Inspection on 25/02/09 for Kirklands

This inspection was carried out on 25th February 2009.

CSCI found this care home to be providing an Adequate 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kirklands 04/06/09

Kirklands 04/03/08

Kirklands 07/03/07

Kirklands 23/03/06

Kirklands 28/06/05

Kirklands 14/03/05

Kirklands 09/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Clover House

Langrigg House

Parkside

Dystlegh Grange

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kirklands Sullart Street Cockermouth Cumbria CA13 0EE     The quality rating for this care home is:   one star adequate 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: Diane Jinks     Date: 2 5 0 2 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: Kirklands Sullart Street Cockermouth Cumbria CA13 0EE 01900822364 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Anchor Trust Name of registered manager (if applicable) Mrs Maureen MacColl Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The home is registered for a maximum of 40 service users to include: - up to 29 service users in the category of DE(E) (Dementia over 65 years of age) - up to 7 service users in the category of OP (Older people not falling within any other category The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Two named service users in the category of MD(E) (Mental disorder, excluding learning disability or dementia over 65 years of age) may be accommodated within the overall number of registered places Two service users in the category of LD(E) (Learning disability over 65 years of age) may be accommodatd within the overall number of registered place Care Homes for Older People Page 4 of 31 care home 40 Over 65 29 2 2 7 0 0 0 0 Date of last inspection Brief description of the care home Kirklands is a modern, purpose built home situated in a residential area of Cockermouth. It is within walking distance of all the local amenities in the town centre. The home is operated by the Anchor Trust and managed by Mrs. Maureen MacColl. The home provides accommodation and care for up to forty older people, thirty of who may have dementia. The accommodation is on two floors, and is divided into four living units. Each unit has a lounge/dining room, with bedrooms, toilets and bathrooms close by. The home has a passenger lift and a range of other equipment to assist people in their day-to day-lives. There are garden areas that are provided with safe and secure seating areas. There is a car park to the front of the home. 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: one star adequate 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 inspection of this service took place over several months. Over a period of time we have monitored the information the home has sent to us as required, including their plan for making improvements to the service. As part of this inspection we made a visit to the home. We spent seven hours there and during this time we spoke to some of the people that live at Kirklands, some of their visitors and some of the staff that were on duty, including the manager. We also sent surveys to some of the people that live at Kirklands and to some of the staff that work there. This helped us to understand the views of people living and working at the home. We looked at a selection of records relating to the care of people that use this service, staff recruitment and training and the general organisation of the home. Care Homes for Older People Page 6 of 31 The manager completed an Annual Quality Assurance Assessment (AQAA), which gave us some information about the service and helped us to organise our inspection process. During our visit to the home the manager gave us all of the information and documents we asked to see. The manager and staff were very open with us and worked well with us during our visit to Kirklands. What the care home does well: What has improved since the last inspection? What they could do better: We discussed the care plans with the manager during our visit. The gaps we identified may result in people not receiving the care they need. Some staff also told us that sometimes they find that peoples needs have changed by chance rather than being properly informed. We found that staff are supervised in their work, but this is not always as frequently as it should be. The manager has told us about the improvements Care Homes for Older People Page 8 of 31 she intends to make regarding staff supervision, including training for supervisors to help ensure staff supervision is effective. There are some areas of the home that have an unpleasant odour, particularly on the ground floor and in some of the bathrooms. We told the manager of our concerns about this matter as it needs urgent attention. We also identified some concerns regarding medication, and again we spoke to the manager and staff about them. There are special arrangements in place for one person who lives at the home, regarding the administration of their medication. These arrangements are not fully documented and the manager needs to attend to this quickly. The manager has identified areas in the AQAA where she intends to make further improvements. One particular area is in relation to staff training and updates regarding health and safety and related topics. 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 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 10 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. People using this service have access to a variety of information and support to help them make their decisions about moving into Kirklands. Evidence: The home produces information for people who are considering moving into Kirklands. There is a Statement of Purpose and a Service User Guide. These documents are reviewed and kept up to date by the service and provide detailed information about the home and the type of services it can provide. This information helps people with their decisions when considering Kirklands as a home. The manager told us that the information is available in a variety of formats to help people who may have special communication needs. There is a process at the home to help make sure that people are admitted to the home in a planned way. People are able to visit the home and meet some of the people that live and work at Kirklands. The manager ensures that she has a detailed Care Homes for Older People Page 11 of 31 Evidence: assessment of their care and support needs. Copies of these assessments are obtained from the social worker and the manager, but the manager also carries one out. These help the manager to ensure that Kirklands will be a suitable place for the person to live and that it will be able to meet their needs and expectations. People are able to enter the home for a trial period of six weeks, this is followed by a review of their experiences and care needs and helps ensure people are happy with their choice of home. Some of the people that live at Kirklands told us that they had enough information about the home to help them make their decision to move there. Copies of the Service User Guide are placed in each persons own room for future reference and information. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service usually receive the care and support they need, when they need it. There are some gaps in the recording systems which may, at times place people at risk of not receiving the support they need. Evidence: During our visit to this service we looked at a sample of the care records and care plans for four of the people that live at Kirklands. We found that the manager has made some improvements to the content and quality of information contained in these records. This helps to ensure that staff working in the home are aware of the things that people need support with and of the things that they can do for themselves, which also helps to promote and maintain independence. The manager and staff at Kirklands start to develop an individual plan of care as soon as someone arrives at the home. Care plans are initially based on the information obtained during the pre-admission assessment of peoples needs and are added to or changed after further assessment and consultation with the resident and their family, if appropriate. We found that care plans are generally reviewed frequently, at least Care Homes for Older People Page 13 of 31 Evidence: every month or when a persons needs change. However, two of the records we looked at belonged to people who have recently returned to the home after a spell in hospital. We found that some aspects of their care plans have not been updated and do not accurately reflect their current care and support requirements. This means that staff may make assumptions about their support needs and places people at some risk of not having their needs met in the most appropriate way. The plans cover various aspects of individual daily needs and support requirements, including personal care, mobility, nutrition, medication and social and leisure interests. Nutritional assessments include information about the likes and dislikes of the person, whether they need any special aids or adaptations to help maintain their independence with eating and drinking or if there are any special dietary needs. Mobility assessments include an element of risk assessment and show that people are encouraged to remain mobile and independent as much as possible, using mobility aids where appropriate or with extra help from staff. We spoke to some of the people that live at Kirklands. They told us that staff are usually available when they need them and that they are very kind and helpful. One person said, I get looked after very well. I only need to ask staff for anything and they get it or help me. This person was very well presented with styled hair, painted nails and her jewellery on. People told us that they are able to see the doctor when they request this, some people have their own telephone and are able to call the doctor themselves. The records, daily notes and contact sheets confirm that people using this service have access to a wide variety of other health care professionals such as community nurses, chiropodist and opticians. During our visit to Kirklands, we observed staff working with some of the people that live at the home. They were patient and helped people to make choices about a variety of things, suggesting alternatives where required. We saw some of the staff making time to sit and chat with some of the people that live at the home. We also looked at the way in which medications are managed at the home and we looked at a sample of the medication records. There is a policy and procedure in place and staff with the responsibility for the administration of medication are provided with training. These measures help ensure that people using this service are supported with their medications safely. We looked at the arrangements in place at the home for the storage of medication. The home has suitable, secure storage including the arrangements for storing medicines that require refrigeration or for medicines that can be liable to mis-use (controlled drugs). There are special arrangements in place regarding one of the people that live at Kirklands. Their records provide some information about how and why these arrangements are in place and involved consultation with social workers and health care professionals. There are some gaps in the information available at the home, for example in the risk assessment and the capacity assessment. We discussed this with Care Homes for Older People Page 14 of 31 Evidence: the manager during our visit as this is an area that requires urgent attention, including consultation with their pharmacist to help ensure that both residents and staff are protected and safe. When we arrived at the home, the morning medication was in the process of being administered. This task took the team leader a considerable length of time to complete. We spoke to the team leader, who confirmed that the medication round takes a long time. We were concerned that people may not always receive their medication with the correct time span between each dose. The records for medication that is regularly prescribed do not record the actual time of administration, although all other areas of the records were completed and signed. The member of staff explained the routine for trying to ensure that medication is given as the doctor intended. The administration of medication process would benefit from a review to help ensure that people receive their medicines as prescribed and with the correct time span between each dose. The administration of medicines that are for as and when required such as Paracetamol for a headache, are recorded on the medication record sheet together with the date, time of administration, amount given, signature and the outcome noted. Community nurses visit each day to administer insulin injections where necessary and there is a process in place to help ensure that people receiving anti-coagulant therapy receive this treatment safely. Where the doctor has discontinued medications, record charts have been amended and signed by the doctor. Some of the people that live at Kirklands are prescribed creams for skin conditions. This type of medicine is kept safely in the persons own room, together with a record chart and instructions for staff to follow to help ensure the creams are used as intended and safely. Others may have difficulties with swallowing and where this is the case, liquid medicines have been obtained. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The chef is aware of all dietary needs and requirements of people using this service. This means that people living at Kirklands are provided with wholesome and nutritious food that helps maintain their health and well-being. Evidence: The home employs three people to plan and deliver social activities for the people that live at Kirklands. The home has developed strong links with a local school. Some of the pupils visit regularly and help with activities or provide musical events. When we spoke to some of the people that live at the home, they gave us examples of activities that are available to them. The home holds a monthly church service, which people may choose to attend. There are games available and we saw that many of the ladies at the home were busy knitting squares for blankets. One person we spoke to told us that she has the talking book service, she has recently moved to the home and is waiting for an extra socket to be put in her room so that she can use this system. People told us about the activities lady and that she tries to get people doing things. Two ladies had had manicures and their nails painted, done by the staff. One person we spoke to was looking forward to having her bath. She said she enjoyed bathing very much. She told us that the staff were very kind and helpful and had no complaints. She was Care Homes for Older People Page 16 of 31 Evidence: very well presented, her hair had been done she wore jewellery and looked very well cared for and nice. She had just finished a lovely lunch of roast pork, she told us that the food was very good. Another person told us that his lunch had been very good enjoyed it. He told us the food is good and the staff are OK. Another lady was very hard of hearing and couldnt hear the questions asked of her but she said; I am very satisfied, you will have to take my word for it! She was busy knitting. Another person told us that they didnt like the home when they first moved in but has settled now. Staff are very nice and helpful. The records we looked at record peoples individual interests, hobbies, likes and dislikes. People are able and encouraged to make choices about their daily life and lifestyle and these wishes and choices are respected by staff. Life histories have been completed in some cases, to help find out about people and their interests. The home has started to produce a Newsletter. This contains information about forthcoming events, reports on past entertainments and includes articles written by staff and residents. The Newsletter is made available to visitors to the home as well as the people that live there. Although there are activities available, the manager recognises and has told us that the home could do better by improving individual activity sessions for those with higher needs or unable to function in larger groups. People living at the home are able to see visitors when they like. They may see them in the privacy of their own room or in one of the communal areas, as they choose. We noted that staff made time to come and sit with people and chatted to them. They helped people to the seat of their choice and asked them if they wanted to watch television or sit with a particular group of people. We saw that people were able to get up and have their breakfast when they chose and staff were on hand to help them and assist where required. We observed the service of the lunchtime meal. People were offered a choice of two main courses. The chef shows people samples of plated meals to help them make their choice. People were asked if they wanted an apron to protect their clothes from spills and were assisted to eat and drink by staff where necessary. This was done sensitively and staff sat at the table with the people they were supporting. We spoke to the chef about the meals served, particularly the arrangements for people who need to eat a soft or pureed meal. The chef showed us samples of pureed meals. They were presented very well with each food item individually pureed (roast pork, potatoes, and vegetables) and set out on the plate with apple sauce and gravy. Meals are freshly cooked, including the pureed alternatives. The chef said that she is told about any special dietary requirements and takes these into consideration when planning and preparing meals. The chef is told when people need fortified meals and extra cream, Pro-Cal and full fat milk are used. Where people need fluids thickened to aid swallowing, instructions for the use of thickeners are recorded to help ensure they are used as directed and safely. There are always at least two choices of main course and dessert at each meal. If people dont want what is offered they are able to choose something else. Menus are on display throughout the home for the whole week. They show the choices available and include Care Homes for Older People Page 17 of 31 Evidence: a wide variety of fresh fruit and vegetables. Care Homes for Older People Page 18 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 using this service are confident that their comments and concerns are listened to and acted upon appropriately by staff. This helps to ensure that people are supported and protected from the risks of abuse. Evidence: There is a complaint process in place at the home. The people who returned surveys to us told us that they know about the process and that they know who to raise their concerns with. They told us that staff always listen and act on what is said to them. The manager told us about the complaints that she has received since our last visit to Kirklands. We looked at the records in relation to complaints. The details are recorded and include details of the action that has been taken to ensure a satisfactory outcome for the person raising the complaint or concern. People living at Kirklands are able to raise any issues on a daily basis with the staff or manager at the home. The manager tries to deal with these matters as they occur, she told us that she is trying to develop a process for recording and monitoring these small complaints to help make further improvements to the service. The home also has a process to help ensure people using this service are protected from harm or abuse. Staff are provided with training to help them recognise the signs and types of abuse. Most of the staff at the home have undertaken this training. Staff told us that they know what to do and who to tell if they suspect a resident has suffered abuse. Where allegations or issues have been raised, the manager has Care Homes for Older People Page 19 of 31 Evidence: involved the social worker at an early stage and informed us of her concerns. We spoke briefly to one of the social care professionals who visits the home on a regular basis. She told us, this is a good home. I am very pleased with the service that Kirklands provides. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally provides a warm, safe and comfortable environment for the people that live there. There are times when the home does not smell fresh and clean, resulting in an unpleasant environment for some of the people that live there. Evidence: The home is generally maintained to a good standard. Communal sitting rooms and dining rooms are bright and comfortably furnished, providing a warm and homely environment for the people that live at Kirklands. Everyone has their own private bedroom (flat) and are able to lock their doors if they wish. People using this service are able to personalise their own rooms with ornaments, pictures and small items of furniture from their own home. All of the flats have ensuite toilet and wash basin facilities and all are equipped with grab rails, to aid people to mobilise independently and emergency call bells so that staff can be summoned quickly if people need help. There are various colour schemes and colour themes running throughout the home to help orientate some of the people that live at the home. Hand rails, mobility equipment, aids and adaptations are available throughout the home to help people move around safely and as independently as possible. There are communal bathrooms and toilets throughout the home. Some of these are locked from the outside. The manager told us that local environmental health officers had requested these to help protect the health and safety of people living at Kirklands. Care Homes for Older People Page 21 of 31 Evidence: We looked at the bathrooms and toilets at the home, they are clean and tidy but there is a musty odour in some of them. These areas are equipped with soap, paper towels and extractor fans as well as grab rails and emergency call bells. There are assisted baths and a walk in shower available to people that use this service. These facilities help to maintain independence. One of the bathrooms has recently been refurbished. Although the home was generally clean and tidy, the ground floor suffers from some unpleasant odours. The manager said that there are processes in place to help combat odours and that carpets have recently been deep cleaned. She recognises that the home does struggle with the problem. We spoke to one of the housekeepers at the home. She told us that they are provided with sufficient cleaning materials and equipment and try to keep on top of odours but they do come back and carpets are regularly cleaned and sprayed. There are systems in place for people living at Kirklands, who wish to smoke. The manager has checked that the arrangements comply with legislation and has included other information in the homes fire risk assessment. The kitchen at the home is maintained in a clean, tidy and well organised manner. People working in the kitchen are aware of food hygiene and infection control procedures. Staff are provided with protective clothing such as aprons and gloves when necessary. The housekeeper we spoke to told us of the training she has been provided with at Kirklands. It includes - health and safety and infection control. 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. People using this service are supported by suitable staff that receive training to help them understand their needs and conditions. Evidence: A variety of staff are employed at the home - night and day carers, housekeepers and kitchen staff plus a maintenance person and all are included in the training programme. We looked at a sample of the staff training and recruitment records and spoke to some of the staff that work at Kirklands. Six members of staff returned surveys to us and made comments about the home and their work. There is a staff rota in place to help ensure that there are sufficient numbers of staff on duty at all times. During our visit to Kirklands, we noted that there appeared to be a sufficient number of staff on duty to support and meet the needs of the people that live at the home. Some of the people that use this service told us that there are usually enough staff available when they need them. Some of the staff said that there are usually enough staff on duty. One person told us, Usually staffing is fine but problems can arise due to holidays or sickness. Everything is done to make sure shifts are covered. The manager told us that there is a robust staff recruitment process in place at the home and that staff are provided with training to help them understand and meet the needs of people using this service. The recruitment records we looked at show that Care Homes for Older People Page 23 of 31 Evidence: prospective staff undergo thorough checks regarding their suitability to work at Kirklands. They are required to complete application forms, attend for interview and undergo checks such as criminal record bureau (CRB) checks and protection of vulnerable adults checks (POVA). References are sought from previous employers and the manager ensures that identity checks are carried out. Staff at the home are required to attend suitable training to help them carry out their job safely and help them understand the different needs of the people they care for and support. The manager told us that all staff have completed training to help them understand the needs of people who may have dementia. Some of them have completed further in-depth training with regard to this subject. New staff are provided with induction training, which includes a general introduction to their job role and the home. Further induction training is also undertaken, this training meets the requirements of national training organisations. The home has a programme in place to help staff gain National Vocational Qualifications (NVQs), including access to their own assessors and verifiers. Over half the staff at the home have gained this type of qualification at level 2 or above. Staff records show that they have attended training in health and safety, manual handling and some staff have attended specialist training to help them understand and support people who may have difficulties with swallowing. The manager also told us that many staff have attended a dining with dignity training course to help them support people who may need help with eating and drinking. We observed some staff working with people during meal times. Staff were very patient, offered people choices and where support was required, this was provided in a sensitive and dignified way. Catering staff and housekeeping staff told us that they have been provided with relevant training including food hygiene and safety, infection control and NVQs. One member of staff told us, I feel we have a good understanding or residents with mental health problems and the stages of dementia. We give good care to all our residents 24 hours a day. The manager has told us about areas where improvements are still needed and the plans for how these improvements will be addressed. We noted that some improvements have been made to the way in which staff training is recorded. There are some gaps in these records and further work could be done to ensure that all training courses are consistently and accurately documented. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed in the best interests of the people that use the service and by a competent and experienced manager. This helps to make sure that people live in an environment that meets their needs in safety. Evidence: The registered manager of Kirklands is suitably qualified and holds management qualifications and qualifications to help her understand and manage the specialist needs of people who may have dementia illnesses. She has many years experience of managing care services. The manager is supported in her role by the Anchor Homes organisation and by a deputy manager and team leaders within Kirklands. We discussed quality assurance with the manager. She told us that she has sent questionnaires out and had a really good response from relatives in particular. People have told her that they did not want organised meetings, they want to know about activities and events at the home. Some people made suggestions that the home Care Homes for Older People Page 25 of 31 Evidence: might provide a relatives room and this is in the process of being organised. The manager told us that the surveys provided the home with good feedback and ideas to act on. As part of this the manager has started to produce a newsletter with up to date information about the home and activities planned. Where people need support with their personal finances, a signed agreement is obtained. Clear records of personal monies that are held by Kirklands are kept. Individual accounts show any money coming into and out of accounts and receipts are kept for purchases. Reasons for any expenditure are recorded and two signatures are recorded for each transaction. We saw evidence to confirm that staff are supervised in their work and meet with their line manager. The records we saw do not indicate that staff supervision takes place as frequently as it should and this is an area where the manager could make further improvements. The manager has told us that she is aware of the senior team requiring training, which will help to make staff supervision more effective. However, some staff did tell us that they meet with their manager. One person said, management are very supportive if I have any concerns or worries they always find time to discuss these. Another person told us, if I had something important I needed to discuss with the manager, I could arrange a meeting with her. The manager has ensured that there is a fire risk assessment in place at the home and this is reviewed at least annually. Additionally there is a fire safety plan in place and in residents care plans there is a plan for their safety and needs in the event of fire evacuation. Records indicate that fire alarms are checked weekly from different points in the home and that monthly fire safety checks are carried. The manager has told us that the emergency lighting and fire alarm system are serviced by contractors regularly as are the central heating system, passenger lift and hoists. We looked at the accident book kept at the home during our visit. It has been completed as necessary and accurately. Accident reports are filed in peoples own records where applicable and the manager notifies us of any adverse incidents. Some staff have undertaken food safety training and first aid training. The records show that staff undertake manual handling training and some health and safety training, including the ancillary staff. The manager indicated in the AQAA that there are no staff who have completed infection control training. Although we did not see any evidence of this type of training on the staff records we looked at, the subject is covered briefly during induction training, some staff told us that they had received this type of training and the manager added that this training is covered in the health and safety training course. The manager has told us that health and safety related training updates could be better organised and has also identified some gaps in the risk assessment processes in place at the home. She told us that she has provided some staff update training days and will continue to build up the skills of the senior team over the next year. Care Homes for Older People Page 26 of 31 Care Homes for Older People Page 27 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 36 18 All staff working at the home 30/04/2008 must receive formal supervision at least six times a year. (Previous timescale of 30/04/07 not met). Care Homes for Older People Page 28 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 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 Care plans must be reviewed 31/03/2009 and updated, particularly where people have returned to the home from hospital. Care plans must clearly reflect the current care and support needs of people using this service. Changing needs and current objectives for health and care support must be recorded and actioned appropriately. This will help to ensure that people receive the care and support they require. 2 36 18 Staff must receive formal 30/04/2009 supervision at least six times per year. Managers and supervisors should receive training in supervisory skills and undertaking performance appraisals. Regular and structured supervision of staff helps to ensure that they are Care Homes for Older People Page 29 of 31 working safely and following the policies and procedures of the organisation. Supervision also helps to identify any gaps in skills and training needs. Skilled supervisors helps ensure that staff supervision is effective. 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 9 Where special arrangements are requested for the administration of medication, there should be clear and detailed care plans and risk assessments in place, and the professional advice of the pharmacist should be sought. This will help ensure that current medications and medications that are prescribed in the future, are managed, administered and disposed of safely. The administration of medication process would benefit from a review to help ensure that people receive their medicines as prescribed and with the correct time span between each dose. Suitable arrangements should be in place to ensure that all parts of the home are free from offensive and unpleasant odours. Staff working at the home should receive health and safety training and updates covering topics appropriate to the work they are to perform. This will help ensure the safety of people living and working at Kirklands. 2 9 3 26 4 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. 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