CARE HOMES FOR OLDER PEOPLE
Kirklands Care Home 2 Fairhaven Kirkby-in-Ashfield Nottinghamshire NG17 7FW Lead Inspector
Richard Ramsden Unannounced Inspection 18th January 2006 10:30 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 Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 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. Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kirklands Care Home Address 2 Fairhaven Kirkby-in-Ashfield Nottinghamshire NG17 7FW 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) 01623 723936 01623 723946 Nottinghamshire County Council Mrs Virginia Bullock Care Home 29 Category(ies) of Dementia (14), Dementia - over 65 years of age registration, with number (14), Old age, not falling within any other of places category (29), Physical disability (5) Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Out of the total number of beds (29) there will be 14 beds for DE 55 and over and/or DE(E) Out of the total number of beds (29) 5 may be used for PD 55 and over Service Users shall be within category OP (29) Date of last inspection 1st August 2005 Brief Description of the Service: This is a Local Authority older persons care home offering 29 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 Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One Inspector completed this unannounced inspection over one-day it took approximately 5 1/2 hours. It included the inspection of care and other records, a discussion with six residents, two visitors to the home, two members of staff and the registered manager. A partial tour of the building was also completed. What the service does well: What has improved since the last inspection? What they could do better:
Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 6 Residents care plans must be reviewed and where appropriate updated at least once each month. This will help to ensure that staff are always aware of what support and assistance each resident requires. The homes medication systems are generally well maintained but some minor improvements need to be made to ensure the health and safety of the residents. Restrictors must be fitted to the new double glazed windows; the window should not open more than 6 inches to ensure the resident’s safety and security. A lock must be provided to the laundry room door so that residents cannot gain access when there is no staff in situ. The laundry contains hazardous equipment and on occasions soiled or infected laundry and could present a health and safety risk to residents. A wooden ramp leading out of the building must be checked to ensure that it is safe. 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 Care Home DS0000036318.V274415.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 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 the following standard(s): 1,3,6. The literature supplied the prospective residents contains appropriate information. The home staff ensures that they can meet the needs of prospective service users by obtaining full written assessments prior to their admission to the home. Kirklands does not provide intermediate care. EVIDENCE: The literature supplied prospective residents, contains sufficient information to enable people to make an informed choice as to whether the home will be able to meet their individual needs. Three residents records were assessed as part of this inspection. A full written assessment had been obtained for each resident prior to his or her admission to the home. This enables staff to ensure that they can meet the prospective residents individual needs. The home does not provide intermediate care.
Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 7,8,9.10. Some resident’s care plans are not being reviewed and updated frequently enough to ensure that staff are always aware of what care and support each resident requires. Some improvements need to be made to the way in which the homes medication system is managed, to ensure the health and safety of the residents. Residents are treated with respect and their right to privacy is upheld. EVIDENCE: Three residents care plans were viewed, as part of this inspection, the care plans appeared to address the issues highlighted in the resident’s assessment process. Some of the residents did not have care plan review records, showing how frequently the care plans are reviewed and where necessary updated. The manager was advised that all care plans must be reviewed at least once a month and updated where necessary, to ensure that staff are always aware of what care and support each resident requires. Residents and where appropriate, their representatives should sign confirm that they have been involved in the review process. Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 10 The individual records show that peoples health care needs are being appropriately met. The residents and the relatives spoken with during the inspection stated that they believe that the staff make appropriate referrals where medical intervention is required. Two relatives confirmed that they are always informed when their parents are unwell. The homes medication systems are generally well maintained, medication is stored safely and all staff that administer medication have received appropriate training. Training records were checked at random. The homes controlled medication was checked and was well maintained. Several recently and admitted residents did not have a photograph attached to their medication Administration records. Photographs enable staff to ensure that they are administering medication to the correct resident’s and therefore it is particularly important that they are available when new residents are admitted to the home. As the medication storage trolleys are kept in the dining room throughout the day staff must record the temperature in this room and ensure that it does not exceed 25°C. The medication can deteriorate and become less effective if it is stored at a higher temperature. All of the residents spoken with during the inspection said that the staff are always friendly and respectful and that they ensure that their privacy and dignity is maintained at all times. This was also confirmed by the relatives who were spoken with during the inspection. One person said that she visits her mother every day and stated that the staff are exemplary. The observed interaction between staff and residents was of a very good standard. Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 13. Residents are encouraged to maintain contact with family and friends. EVIDENCE: All of residence spoken with confirmed that they can have visitors at any time and that their visitors are always made welcome. Two people said that they could use one of the first-floor lounges if they wish to see visitors in private but do not wish to use their bedrooms. The three visitors spoken with during the inspection stated that they can visit their relatives, at any time and confirmed that staff are always friendly and make them feel welcome in the home. Two people said that they are encouraged to see Kirklands as their mother’s home and treat it accordingly. (This is considered good practice). The manager could not locate a policy relating to visitors to the home, however a member of staff spoken with during the inspection was clear that she would always check who visitors are before allowing them access to the home. It is recommended that the written information provided to prospective residents and their representatives contain details of the homes policy on visitors.
Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 12 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 the following standard(s): X None of these standards were assessed as part of this inspection. EVIDENCE: Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 13 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 the following standard(s): 19,24,26. The premises are generally well maintained and comfortably furnished. However some issues need to be addressed to ensure peoples health and safety is protected. At the time of inspection the home was clean and there were no offensive odours. EVIDENCE: A partial tour of the premises was completed as part of this inspection. The accommodation is comfortably furnished and acceptably decorated. The residents spoken with during the inspection said that they are very satisfied with their bedrooms, they confirmed that there are encouraged to bring photographs, ornaments and small items of furniture to personalise their individual rooms. Staff have redecorated several areas of the home. (This is good practice).
Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 14 Residents and visitors confirmed that the home is always kept very clean and tidy. Following the last inspection requirements were made that some carpets must be replaced and that the vinyl floor covering on the staff only staircase be repaired. This work has been completed. New double glazed windows have recently been fitted throughout the home; while this is considered good practice, window restrictors must be fitted to ensure the safety of the residents and their personal belongings. A light has been fitted at the top of the stairs in the main entrance to the home. Anyone over 6 feet tall could potentially injure himself or herself on this light. Action must be taken to remove this hazard. The homes laundry is very compact but the wall and floor coverings are appropriate and the laundry is well equipped. A lock must be fitted to the laundry door to ensure that resident’s health and safety is not put at risk when there is no staff in situ. A ramp leading to the outside of the home was slippery and a health and safety audit completed in May 2005 stated that the wood underneath the ramp needed to be checked. This work has not been completed. Note The manager reported these issues for urgent repair, while the inspector was on the premises. Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X None of these issues are assessed as part of this inspection. EVIDENCE: Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32.38. Residents’ benefit from the ethos, leadership and management approach to the home. The health and safety and welfare of the residents are generally promoted and protected although fire drills must be completed on a more regular basis. EVIDENCE: The residents and relatives spoken with during the inspection stated that the manager is very approachable and that they believe if they had any issues or concerns she would deal with them appropriately. Two people confirmed that there are regular residents meetings and that people are encouraged to voice their opinions about the way in which the homes managed. (This is good practice). The last visit by the fire officer was on the 29th January 2005 the inspector was advised that there is no work out something from this inspection.
Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 17 The homes of Fire records have generally been well maintained the manager was reminded that fire drills must be completed at least twice a year and that all staff must attend at least one fire drill each year. The home has an appropriate Legionella risk assessment. The manager stated that all staff receives training in how to assist people with their mobility safely, as part of their induction course. People are not allowed to assist residents with their mobility until they have completed the training. The home has good risk assessments, which helped to ensure, safe working practices within the home. All staff are required to sign to confirm that they have read and understood these risk assessments. (This is good practice). 10 members of staff completed first aid training in 2005. The manager stated that she ensures that there is a member of staff who is qualified to provide first aid on duty at all times. Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 18 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X 3 X 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 4 X X X X X 3 Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement It is required that care plans are reviewed at least once each month and that evidence is provided that residents and where appropriate their representatives have been involved in the review process. It is required that: 1.All residents’ medication administration records have an appropriate photograph attached. 2.The temperature is checked and recorded in all areas of the home where medication is stored; the temperature must not exceed 25°C. It is required that: 1.Restrictors are fitted to all the new double glazed windows. The windows should not open more than 6 inches to ensure the resident’s safety and security. 2.The light at the top of the stairs in the main entrance hall must be altered so that it does not present a Health & Safety risk. Timescale for action 06/03/06 2. OP9 13 18/01/06 3. OP19 23 06/03/06 Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 20 4. OP19 23 It is required that: 1.The wooden ramp leading out of the building is checked to ensure it is safe for use. 2.A lock must be fitted to the laundry room door. This room must be kept locked when there is no staff in situ. 06/03/06 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 OP13 Good Practice Recommendations It is recommended that the literature supplied to prospective residents/their representatives contains information on the homes policy on visitors. Kirklands Care Home DS0000036318.V274415.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Nottingham Area Office 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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