes and feelings of those people receiving care and where they are unable to make their wishes known consult with relatives or their representatives to ensure well being of the person using the service. All medication must be 06/07/08 administered as prescribed and a record must be made at the time it is given. Accurate records must be kept for the receipt, administration and disposal of all medicines including controlled drugs. A system must be in place to check expiry dates of medicines and medication with limited use once opened. These actions will help to make sure that people receive their medicines correctly and that medication is safe to administer. Additional medication training 06/09/08 and in-house assessment in line with best practice guidance must be provided to all staff involved in the administration of medicines. Having well trained competent staff helps to reduce the risk of medication errors. The Registered person must consult with people that use the service, relatives and their representatives and plan a varied programme of activities and outings to give opportunities for stimulation, which will help to ensure well being. DS0000000182.V363499.R01.S.doc 7 OP12 16 30/07/08 Kirkdale Nursing Home Version 5.2 Page 29 8 OP15 OP27 16, 18 9 OP27 18 10 OP31 8 11 OP38 23 The Registered Person must consult with people that use the service, relatives and their representatives and provide an appealing, balanced diet • The Registered Person must look at the dependency of people that use the service and need help at mealtime to determine if there are sufficient staff on duty The Registered Person must ensure that suitably qualified, competent and experienced staff are working at the care home in such numbers as are appropriate for the health and welfare of people that use the service. The Registered person must review the high number of agency staff used to ensure continuity of care provided The newly appointed Manager must apply to be Registered with the Commission for Social Care Inspection The Registered Person must ensure that tests of the fire alarm system are carried out on a regular basis to ensure safety of all. • 30/07/08 30/07/08 30/08/08 20/05/08 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 OP9 Good Practice Recommendations • The medicine policy and procedures should be updated in line with current best practice guidance DS0000000182.V363499.R01.S.doc Version 5.2 Page 30 Kirkdale Nursing Home so that staff understand how to handle and administer medicines safely. • Handwritten entries and changes to MAR charts should 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 the medication is given correctly. • 2 OP15 3 OP18 4 OP30 5 OP35 The Registered Person should ensure that liquified/soft meals are presented in a manner, which is appealing this will help to maintain the appetite and nutrition of the person using the service. The Registered Person should update the adult protection procedure with new contact details for the Commission for Social Care Inspection to ensure the smooth running of the referral process. A system should be developed to ensure that all induction training is completed. This will help to ensure that staff are appropriately trained to meet the needs of people using the service. The management of pocket money accounts for people that use the service should be more robust to help to ensure the protection of people that use the service and staff Kirkdale Nursing Home DS0000000182.V363499.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V363499.R01.S.doc Version 5.2 Page 32 - 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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