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Inspection on 01/12/08 for Kirksanton Care Centre

Also see our care home review for Kirksanton Care Centre for more information

This inspection was carried out on 1st December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

We spoke to a number of people and their visitors on the day who were happy with the way things are in the home. Several Social workers were happy with the care given to their clients. One relative said how happy she was as her relative: "Is very settled and calm. The staff are kind to him and always make me welcome when I visit." People told us they were happy with the quality of food provided. "We are well fed here ...it is good home cooking...". The company has a good complaints procedure and suitable procedures in place to protect people from harm. The home is situated in a rural location and residents were happy with their environment. Furniture and fittings are of a good standard and decoration continues to be upgraded. The home has enough staff on each shift to make sure people`s needs are attended to. The manager only takes on new staff after she has made sure they are suitable to care for vulnerable adults. Almost three quarters of the staff team are qualified in NVQ in care. Staff receive suitable basic training. The staff team deal with health and safety issues in an appropriate way.

What has improved since the last inspection?

We judged that the manager had been careful about assessing prospective new admissions and was taking advice about making sure she only took people who she was sure could be cared for in the home. The home has made some improvements to the information they keep on care and we could see that staff had put a lot of work into some people`s files. The home has improved the way they account for medicines month by month and this means they can keep a better tally of the medicines in the home. We were pleased to see that the home has a new activities organiser and that she has introduced some new activities. Several people were very pleased with the fortnightly swimming that she had organised. The company have adressed some problems with the building that we noticed at the last inspection. The manager has taken on a number of new staff and promoted others. She continues to recruit new staff so that people will get good levels of care and services. The staff have received training in a range of subjects and more training is planned for the new year.The company have appointed a manager and she is in the process of applying to be registered with the Commission for Social Care Inspection. Residents now have savings accounts in their own names. All the staff have now had updates to their training in manual handling. The company have not yet provided us with a business plan but they have kept us informed of what is happening in the service and have sent us action plans about developments.

What the care home could do better:

The home needs to review and edit the Statement of Purpose and Service User Guide so that they are clear about the care and services they can provide. Staff need to make sure that anything they write in care plans is actually happening and that each plan reflects the needs and rights of the individual. The manager needs to make sure that staff record medical advice sought and medicines given in as much detail as possible so they can prove that people always receive the highest levels of care. The manager needs to review her medication ordering systems so that medicines are always available. There had been allegations made about staff attitude and approach and this was dealt with by Social Services and by the company. We want Guardian Care to continue to help all staff develop and improve their practice though staff development, supervision and training. The service needs to keep on developing suitable leisure, recreational, cultural, social and educational activities. We judged that although there are activities available they do not always reflect people`s age, ability, background and culture. The manager needs to make sure that people are sure about how to complain and that all staff understand that any concerns residents have need to be acted upon. She also needs to make sure every staff member is really confident that they can recognise what is abusive and they know how to report anything of this nature as some staff were a little unsure. Some areas of the building were not as warm or as tidy and clean as they could have been on the day of the inspection and we want the manager to make sure that people are always comfortable in the home. The company need to keep on developing and supporting the manager and the newly appointed deputy as they need to widen their knowledge of the mental health needs of people in the home and update their practice. They also need to extend their knowledge and skills in managing and developing staff teams.The manager had done some monitoring of quality in the home but now needs to work on plans for how to develop and improve care and services.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kirksanton Care Centre Kirksanton Care Centre Kirksanton Millom Cumbria LA18 4NN     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: Nancy Saich     Date: 0 1 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 33 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Kirksanton Care Centre Kirksanton Care Centre Kirksanton Millom Cumbria LA18 4NN 01229772868 01229774015 enquiries@guardian-care.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Guardian Care Homes (UK) Limited Type of registration: Number of places registered: care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP, (maximum number of places: 25) Dementia Code DE The maximum number of people who can be accommodated is: 45 Date of last inspection Brief description of the care home Kirksanton Care Centre is owned by Guardian Care Homes. This company own other residential and nursing homes in England. The home has three distinct areas. The original house has been renovated to accommodate up to 10 people who have dementia. This part of the building is known as The Croft. Not all of these bedrooms have ensuite facilities but all have bathrooms near to the bedrooms. This area has two Care Homes for Older People Page 4 of 33 45 0 Over 65 0 25 Brief description of the care home lounges for shared use. The home also has a more modern annex built on to the original building where up to 25 older people -- who may or may not have dementia -are accommodated. This area has a large lounge and a dining room. Some rooms in this part of the building have ensuite bathrooms, others have washbasins only. The Mews building is connected to this central part of the home. Younger people with a diagnosis of alcohol related dementia (Korsakoffs syndrome) live in this Mews building. The Mews is set out as self-contained apartments with their own lounge/kitchen, bedroom and bathroom. There is a lounge where people may smoke and a small kitchen and dining area. Information about the service can be obtained from the home or from the providers website. Charges for care range from 373 pounds per week to 568 pounds per week but this home has a very individualised charging system that depends on the level of dependency of each person. Care Homes for Older People Page 5 of 33 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: This was the second key inspection for the year. We sent out surveys to people who live in the home and to the staff and to people who visit the service. We had a number of surveys returned from people who live in the home and from visiting professionals but very few staff surveys returned. We also received phone calls from interested parties and information from the outcome of individual Social Service reviews. We met with senior managers from Guardian Care in mid November and discussed issues that had been brought to our attention from surveys and other sources. Nancy Saich and Margaret Drury made an unanounced visit to the home on 01/12/08 and the pharmacy inspector, Angela Branch visited on 16/12/09. We spoke to people who live in the home and to the manager and the staff on duty. We toured the Care Homes for Older People Page 6 of 33 building, observed interaction between staff and residents and read files and documents that backed up what we saw and what was said. What the care home does well: What has improved since the last inspection? We judged that the manager had been careful about assessing prospective new admissions and was taking advice about making sure she only took people who she was sure could be cared for in the home. The home has made some improvements to the information they keep on care and we could see that staff had put a lot of work into some peoples files. The home has improved the way they account for medicines month by month and this means they can keep a better tally of the medicines in the home. We were pleased to see that the home has a new activities organiser and that she has introduced some new activities. Several people were very pleased with the fortnightly swimming that she had organised. The company have adressed some problems with the building that we noticed at the last inspection. The manager has taken on a number of new staff and promoted others. She continues to recruit new staff so that people will get good levels of care and services. The staff have received training in a range of subjects and more training is planned for the new year. Care Homes for Older People Page 8 of 33 The company have appointed a manager and she is in the process of applying to be registered with the Commission for Social Care Inspection. Residents now have savings accounts in their own names. All the staff have now had updates to their training in manual handling. The company have not yet provided us with a business plan but they have kept us informed of what is happening in the service and have sent us action plans about developments. What they could do better: The home needs to review and edit the Statement of Purpose and Service User Guide so that they are clear about the care and services they can provide. Staff need to make sure that anything they write in care plans is actually happening and that each plan reflects the needs and rights of the individual. The manager needs to make sure that staff record medical advice sought and medicines given in as much detail as possible so they can prove that people always receive the highest levels of care. The manager needs to review her medication ordering systems so that medicines are always available. There had been allegations made about staff attitude and approach and this was dealt with by Social Services and by the company. We want Guardian Care to continue to help all staff develop and improve their practice though staff development, supervision and training. The service needs to keep on developing suitable leisure, recreational, cultural, social and educational activities. We judged that although there are activities available they do not always reflect peoples age, ability, background and culture. The manager needs to make sure that people are sure about how to complain and that all staff understand that any concerns residents have need to be acted upon. She also needs to make sure every staff member is really confident that they can recognise what is abusive and they know how to report anything of this nature as some staff were a little unsure. Some areas of the building were not as warm or as tidy and clean as they could have been on the day of the inspection and we want the manager to make sure that people are always comfortable in the home. The company need to keep on developing and supporting the manager and the newly appointed deputy as they need to widen their knowledge of the mental health needs of people in the home and update their practice. They also need to extend their knowledge and skills in managing and developing staff teams. Care Homes for Older People Page 9 of 33 The manager had done some monitoring of quality in the home but now needs to work on plans for how to develop and improve care and services. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service gives people sufficient information about admission but needs to be clearer about what kind of needs they can meet. Evidence: At our last inspection in June 2008 we made a requirement that Guardian Care update their Statement of Purpose and Residents Handbook as these did not reflect the type of care available in the home at the time. At this visit we were given updated versions of both of these and these documents now give a better indication of the intended aims of the service. We read both of these and we did think that they needed some review and revision and a little more detail about the specialist care that the manager told us they intended to give in the old part of the property. We judged that the requirement has been met but we make a new recommendation that these documents are reviewed again to make sure they really give a clear picture of the service. Care Homes for Older People Page 12 of 33 Evidence: At this visit we noted that there had been very few admissions since our last visit. We did have information about a prospective admission that hadnt gone ahead and we were told by the manager and a senior manager of the company that they had considered this but realised that this would not have been a suitable placement. We noted that the company has suitable assessment formats and staff have been using these. We did see some evidence of these and we also saw on file new social work assessments for each person in the home. Social Services had done this as a result of a safeguarding alert. Care Homes for Older People Page 13 of 33 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. More detailed attention to the delivery of care is needed so that the complex needs of residents are met consistently. Evidence: All three inspectors on two separate visits checked on the written plans of care for a number of people and we read some of these in depth after speaking to the individuals. We saw that each persons file had a lot of documents and it was obvious that staff at all levels had put a lot of work into these care plans. Some of the plans met peoples needs in an appropriate way. We did however discover that some of these plans followed a formula. For example many of the plans for people with Korsakoffs syndrome say: provide with education on effects of alcohol on bodys system... . We could find no evidence that this was actually happening. Similar things were written into care plans about smoking but again we could not see that the manager Care Homes for Older People Page 14 of 33 Evidence: had any plans for group or individual work to support people with this habit. We had one survey from someone who was clearly upset and distressed about having his or her cigarettes doled out. Several plans had statements in them that placed restrictions on peoples wishes. We also saw some plans where incidents in daily notes were not followed through. For example one persons daily notes showed a health problem but this is not in the care plan and there was no outcome in the daily notes. One persons plan said she needed to wear her spectacles and her dentures. At 11 a.m these were in her room and no one had come to look for them. This person was showing some distress during the morning. Another person has an assessment of a chronic condition and this continues to be referred to as a different illness. A person with a serious illness did have a new care plan but the daily notes about this aspect of care simply repeated a reported symptom. There were no notes saying that the person had been reassured or that the GP had been called or that any medication had been given. When we read care plan reviews about people with complex needs due to their disorientation and memory loss they said things like: continues to be a little confused... but when reassured and has a chat... helps minimise her confusion for a while. We saw no evidence to show that staff routinely used techniques like reality orientation . We also noted that staff continue to do mental status assessments and give people scores. We couldnt find any staff who had been trained in this form of ongoing assessment and we didnt see that outcomes of these assessments meant care plans were changed accordingly. We judged that staff need to continue to work on the care planning process so that what is written down is followed through in practice. The pharmacy inspector visited the home and these are her findings. We saw medication records that were mostly well maintained but very occasionally signatures were missing and it was not possible to tell if people had received their medication or not. We saw that one medication for the emergency treatment of epilepsy had been missed off the record so that, at times of need, staff might not be aware this is prescribed. On one occasion a painkiller patch for application every three days was delayed by one day and could have resulted in the person getting breakthrough pain. This was because the data was not transferred from the old record to the new record at the beginning of the month. However, all other administrations were done at the correct time. The service had a new system for accounting for medication by recording the quantity carried over from one month to the next. This is good practice as it allows checks to be Care Homes for Older People Page 15 of 33 Evidence: done on medication to ensure it is administered properly. However, some of these records were slightly confusing and it is recommended that they be clearer. A sample of care plans relating to when required and high risk medication was checked. These were mostly well completed, giving clear instructions for management review of treatment. However, sometimes further clarification was needed such as how often medication can be repeated and the maximum number of doses in the day. We saw good records of changes to medication and these were implemented promptly. Medicines liable to misuse, called Controlled Drugs, were checked and were in order. A very small quantity of sleeping tablets that had been recently prescribed needed to be stored in a controlled drugs cupboard but were found in the medicines trolley. The manager assured us that these would be stored appropriately. Earlier in the summer we had received some information that alleged that not all staff treated people in this service with dignity and respect. One survey also stated that they were unhappy with the attitude of a staff member and another person had complained to the manager about the attitude of another member of staff. (We discuss these matters later in the report under Complaints and Protection). On our visits to the service we did not see anything disrespectful going on. We saw a number of very nice interactions where people were being treated in a friendly and caring way. Some surveys said the staff were caring and respectful. We asked the manager and the company to look into this further so that people who live in the home have the kind of rights we all need and expect. Care Homes for Older People Page 16 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service needs to improve the way they ensure that everyone who lives in the home gets the kind of lifestyle that meets their individual needs in terms of their age, ability, culture and personal preference. Evidence: We judged the outcome of these standards by observation, reading surveys and by talking to residents on the day. As in all other outcome groups the Older Adults standards are used but we also considered the different standards set out for Younger Adults. We needed to do this as younger people may need more activities and opportunities than older people want. We therefor also looked at things like occupation and employment opportunities that would not be considered with a home for people who are over retirement age. On the day of our visit we found that people got up more or less when they wanted and could spend time in their own rooms or in the lounge. People told us they could go to bed when they wanted and could choose how they spent their time. None of the younger people attend any further education or leisure classes out of the home and no one has either a paid or voluntary job. Care Homes for Older People Page 17 of 33 Evidence: We had a number of surveys stating that visitors were always made welcome and we met some relatives on the day who were happy with the care provided and with the way they were supported when they visited. We had some evidence to show that people in this home do have some involvement with the church of their choice. No one had developed any new relationships outside of the home, although there was some more contact with family members. We would like to see people in this service having more opportunities to meet people in their peer group who live in the community. Currently people in the home tend to do things with others who they live with and we didnt find much evidence of involvement in community groups. We were pleased to see that there is a new activities co-ordinator in post and that she is trying very hard to provide people with suitable activities. This person is currently only employed for twenty hours per week and on the day of our visit she had been used as an escort for one resident to go to the G.P. Staff said they also tried to organise activities and several people were enjoying board games during the morning. We judged that some more formal planning around activities would help make best use of staff time. We were pleased to see that the activities organiser had undertaken some training on activities for older people and on understanding dementia. She was keen to undertake more training and wanted to develop activities suited to younger people. As yet there was still not enough evidence to show that the staff team as a whole have an understanding of the different therapeutic needs of older and younger adults with different types of dementia. There was no real understanding of individual needs based on past preferences. For example there was an outing to the local pantomime being organised for Christmas but no realisation that some people would not have chosen this as an activity. One person told us they were going just to get out but another said thats for kids. Staff didnt seem to understand that this type of outing might not have been age appropriate. We could find little evidence of one of the companys stated aims as set out in the Service User Guide As part of the care planning process, all service users will be offered a personal programme of social, educational and therapeutic activities based on their expressed need. We did see daily programmes that covered things like helping with household tasks and being involved in activities in the home but we did not find any evidence of Care Homes for Older People Page 18 of 33 Evidence: therapeutic activities that would help people with their self-esteem, poor memory or social, educational or cultural needs . We spoke with a number of staff who told us how difficult it was to engage some people in activities and we learnt that although there are things available people dont always want to participate. We judged that the staff in this service need to have a very thorough knowledge of how to counteract the problems motivating people who have both mental health and psychological needs. A number of younger people expressed their dissatisfaction with their lifestyle and we want to see the service looking at individualised and planned activities that will help people to overcome these feeling of being as one person said: Bossed around and treated like a little kid. We are aware that restrictions and specific care planning needs to be in place but we judged that for some people there could be more and varied activities available and that staff need to be sure about how to approach some of the issues about motivation, opportunity and activities. Again we judged that activities for older people with dementia didnt really take into account their special needs. We want to see more integration with the local community and more involvement with families, some educational activities for younger people and more awareness in the staff group of some of the more up to date therapies available for people with dementia. We ate with residents and thought that the food was of a good standard and residents told us they were happy enough with what was provided. We did think that on the day the menu needed a rethink in terms of what some younger people would have preferred. We asked the manager to look at this and to think of new ways to involve the residents in menu planning. Care Homes for Older People Page 19 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the service are only adequately protected from harm and there now needs to be steps taken by the company to make sure that people can voice any concerns. Evidence: The company has a suitable complaints procedure in place and we saw some copies of this on the day. We had received no complaints other than safeguarding allegations that were investigated by Social Services and unproven. Residents meetings are held but these are chaired by the activities co-ordinator not the manager. One or two people told us they thought the manager should do these herself. One or two surveys gave us evidence to show that people were not always sure about how to make complaints. One or two people said to us that they wouldnt complain because nothing would happen. Some months before this inspection we had received information relating to allegations about poor practice and disrespectful behaviour by some members of staff. We referred the matter to Social Services and they accepted this as a safeguarding referral. Social Workers reviewed the care of everyone who lived in the home and they found no evidence to back this up. A second allegation of bullying was referred to Social Services by the manager and the matter dealt with effectively by the company. Care Homes for Older People Page 20 of 33 Evidence: A further allegation was made in our surveys and we met with senior management of the company in mid November and they agreed to look into all these matters. Guardian Care do have suitable policies and procedures in place about safeguarding vulnerable people and they provide staff training. We asked the company to continue to look at these issues which may relate to institutional practice, individual staff development or the philosophy of care in the home. The company agreed to look into these matters further. We looked at staff training records and we discovered that some people had received training about Adult Safeguarding in August and September. The training plan shows that 12 people are still waiting for updates to this training. We spoke to one member of staff about how they would approach a potentially harmful situation and we judged that this person was not as clear about safeguarding as they might have been. We want Guardian Care to make sure by training, development and supervision that everyone who works in the home understands what is abusive and knows how to deal with any potential harm. Care Homes for Older People Page 21 of 33 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. More attention to the details of individual residents needs is required so that people are always comfortable in their environment Evidence: Kirksanton Care Centre is situated in a rural setting within the village of Kirksanton approximately 2 miles from Millom. The village does not have regular or frequent public transport and is some distance from the railway station. The home does have its own vehicle that staff use to take residents out. The home is divided into three areas. The older part of the house - referred to as The Croft - had no residents on the day of the visit and manager told us that she did not have staffing in place yet for this part of the home. This part of the building does have a passenger lift but some bedrooms are only accessible after negotiating steps. Some of the bedrooms still contain kitchen equipment. We asked the company to ensure that all bedrooms would be suitable if any person were admitted there. Guardian Care agreed that they will assess each new admission as they might admit people who will be able to use this equipment. The main part of the house - The Annex - is home for up to 25 older adults. Some of these people may have dementia and some may not. Everyone lives together and use the dining room and lounge in the unit. Some of the bedrooms are of a very good size with ensuite facilities. Other bedrooms are smaller and have a wash hand basin. However this area has been refurbished quite well and the furniture and fittings are of good Care Homes for Older People Page 22 of 33 Evidence: quality. Residents and visitors were happy with the environment of this area. On the day of the visit we did notice some minor problems around the home with things like small areas of dampness in one bedroom and carpets that needed cleaning or replacement. Even later in the morning some bedrooms had an odour of urine and one bedroom was untidy and the floor was sticky and unwashed. A number of radiators in this part of the building were not working. The main lounge was cold and although staff were around no one had made an attempt to put knee rugs on people who are largely immobile. The dining room also had radiators that did not work and a fan heater was switched on in here although everyone had had their breakfast. The staff team said that it was only cold because it was a cold morning. The handyman said that there had been work done on the boiler but he agreed when we asked him to look at the radiators and he did manage to make the home warmer later in the day. We were surprised that the manager and the staff team hadnt dealt with this problem. The third area - The Mews - is specifically for younger adults with Korsakoffs syndrome. Each person has a flat comprising of bedroom, lounge (with a small kitchen area) and bathroom. A number of people said they liked having these spacious rooms. The rooms are suitably furnished and decorated. There is one lounge in this area and this is used as the smoking room for the entire home. People who do not smoke do not have access to a non smoking lounge other than their own flat. Some residents like to eat together and they do this in the kitchen. One of the inspectors joined them at lunchtime and it was a little cramped. However the shortfalls in these shared areas are made up by the size of individual flats. The home employs people to do all the laundry and residents told us they were happy with the way this was done. We checked on bedlinens and these were clean and fresh. When we walked around the home we did see a number of areas that were not as tidy as they might be. We did comment on this and the manager agreed to make sure that staff dealt with some of the things we saw. The areas of dampness in The Croft had been dealt with externally and the manager assured us that the internal damp patches would be dealt with once they had dried out sufficiently. Care Homes for Older People Page 23 of 33 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. More staff members and more training for staff mean that people who live in the home are seeing improvements to the way they are cared for. Evidence: We were given copies of the weekly rosters for the month before the inspection. We saw good levels of staffing throughout the month. We did think that some staff worked quite long hours. Care staff in this home regularly work 12 hour shifts and sometimes people cover for absences and may work up to sixty hours a week. The manager said she was recruiting and hoped to fill all the vacant hours shortly. She has recruited a deputy, two new care staff, a handyman and an activities organiser in the last few months.Care staff are supported by good levels of housekeeping staff including cooks, laundry workers, domestics and the handyman. We checked on the recent recruitment and found that this had been done correctly with good checks on peoples background and previous work record. The manager was aware of her responsibilities about taking people on only after checking the persons background thoroughly. A good proportion of staff had gained their NVQ qulaifications in care and the deputy was about to start her Registered Managers Award at level 4. The manager told us that Care Homes for Older People Page 24 of 33 Evidence: nearly 75 percent of staff had a NVQ. We asked for a copy of the up to date training plan and we were given a copy of the training schedule for 2008-2009. This showed that nearly every one had completed manual handling training, fire training, food hygiene training, hazardous substances awareness,equality and diversity, end of life care and Korsakoffs syndrome awareness. There were some areas - mainly safeguarding, managing challenging behaviour and dementia care training - where some staff were waiting for training. The manager said she was making arrangements for trainers to come to the home and we saw evidence that planning for this was under way. We judged that the home has improved basic training for staff and the manager is now trying to make sure that individual staff members have training that meets the needs of their role. We look forward to seeing the development of training that is targetted at individual staff needs. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service needs to continue to work on management systems so that people who live in the home will receive improved standards of care and services that meet their needs and wishes. Evidence: This home has had three managers in the last year and one or two people mentioned in surveys that these changes took a bit of getting used to. The home is currently being managed by Christine Munroe who has previously managed the home. She has been the deputy manager for some time. She has worked in this home for a number of years and was previously the registered manager. She is in the process of applying for registration. She has gained her Registered Managers Award but has limited training in some of the specialist skills needed to work with people who have unusual kinds of dementia. We would like to see her further her skills and knowledge of working with people with different types of dementia. We Care Homes for Older People Page 26 of 33 Evidence: recommend that this manager is given as much support as possible to update her practice and further her knowledge. We have been impressed with the involvement of senior management in the home during this time of transition and we have received a number of action plan updates from them. We have also met with them to discuss some concerns. This inspection has shown us that the company have worked on all the requirements made at the last inspection. We judged that there is still some improvemenets to be made in the service. For example although each resident has a care plan we discovered that the manager and her deputy have had no formal training in the care planning process. Again we would like to see more formalised development of this for the people who run the home on a day to day basis. When we looked at some records relating to staff performance we judged that both the manager and the newly appointed deputy are trying very hard to develop staff but need to further their understanding of their role in managing people. The company have told us that they plan to send the manager on management training and on the day she told us that this was a two day course. We want to see this company continue to make an investment in terms of formal training and development of this manager and her deputy. We asked the manager for a copy of her most recent Annual Quality Audit and she gave us a breakdown of some surveys that had been sent out to people who live in the service, their relatives, the staff and health care professionals. These survey results showed some very positive responses and some areas for improvement. We did not see any evidence on the day to show that the manager had analysed the process she had used for surveying people who have problems with their memory, nor had she used some of the other monitoring to pull together all the information needed for an annual quality audit. We asked the manager if she had her own plan for the home for the next twelve months and she said she hadnt. We now want a simple plan in place, using the results of surveys and other quality monitoring to show how the manager plans to develop the service. The company have not yet sent us their business plan but have agreed to develop a simple plan for the home that will clarify their intended plans for the future. On this occasion we did not look in-depth at individual service user financial accounts but we were told by the manager and the administrator that a new system is in place to individualise accounts. This has been confirmed by the company on more than one occasion and we accept this as evidence of the requirement about resident accounts being met. Care Homes for Older People Page 27 of 33 Evidence: We did look at health and safety matters in the home and we found that these things continue to be delegated to senior staff and to the handy man and they are being recorded regularly. We want the manager to make sure she checks these recordings so that any problems with the outcomes can be dealt with under her routine quality monitoring. At the last inspection we discovered that not all staff had received up to date training or competency checks on manual handling. The company told us that this has now been completed and staff confirmed they had now received suitable updates. We checked the fire log and this was up to date as was routine maintenance of equipment and services. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 29 of 33 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 9 13 Ordering procedures for medication must be reviewed to prevent them running out. 28/02/2009 This must be done so that all residents have access to prescribed medication at all times. 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 1 It is recommended that Guardian Care review and edit the Statement of Purpose and Service User Guide so that the contents are clearer about the care they intend to provide. It is recommended that all care plans are reviewed again so that formulaic planning is avoided and that daily notes show that the care plans are active and work for each Page 30 of 33 2 7 Care Homes for Older People individual. 3 8 It is recommended that all health care needs and responces are shown clearly in care planning so that staff have good evidence to show that peoples health care needs are dealt with promptly and appropriately. It is recommended that staff take greater care to prevent any ommissions in the administration of medication records. It is recommended that Guardian Care continue to look into any allegations made about staff attitude and approach and that they take suitable action in terms of staff development. It is recommended that an activities programme is developed that will meet individual needs and will give varied opportunities for leisure, recreation, occupation and education. It is recommended that the manager continue to give support to people and their families and that she start to make more meaningful contacts with local community groups so that people can, if they wish, develop a life outside of the service. It is recommended that Guardian Care makes sure that everyone in the home is given suitable levels of support to make their own life choices. This must be done in line with the Mental Capacity Act so that peoples capacity is assessed correctly and their individual rights upheld. It is recommended that Guardian Care and the manager of the home help and support people who live in the home to feel that they can make complaints or suggestions and that any issues will be acted upon. It is recommended that the updates to safeguarding training are continued and that the company and the manager promote good practice issues with the staff group through meetings and individual staff development. It is recommended that the manager reviews the way the suitability of the environment is assessed on a daily basis so that people always live in a warm, comfortable, orderly and clean home. It is recommended that the company continue to support and train the manager and her deputy in further their management skills and developing their knowledge of the special needs of people who live in the service. It is recommended that the company support the manager and help her to analyse her quality monitoring so that a quality improvement plan can be produced. Page 31 of 33 4 9 5 10 6 12 7 13 8 14 9 16 10 18 11 26 12 31 13 33 Care Homes for Older People Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. 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