CARE HOMES FOR OLDER PEOPLE
Kirklands 2 Fairhaven Kirkby in Ashfield Nottinghamshire NG17 7FW Lead Inspector
Jayne Hilton Unannounced 1 August 2005, 10.00am
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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 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. Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Kirklands Address 2 Fairhaven Kirkby in Ashfield Nottinghamshire NG17 7FW 01623 723963 01623 723946 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Nottinghamshire County Council Virginia Bullock Care Home 30 Category(ies) of Older People - 30 registration, with number of places Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 7/3/05 Brief Description of the Service: This is a Local Authority older persons’ care home offering 30 beds, with attached day centre facilities. The home is on two floors with vertical lift access to the first floor and all service users have single bedrooms. Grab rails and call alarms are sited around the home and there are assisted bathing facilities. The home is set within a secure enclosed garden and is sited in a residential area conveniently close to the town centre of Kirkby-in-Ashfield and close to public transport routes. Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 1st August 2005 at 10am by Regulation Inspector Jayne Hilton. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The methodology used at this inspection included a tour of the building, examination of records, including service user finances, three service users’ care plans and associated documentation, staff personal records, the accident book, fire safety records, complaints records, service contracts, training records and quality monitoring records. Fourteen service users were spoken with throughout the inspection. The registered manager and three staff were also spoken with. The overall outcomes for service users at Kirklands are extremely positive. What the service does well:
Service users have all of the information and required documentation they need in relation to the placement, and relatives and friends are welcomed to the home and invited to attend carer meetings. Twelve service users were able to confirm that their needs were being met, and praised the staff team highly. Service users wishes and preferences are clearly identified within the care plans, and service users informed the inspector that they can go to bed and get up when they want to, and have a say in all of their daily routines and lifestyle wherever possible. Staff training is clearly provided to a good level and there are good monitoring systems in place to ensure service users’ needs are met and that the input of care is of a good quality. Staff reported that the best thing in the home were the service users as they are a good bunch and that the staff team try to make Kirklands a happy place. In appearance and demeanour service users presented as well cared for. Service users unanimously reported that staff treat them with respect at all times. Service users expectations and preferences are met and they exercise control and choice over their lives and confirm they are happy with the food provision. Service users are very clear about how to make a complaint should they wish to do so and use their right to vote. From evidence gathered at the inspection service users are protected from abuse. Service users live in a generally safe, clean and well-maintained environment with adequate bathroom and toilet facilities, of which most are adapted for use by service users with a disability. Furniture and equipment meets required standards.
Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 6 Service users benefit from the ethos, leadership and management approach to the home, where their financial interests are safeguarded. Staff are well supervised and the record keeping is good. Staff spoke highly of the manager and team leaders, saying that there is an open door policy and that the home is very well managed. The manager was described as ‘brilliant’, ‘fair and speaks to staff in a proper manner’ ‘a good listener’, ‘nothing is too much trouble’ Staff are confident that the manager is knowledgeable and leads them appropriately.’ Staff described a strong and bonded team who work well together with support and mutual respect. The ratio of staff, who have achieved NVQ level 2 or above is now 52 , many are undertaking level’s 3 or 4 also. The team are commended for this. What has improved since the last inspection? What they could do better: 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.
Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1-5 Service users have all of the information and required documentation they need in relation to the placement. Relatives and friends are welcomed to the home and invited to attend carer meetings. EVIDENCE: Service users spoken with confirmed that they had all the information they needed about the home, and confirmed they had been issued with a service user guide and copy of the complaints procedures. Service user guides were evident in service users’ rooms. There was evidence of terms and conditions of residence, however, this was not signed by the service user and this is needed. Three service users’ files were examined and Extended Community Care assessments and the homes own assessment documents were seen. There was evidence of annual care reviews and a key-worker system is responsible for completion of three monthly summaries. Service users confirmed that they have visitors who are welcomed at any time and there appeared to be good liaison with relatives regarding contact, carers meetings and entertainment events in the home. Service users confirmed they could have visitors in private.
Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 9 Twelve service users were able to confirm that their needs were being met and praised the staff team highly. Service users wishes and preferences are clearly identified within the care plans, and service users informed the inspector that they can go to bed and get up when they want to, and have a say in all of their daily routines and lifestyle wherever possible. Staff training is clearly provided to a good level and there are good monitoring systems in place to ensure service users’ needs are met and that the input of care is of a good quality. Staff reported that the best thing in the home were the service users, as they are a good bunch, and that the staff team try to make Kirklands a happy place. In appearance and demeanour service users presented as well cared for. Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7-11 Service users are well aware of their care plans, and state that their needs are fully met, including personal and health care. Medication management is generally of a good standard, however staff need to ensure that the policies and procedures are followed on every occasion. Service users unanimously reported that staff treat them with respect at all times. Service users are assured that at the time of their death, staff will treat them and their family with respect. The registered provider needs to address NHS entitlements on behalf of some service users. EVIDENCE: The care plans for three service users were seen on this inspection. They all contained comprehensive information and instructions for staff, as to the level of need and actions required. The care plans are signed in agreement by either the Service User or their representative, and one of the Service Users spoken with said they had a copy in their bedrooms. Monthly reviews take place by team leaders on the electronic system but there was no evidence in the hard file that these had been carried out. It is recommended that the previous system be re-instated for this purpose.
Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 11 The inspector saw records to confirm that the service users health needs are monitored, and GP interventions sought for any health concerns. There was also evidence of other healthcare input including physiotherapy, optical and District Nurse visits. The requirements set at the previous inspection regarding risk assessments for manual handling, and for improvement to the pressure area risk assessment pro forma were identified as met. All service users confirmed that staff contact GP’s promptly if they are ill. There was evidence of risk assessments for falls, and incidents of falls are monitored and evaluated. Accident records were examined and found to be satisfactory. There was evidence that not all service user’s who should be receiving NHS entitlements, are doing so. The manager explained that there have been attempts to resolve this. The registered provider should now address this. Medication management was assessed and found to be generally satisfactory, however a medicines round was observed, and the staff member actually signed for the medication prior to visually observing the medication being taken, and this is not appropriate practice. It was reported that there are no service users self-medicating currently, but appropriate policies and procedures were seen in relation to all medicines management. Photographs and sample signatures of staff were seen and the records were satisfactory. It is recommended that the old service standards information sheets for homely remedies etc are removed and new policies in conjunction with the Royal Pharmaceutical Society’s Guidance are developed in relation to this. Staff were aware of the need to keep medication for seven days after the death of a service user. Service users confirmed that their privacy and dignity is promoted and maintained in every aspect. Staff were said to be kind and respectful. Service users’ comments included, “staff are great,” “it’s a pleasure to be here and they have taken away my worries” Policies were seen for dealing with service users who may be dying or after death. Appropriate information is gathered on admission wherever possible and documentation was seen in the care plan files examined. Staff spoken with [including the manager] demonstrated commitment to ensuring that any service user who is dying is sat with, and attended to in a sensitive and caring manner, with care charts in place, which include mouth care and constant monitoring. Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,14,15 Service users expectations and preferences are met and they exercise control and choice over their lives and confirm they are happy with the food provision. EVIDENCE: A full and varied activities programme is provided, and service users confirmed that they could choose whether to participate or not, and that trips out are arranged. A recent trip was arranged to Skegness. Staff appear to have lapsed in the documentation in recording participation of activities, which therefore does not reflect the true picture of reported efforts by staff to provide stimulation, and leisure time for service users, and this should be reinstated. Service users confirmed that they can make decisions about their daily routines, and this was evidenced in care plans and through observations made at the inspection. The quality and quantity of food was reported to be satisfactory, and the lunchtime meal of fish, chips and peas looked appetising and well presented. The manager reported that she had carried out some research work on nutrition, and that this area is yet to be developed. One service user said that on rare occasions the wait at the table to be served could sometimes be a long time. Weight records were maintained and staff were very clear about the need to monitor dietary intake, and how to raise any concerns identified. Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 Service users are very clear about how to make a complaint should they wish to do so and use their right to vote. Service users are protected from abuse. EVIDENCE: The inspector spoke with twelve of the Service Users about complaints and all were very clear about how they would raise any issues or concerns. None had made any recent complaints. No complaints had been received by the home since the last inspection. The complaints procedure was available on the notice board in the entrance to the home. Service users confirmed that they were able to use their vote at the recent election. Adult protection policies are in place and records and staff spoken with confirmed that all staff attend induction and training on abuse awareness. Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23, 24, 25, 26 Service users live in a generally safe, clean and well-maintained environment, with adequate bathroom and toilet facilities, of which most are adapted for use by service users with a disability. Furniture and equipment meets required standards, however some of the carpets are badly stained, emit mal odour and require replacement. EVIDENCE: The communal areas of the home including lounges, dining room, and reception areas were seen to be clean and well maintained. The décor and furnishings were in reasonable condition and there were no health and safety concerns seen at this time. The carpeting in the entrance hall, bar lounge and corridors to bedrooms are in need of replacement. There was a malodour observed, which was possibly due to the carpets being cleaned during the inspection and emitting the odour. The carpets in the identified areas were badly stained and normal cleaning processes are reported to be fruitless. The garden was observed to be safe and pleasant. There were sufficient toilets and bathing facilities, and these are fitted with grab rails and chairs throughout.
Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 15 One toilet is due to have the flooring replaced and is currently out of use. Grab rails and call alarms are sited throughout and a passenger lift, ramps and hoists were all observed in the home. Three service users’ rooms were examined and all had the appropriate furniture and equipment to meet the standard. Service users who can use or wish to have a key, do so, and this is risk assessed and documented in the care plan. Service users said they are encouraged to bring personal possessions to Kirklands, and bedrooms viewed during this unannounced inspection were personalised to suit the individual in residence in that room. Service users are individually encouraged to be as independent as possible and this is reflected in their plan of care. Radiator covers are being fitted throughout on a rolling programme. Service users expressed that new windows and blinds would improve the home. The manager reported that this work is to commence over the next twelve months and that new blinds/curtains will be purchased at this time. Window restrictors were observed throughout and systems for the prevention of legionella and safe water temperatures have been implemented. Apart from the issues with the carpets, the home was noted to be clean and hygienic. The ‘staff use only’ staircase was noted to have lifting vinyl to the steps, which the manager reported to be with the supplying contractor for rectifying. The fire safety records and equipment servicing was satisfactory, however there was no evidence of electric circuit testing [ 5 yearly hard wiring check] or of an annual gas safety certificate. These will need to be located and copies sent to CSCI. Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Service users’ needs are met by, adequate staffing numbers, staff who are well trained, competent and who are recruited appropriately. EVIDENCE: Standard 27 was not assessed at this inspection as it was fully assessed at the last visit and found to be met. Service users and staff did however make comments that there was sometimes a problem with staffing numbers due to short notice sickness and holidays. On further discussions it was apparent that the number of staff in the afternoon to care for twenty-seven service users had on occasions dropped to three. This calculates to one staff member to nine service users which although is acceptable on rare occasions is clearly not sustainable for regular periods. The manager confirmed that there had been some unavoidable issues with long-term staff sickness, and that two relief staff have recently been recruited. The ratio of staff who have achieved NVQ level 2 or above is now 52 , many are undertaking level 3 or 4 also. The team are commended for this. Recruitment practices were satisfactory. Three staff personal files were examined. Through the examination of training records, discussion with staff and the manager the inspector was able to identify that the level of training provided is good. Excellent records are kept by the manager in relation to this. Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35, 36, 37 Service users benefit from the ethos, leadership and management approach to the home, where their financial interests are safeguarded. Staff are well supervised and the record keeping is good. EVIDENCE: Staff spoke highly of the manager and team leaders, saying that there is an open door policy and that the home is very well managed. The manager was described as ‘brilliant’, ‘fair and speaks to staff in a proper manner’ ‘a good listener’, ‘nothing is too much trouble’. Staff are confident that the manager is knowledgeable and leads them appropriately.’ Staff described a strong and bonded team who work well together with support and mutual respect. A variety of staff meetings are held, and minutes of these were seen. Quality monitoring systems are in place with service user surveys and feedback in service user meetings being evident.
Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 18 The local authority and home business plans were examined alongside appropriate insurance policies and Regulation 26 reports. Evidence was seen of staff supervision records and staff spoken with confirmed this was in place. A sample of service users small cash amount records were examined and found to be satisfactory. All records examined were also satisfactory. There is documentation on file to support the conclusion that approved contractors regularly service equipment throughout the Home. Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 4 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x 4 3 3 3 3 3 x Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? 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. 2. 3. Standard OP9 OP19 OP19 Regulation 12 23 23 Requirement Medication must be signed for only, after being visualy observed as taken. Replace the carpets as identified. Ensure the lifting Vinyl on the staff only staircase is rectified. Timescale for action 1/10/05 1/12/05 1/11/05 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. 2. 3. 4. 5. 6. Refer to Standard OP2 OP7 OP8 OP9 OP12 OP19 Good Practice Recommendations Evidence of service users signatures should be obtained in relation to the terms and conditions/contract documents. Re-instate the monthly review record sheet for the hard copy of care plans. Ensure service users receive their NHS entitlements in relation to Chiropody and Inco aids. Review the medication policies in relation to homely remedies and remove any oudated information from the medication file. Re-instate the participation records for activities. There was no evidence of electric circuit testing [ 5 yearly hard wiring check] or of an annual gas safety certificate. These will need to be located and copies sent to CSCI. Kirklands C02 C53 S36318 Kirklands V235644 010805 Stage 2.doc Version 1.40 Page 21 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham, NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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