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Inspection on 10/06/08 for Kirksanton Care Centre

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

This inspection was carried out on 10th June 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

Kirksanton Care Centre is a pleasantly appointed home that has benefited from major renovations to the building in the last few years. Most of the residents told us that they were reasonably content living there. Several people said how much they like their own bedrooms. Residents also said that most of the staff were kind and pleasant to them. People told us that they had plenty to eat and their meals were nicely prepared and well presented. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 7No one had any complaints on the day and most people knew how they would complain if they felt the need. A good proportion of staff in this home have National Vocational Qualifications in care. Some staff have quite extensive training that help them to understand the needs of residents. The management of the home make sure that when they take on new staff unless they have completed the appropriate checks so that only people of good character are taken into the staff team. The Deputy Manager makes sure that every member of staff gets the opportunity to talk about their work and their personal development in a confidential meeting with her. Health and safety, maintenance, food hygiene and fire safety were checked and found to be managed in an efficient way.

What has improved since the last inspection?

At the end of this inspection we could see that there had been improvements in the number of areas. For example we could see that the environment had improved and that staff continued to keep it as clean and tidy as possible. We thought that some of the written plans for residents had improved in their general content. We judged that activities and entertainments had improved during the first half of the year. We also saw that some staff had had training and development opportunities.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Kirksanton Care Centre Kirksanton Millom Cumbria LA18 4NN Lead Inspector Nancy Saich Unannounced Inspection 10:00 10th June 2008 X10029.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 Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. 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. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kirksanton Care Centre Address Kirksanton Millom Cumbria LA18 4NN 01229 772868 01229 774015 enquiries@guardian-care.com www.guardiancarehomes.co.uk Guardian Care Homes (UK) Limited 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) Manager post vacant Care Home 45 Category(ies) of Dementia (45), Old age, not falling within any registration, with number other category (25) of places Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, 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 30th May 2007 Brief Description of the Service: 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 and need nursing care. 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 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 (Korsakoff’s 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 provider’s website. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 5 Charges for care range from £373 to £568 per week but this home has a very individualised charging system that depends on the level of dependency of each person. Charges for nursing care will be higher but no figures were available during this inspection. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was the main or key inspection for the year. The lead inspector Nancy Saich asked the acting manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the last inspection and for the plans for the coming year. This was completed promptly. We then sent out postal surveys to people who live in the home and their relatives and friends and to the staff group. We had a good response to these surveys and followed some of these up by telephone. We quote from them in the report. The responses gave us a good picture of what its like to live and work in the home. Nancy Saich and Margaret Drury completed an unannounced inspection of the service. We toured the building, sat in lounges and spoke to residents and staff. We met with the Deputy Manager who was in charge on the day. We also looked and files and documents that backed up what was said and what was seen. We had also visited the home on 29th November 2007 when we completed a random unannounced inspection. The purpose of this visit was to check on management arrangements for the home as the Registered Manager had resigned in November 2007.At this November visit we saw that things had improved in the home since our last key inspection in May 2007. There is a letter available on request from the Preston office that details our findings during this visit. What the service does well: Kirksanton Care Centre is a pleasantly appointed home that has benefited from major renovations to the building in the last few years. Most of the residents told us that they were reasonably content living there. Several people said how much they like their own bedrooms. Residents also said that most of the staff were kind and pleasant to them. People told us that they had plenty to eat and their meals were nicely prepared and well presented. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 7 No one had any complaints on the day and most people knew how they would complain if they felt the need. A good proportion of staff in this home have National Vocational Qualifications in care. Some staff have quite extensive training that help them to understand the needs of residents. The management of the home make sure that when they take on new staff unless they have completed the appropriate checks so that only people of good character are taken into the staff team. The Deputy Manager makes sure that every member of staff gets the opportunity to talk about their work and their personal development in a confidential meeting with her. Health and safety, maintenance, food hygiene and fire safety were checked and found to be managed in an efficient way. What has improved since the last inspection? What they could do better: Guardian Care Homes need to review a document called the Statement of Purpose so that they can be clear about what the home has to offer. Currently they say that they are a nursing home but they do not have any nurses on the staff. They also need to make sure that they only admit residents who they know can be cared for by the existing staff team. Staff need help and support to understand how they can improve the written plans so that every resident gets individual care given to them in the same way. Some peoples plans need to show in more depth how people’s health care needs are met. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 8 The staff team must make sure that they can account for all medication at any time. Although there have been more activities offered to residents we would like to see more options and choices in place - especially for people who have some form of dementia. We also recommend that the home find ways of encouraging more involvement from families and local community. We want the company to make sure that every member of the staff team receives updated training in how to recognise and report any instances of abuse. We want Guardian Care Homes to make sure that all bedroom carpets are clean and odour free and that any areas of penetrating dampness from outside are dealt with. The company must make sure that all bedrooms in the Croft have kitchen equipment and fittings removed so that the room can be recognised as a bedroom. We want the company to look at the kind of staff team they want and need to run this home at its capacity. This means that they need to make sure that they have enough staff who are suitably trained and qualified to meet all the residents’ needs. Guardian Care Homes must make sure that all staff receive basic training so that they can do their jobs efficiently We also want Guardian Care Homes are to make sure that all staff have suitable, up-to-date dementia care training that will help them to deal with peoples needs depending on the type of illness they have. The home has been without a registered manager since early in November 2007. Guardian Care Homes must now recruit a new manager who can move the home forward. Guardian Care Homes needed to undertake a review of the service so that they can find out whether people who use it think they receive good quality care. They also need to make sure that they have a business plan in place so that people who live and work in the home know what the company intends for the future. We want to see a change to the way that resident savings are handled so that individuals may have more choice about what happens to their money. The home needs to look at how they store cleaning equipment in the Mews. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. This service is poor at making sure that it only takes new people who they know they can care for and who will fit in with people who already live in the home. EVIDENCE: We had received a copy of the Statement of Purpose from the company earlier in the year. This document explains what the aims and objectives are of the home. It told us that the home planned to provide nursing care as well as Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 12 personal care. When we spoke to the Deputy Manager and to staff at this visit people were unsure as to whether this was a home that could provide nursing and there were no nurses in post. The Statement of Purpose therefore doesnt reflect what is happening in the home. We met with some people who had not been long in the home and they could remember visiting and making the decision to come in. They told us that staff helped them to settle in. We saw some admission forms that had been filled in appropriately but we also saw one where staff had missed a health care need and where another health problem was recorded in the care plan as a very different illness. When we visited in November 2007 we judged that the manager had admitted someone with needs the staff found hard to meet. At this visit we discovered that another person had been admitted to the Mews but didnt have a diagnosis of alcohol related dementia. We also noted that one person without nursing needs had been accommodated in the Croft building that the company tell us is for nursing care. This person had however used the facilities of the Mews and this meant that although the Mews can only take 10 people, 11 people had used the facilities in this area for a number of weeks. The company need to make sure that people who complete initial assessments are suitably skilled and knowledgeable so that any new persons needs can be met fully by the home. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. More detailed attention to the delivery of care is needed so that the complex needs of the residents are met consistently. EVIDENCE: We read a number of care plans during this inspection. These documents are intended to help staff to understand the needs of residents and to give Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 14 guidance about how to help people with a range of needs, aspirations and specific interventions. At this visit and in November 2007 we found that the content of the care plans had improved in general terms. We had also seen this improvement at last year’s key inspection and had hoped that this general improvement would have moved on. At this visit we discovered that although some plans were suitable, a number of care plans had not been updated for a year despite the fact that peoples needs had changed. We judged that care staff still need help with evaluating and re-writing plans when peoples needs change. We also noticed that a number of plans were very similar about specific issues for different people. We want to see care planning becoming much more person centred. We had evidence to show that staff call out the GP when people are unwell, that they give people support when they have health needs and that the district nursing service is used. We did however discover with one or two newer residents that their care plans missed out on some health care needs that had been noted by Social Workers or health professionals before they were admitted. In one case the person had a serious condition that had been written into the care plan as a different health problem. We checked on some of the medication held on behalf of residents and we found that drugs were stored correctly and given appropriately. We judged that arrangements made by the staff when there were changes to medication needs to be looked at again. We found that in two instances staff were using medicines from a blister pack and from boxes of tablets at the same time. We found that it was difficult to work out exactly how many tablets had been given. The staff need to be much more careful about accounting for medicines. During the visit we observed how staff treated residents and we saw a lot of caring and friendly interactions. Some care plans gave a lot of detail about the kind of support residents preferred. Residents told us that staff were nice to them and no one on the day had any specific complaints. Most of the surveys we had returned to us were also positive. However one or two surveys did make some comments on the way that care was delivered. One person commented on their relative not having enough support with personal hygiene. Another person commented on staff attitudes. We also noted in a written plan that a member of staff seemed to think that the behaviour of a person with dementia was purposeful rather than part of their illness. The company need to make sure that staff attitude and approach meets with the needs of residents. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate This judgement has been made using available 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: The inspection started just after 9 a.m. and most people had already had breakfast. One or two residents got up much later as this was their preferred Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 16 choice. People told us that they could go to bed late and some care plans were very specific about times of rising and going to bed. Residents said that they had quite a lot of choice about what they did during the day. When we visited earlier in the year we found that activities had improved dramatically and we were pleased to see that the activities organiser was trying all different types of activities and entertainments. This person has now left the service and the Deputy Manager said she was trying to find a replacement. One survey told us: • “ I was unhappy when at my relative told me that the activities coordinator had stopped spending so much time in the Mews -and even more concerned when this person resigned. My relative is only young and needs to be active and involved in life.” The residents told us that activities were not quite so varied and interesting as before. However on the day there was an exercise class that a number of older people joined in with and we could see that staff did try their best to provide some activities for residents. We were pleased to see that some of the younger residents had been on holiday to a rented cottage. We checked on individual peoples files to see what kind of activities and entertainments they had been involved with and we found that some people had not found anything in particular that they wanted to do. We recommend that the activities organiser post is filled as soon as possible and that more attention is paid to activities that will suit peoples’ age, culture and ability. We would particularly like to see activities that take into account the needs of people with dementia. We could see from the visitors’ book that relatives and friends come to the home. Surveys told us that people felt welcome in the home. We did discover that some people had not had as much contact as they wished with relatives. • “ I would like to see more of them but it is difficult for me to go there on my own. I feel lonely and would like more contact”. In the past year staff have tried to make more local contacts and we hope that this continues once the activities organiser post is filled. We would like to see both younger and older people having a role to play in the community. When we observed what happened in the home and read the care plans we judged that staff do need to support some people with their lifestyle choices. Some residents were unhappy with these restrictions and we were aware that some arrangements have become accepted as part of the daily routine for groups of people. For example some people in the Mews are still being given cigarettes on an hourly basis and they wait outside the office until staff give each of them a cigarette. This kind of practice needs to be looked at again so that the way things are done in this home becomes less institutionalised. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 17 We were told that one or two members of staff had attended a training session about the Mental Capacity Act but we could find little evidence to show that residents’ capacity had been assessed before restrictions were made on their lives. We had evidence to show that at least one persons wishes were not being followed through because relatives were unhappy with this persons choice. We spent some time with the cook and were impressed with the cleanliness of the kitchen and her understanding of residents needs. Residents told us that they enjoyed their food and the meals we saw on the day looked appetising. • “ I enjoy my meals -the food here is very nice.” Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The company needs to make sure that the staff team in this home have enough skills and knowledge to always protect people from harm and abuse. EVIDENCE: The home had received two formal complaints in the last year. We saw the details of how these were handled and we thought that these had been resolved in a suitable way. We had not received any formal complaints about the home. We asked a number of staff about how they might report any concerns they had about abuse. Staff gave us a reasonably good account of what they thought was abusive but some people were unsure about who should deal with any serious concerns. We discovered that staff had not had training for some time and that some new members of staff had not received training in safeguarding. We also noted from the accident book that were some instances where residents with dementia were upset with each other. These might be Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 19 considered to be safeguarding issues but had not been reported under the local agreement. Again we judged that refresher training would help people to gain confidence in recognising what was abusive. We spoke to residents and staff, checked on written documents and observed things in the home. We found no evidence on the day to show that anything untoward was happening in Kirksanton. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Guardian Care Homes must make sure that all areas of the home are safe, clean and well maintained so that people with physical frailty or dementia feel relaxed in their own environment. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 21 EVIDENCE: This home has been upgraded and refurbished to a good standard and we were pleased to see that staff were taking pride in the environment. Generally the home was neat and tidy and provided residents with a comfortable home. The residents we spoke on the day said they were happy with their bedrooms and the shared spaces. • • • “I am happy with my ‘flat’ – I can spend as much time on my own as I want”. “I have a nice little room and I am quite comfortable”. “I like the company in the lounge”. The residents in the Mews especially like the fact that they have both a bedroom and a lounge area to themselves. One or two bedroom carpets may need to be changed as they had a bad odour coming from them. The home might want to consider providing alternative floor coverings. We noticed two areas in the Croft where there was evidence of penetrating damp. These bedrooms had no residents in them but this needs to be dealt with before people are admitted. We also noticed that the annex lounge external door needs to be repaired or replaced because it too is letting in water. We were concerned that some bedrooms in the Croft still have fully functioning kitchen units in them and we do not want any residents who have nursing needs because of their dementia being in a bedroom with hot-plates or washing machines. We judged that this could be dangerous and very confusing. All bedrooms in the Croft need to be recognisable as bedrooms before anyone moves into this unit. There was evidence to show that staff were aware of the need to keep infection down and the company provide suitable equipment and systems to do this. However we noticed that in the Mews there is no storage available for cleaning equipment and we found two mop buckets - one for the kitchen and one for lavatories, were being stored together in the office. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. This company needs to make sure it can recruit, retain and train enough staff with suitable skills to meet the complex needs of the people they say they can care for. EVIDENCE: The Deputy Manager told us of that there was one full-time care assistant post vacant, a 20 hour a week activities organiser job vacant and that there was no full-time, registered manager in post. The company had allowed her 40 extra hours as she was acting up as a manager for the time being but these hours are not being filled. We looked at weekly rosters and saw that the existing staff team were covering the vacant care hours. We also had evidence to show that in the Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 23 interim they were trying to carry out activities. Rosters showed that there were three people in the Mews (although one of these spends their shifts caring for one person) and three in the annex during the day and three people awake for the entire home during the night. We judged that this staffing was suitable for the number of residents and the dependency levels on the day of the visit. However it would not be enough if the vacant care and nursing beds were to be filled. We noted that although the home had been registered earlier in the year as a nursing home, and despite the last registered manager having recruited some nurses, no one with a nursing qualification is working in this home. The Deputy Manager was aware that she could not admit anyone with nursing needs until this has been dealt with. We judged that this home cannot progress any of its aims and objectives until it has the right mix of skilled and trained staff in key posts. Staff told us that the company expected them to complete their National Vocational Qualifications in care and that they were given suitable levels of support to do this. A good proportion of staff had this qualification. We checked recruitment in the last year. We discovered that this had been done correctly and that any new member of staff had suitable checks on their background to make sure that they were the right kind of people to work with vulnerable adults. We asked the Deputy Manager for a copy of training undertaken by staff and for the training plan for the coming year. This was provided for us and we saw that in the past couple of years there had been a number of training courses for staff. On the day of the inspection some staff were attending a training provided by the Drugs Action Team. We also checked on individual staff records and spoke to staff about their training needs. We saw that some staff needed either new training or updates to training that they had had in the past. For example we looked at one person who is sometimes left in charge of the home. This person had not had any moving and handling training, and needed an update to health and safety training, safeguarding and first aid training. The training plan didn’t show opportunities for shift leaders to complete this training in the next year. We then checked at random on a number of other staff records and although we could see that some people had had some very good training others now need to complete the basic training for their job. For example not everyone has had up to date training on understanding dementia and we also had evidence to show that staff need to revisit training on how to manage challenging behaviour and how to safeguard vulnerable adults. We want to see training in place that will ensure that all staff receive suitable training. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 25 This home needs to have a registered manager in post who can make sure that the service is improved and developed in line with the needs and wishes of residents. EVIDENCE: The Registered Manager for this home resigned from his post in November 2007. Later in that month when we visited there was a temporary manager in place but he left the company in March 2008. We had not been informed of this nor had we been told of the temporary measures in place. The Deputy Manager told us that she was acting as the homes manager. The company should have told us about these arrangements and informed us of their plans in terms of their nursing home status because this home has no employees with nursing qualifications. Guardian Care Homes have left this home without a registered manager for more than six months and this matter needs to be dealt with urgently. We asked the Deputy Manager for a copy of the annual quality assurance audit. There was no up-to-date quality assurance report. We had asked residents about this and they said they were consulted on a fairly regular basis but did not think they had been consulted on whether they thought the home was giving good quality. Guardian Care Homes need to make sure that there is consultation with people who live in the home, staff and other people who are involved in the life of the home. They also need to make sure that their management systems are working efficiently. Staff were unsure of what was going to happen in the future and no one in the home was really aware that the home is now registered as a nursing home. We asked the Deputy Manager for an up-to-date copy of the business and financial plan for the home, as we too were unsure of Guardian Care Homes Ltd’s plans for Kirksanton Care Centre. She did not have an up to date plan that she could give us on the day. We also looked at the money belonging to residents kept on their behalf by the home. We found that the money was properly accounted for with receipts for purchases. We did however discover that residents in the home still dont have individual account for their savings. The Deputy Manager and the administrator told us that everyone’s savings are in a company account and people do get interest on this. However they could not tell us on the day how much interest was due to people. The Deputy Manager told us that the company was dealing with this in the next few weeks. This has taken more than a year to be resolved and action does need to be taken on this. We spoke to staff about their supervision arrangements and they told us that the Deputy Manager gave them support and advice. We read a number of the records of these one to one meetings. We saw that the Deputy Manager was Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 26 undertaking all of the formal supervision for the entire staff team. We found that although these meetings were being completed on a regular basis they were lacking detail especially in terms of individual staff training and development needs. We checked on the records for maintenance and health and safety. We found that some of these tasks had been delegated to senior care staff and to the handyman and that these things were being done in a very efficient manner. However as we have stated earlier in this report there are a number of issues relating to the fabric, fixtures and fittings that need to be dealt with before things deteriorate further. We also saw that the kitchen in this home is run very efficiently and the local environmental health officer had given them a three star rating at their recent visit. We were told by the Deputy Manager that all staff needed updates to their training and competence checks for manual handling. Guardian Care must now put robust arrangements in place to make sure that all staff know how to do this without putting themselves or service users at risk. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 27 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 1 2 X 3 1 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 2 25 X 26 2 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 X 33 1 34 1 35 2 36 3 37 X 38 2 Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 6 Requirement The registered person must revise the Statement of Purpose and the Service Users’ Guide and send copies of these to the Commission for Social Care Inspection by the due date. The registered person must ensure that no service user is admitted to the home unless all information about the person is received and a full assessment is undertaken by a person trained to do so. Any assessment must take into account the conditions of the registration of the service. The registered person must make sure that all care plans contain information gained on assessment, are detailed, up to date and individual to each service user. The registered person must ensure that all staff at suitably trained and supervised in understanding what constitutes abuse and in how to report any concerns so that all service users are safeguarded. Timescale for action 31/08/08 2 OP3 14 31/08/08 3 OP7 15 31/08/08 4 OP18 13 (6) 31/08/08 Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 29 5 OP24 23 (2) (f) 6 OP30 18 (1) (c) 6 OP31 8 7 OP31 38 8 OP33 24 9 OP34 25 10 OP35 20 (1) The registered person must ensure that all bedrooms contain only furniture and fittings that are suitable for a bedroom. Fitted kitchens and appliances must be removed from rooms that are intended as personal bedrooms. The registered person must provide evidence to show that all members of staff have received training suitable to their role. This must include training on understanding different types of dementia, how to help people manage these illnesses and how to deal with challenging behaviour. The registered provider must ensure that a manager is appointed as soon as possible and that this individual is registered without delay with the Commission for Social Care Inspection. The registered provider must ensure that they inform the Commission for Social Care Inspection of any absence or change to the way home is managed. The registered person must undertake a Quality Assurance audit and a copy of the report must be sent to the Commission for Social Care Inspection. The registered person must prepare a business and financial plan for the service. A copy of this plan must be sent to the Commission for Social Care Inspection by the due date. The registered person must make sure that any money belonging to a service user is paid into an account that is in that person’s name. DS0000057674.V362997.R01.S.doc 31/08/08 31/08/08 31/08/08 31/08/08 31/08/08 31/08/08 31/08/08 Kirksanton Care Centre Version 5.2 Page 30 11 OP38 13 (5) The registered person must make arrangements for training and competence checks on all staff who are involved in any manual handling operations. 31/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations It is recommended that staff make sure that all health care needs are recorded in care plans and appropriate action taken to make sure that service users get prompt and suitable treatment. It is recommended that the company make sure that all medication can be accounted for at any time. It is recommended that Guardian Care Homes make sure that every member of the staff team has a suitable understanding of the needs and rights of people in their care. They also need to make sure that the delivery of care always ensures that service users dignity, privacy and independence is maintained. It is recommended that a new activities coordinator is appointed as soon as possible, that every resident is consulted about their personal preferences and that an activities program for groups and individuals is recommenced. It is recommended that residents are given more support so that their relationships with family members and friends are maintained and that new relationships can be made in the local community. It is recommended that Guardian Care Homes make sure that all residents are given enough support to allow them to make suitable choices about how they control their own lives. We want the company to take the Mental Capacity Act into account when they do this. It is recommended that Guardian Care Homes check that all floor coverings and other fixtures and fittings are suitable for the needs of residents and that any DS0000057674.V362997.R01.S.doc Version 5.2 Page 31 2. 3. OP9 OP10 4. OP12 5. OP13 6. OP14 8 OP19 Kirksanton Care Centre penetrating dampness problems are dealt with. 9 OP19 It is recommended that the office in the Mews is no longer used for storing mops and buckets used in lavatories and toilets so that good hygiene levels can be maintained. It is recommended that Guardian Care Homes make sure that they have enough staff with a variety of skills and knowledge to meet the specialised care needs of all residents. This review must consider the fact that this home is registered as a nursing home but there are no nurses on the staff team. 10 OP27 Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Kirksanton Care Centre DS0000057674.V362997.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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