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Inspection on 16/10/06 for Kirksanton Care Centre

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

This inspection was carried out on 16th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What has improved since the last inspection?

The company have organised a number of training courses for staff in the home that would have helped to increase their knowledge of the residents care needs. The company have improved systems for managing medication Some parts of the grounds had been landscaped to good effect. The company continue to develop a good system for checking on quality.

What the care home could do better:

The home needs to make sure that any new resident will fit into the home, that they keep within the terms of their registration and that staff are fully aware of the new person`s needs before they come to stay. The registered manager must make sure that the written plans of care help staff to understand exactly what residents want and need and the steps they need to take to make sure this happens. She must also make sure that risks are managed properly to make sure residents can take normal risks in a safe way. The registered manager needs to make sure that she keeps on developing the contacts she has with mental health professionals. She needs to make sure that the medication is handled correctly and that medicines are available when residents need them. The registered manager needs to ensure that care plans with regard to medicines administration are improved so residents needs are met particularly for "when required" medicines. She must make sure that residents have choice as to when they received their medicines. She also needs to help staff to understand why care is delivered in specific ways and make sure she helps them to develop their awareness of what the right approach is when people have difficulties with things like memory and behaviour. The inspectors judged that residents weren`t getting enough outings or activities and weren`t being helped to deal with some of their needs through things like group work. This has been something that the Commission for Social Care has required for at least a year and this still hasn`t been dealt with. The registered manager needs to keep helping residents to have as much choice and control as they can manage. The inspectors thought that there wereKirksanton Care CentreDS0000057674.V317188.R02.S.docVersion 5.2Page 8a number of things that could be done with individual and groups that would at least make people feel they had more choice. The food on the day was nicely presented but more work needs to be done on making sure everyone has good nutrition that meets their needs. Some residents said that they wanted more response from the staff when they had `grumbles` or `niggles` about their daily lives. There had been an incident in the home where two people might have been at risk of abuse. This hadn`t been reported to Social Services when it happened. Staff had told the lead inspector but still weren`t sure of exactly how or when to report an incident to Social Services. On the day of the visit some areas of the home were not as clean as they might be. Some repair work hadn`t been done. The call bell system didn`t work for some hours during the day. Some residents had locks on their doors, some didn`t. One person found the lock difficult to use. The staff had locked a fire door as one person was at risk of leaving the house. They did this, as the external doors didn`t have special locks to stop people wandering outside unsafely. One bed needed clean sheets and pillowcases. Residents clothing was hanging up in a corridor. The inspectors felt that staff had a lot of residents to care for as well as other duties to carry out. They wondered whether the roster made the best use of available hours so that residents had enough staff on through out the day. They thought that the company needed to try harder to make sure they recruit good staff that can help with some of the things the home is failing to do well. The registered manager needs to makes sure she works on all the things that are outstanding legal requirements. She also needs to make sure she is leading a staff team who understand what the Commission for Social Care Inspection judge to be current good practice and to act on these things. She needs to use Guardian Care`s quality assurance system to pick up on the things that aren`t meeting good standards of care. She also needs to find ways of involving residents in future planning for the home. The registered manager wasn`t making sure residents money was being handled correctly. The company had looked at this and dealt with some matters but need to make sure this is done correctly. They must help residents to open their own savings account. The registered manager admitted that she wasn`t able to meet with each member of her care team six times a year and that she was behind in the records of these `supervision` meetings. Written records in the office were not all filed away so that things could be found easily. The company need to consider whether they have a home and grounds that are secure and safe for residents and staff alike. The registered manager must make sure that staff don`t lock fire doors and that all stored items are locked away safely and don`t pose a fire hazard

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Kirksanton Care Centre Kirksanton Millom Cumbria LA18 4NN Lead Inspector Nancy Saich Unannounced Inspection 10:00 16 & 25th October 2006 th 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.V317188.R02.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.V317188.R02.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 None 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) Mrs Christine Marina Munroe Care Home 35 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (13), Learning disability (1), Learning disability of places over 65 years of age (2), Mental disorder, excluding learning disability or dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (1), Old age, not falling within any other category (12), Physical disability (5) Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 35 service users to include: up to 13 service users in the category of DE(E) (Dementia over 65 years of age) 1 named person in the category DE(E) (Dementia over 65 years of age) up to 10 service users in the category of DE (Dementia under 65 years of age) up to 5 named service users in the category of PD (Physical disability under 65 years of age) up to 12 service users in the category of OP (Older person over 65 years of age not falling within any other category. up to 2 named service users in the category of LD(E) (Learning disability over 65 years of age) 1 named person in the category of LD (Learning disability under 65 years of age) 1 named person in the category of MD (Mental disorder under 65 years of age) 1 named person in the category of MD(E) (Mental disorder over 65 years of age) The main house must not be used to accommodate service users until it has been appropriately refurbished. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The mews building may only be used to accommodate younger adults with dementia - apart from one named person in the category MD and one named person in the category DE(E) as shown above. 8th May 2006 2. 3. 4. Date of last inspection Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 5 Brief Description of the Service: Kirksanton Care centre is owned by Guardian Care Homes and is managed on their behalf by Christine Munroe. Guardian Care Homes own a number of other residential and nursing homes in England. The home has three distinct areas. The older part of the property is currently undergoing renovation and is not occupied by residents. The dining room, main lounge and bedrooms are in the modern extension to this older property. The Mews building is connected to this central part of the home. The Mews is set out as self-contained apartments with their own lounge/kitchen, bedroom and bathroom. Younger people with a diagnosis of alcohol related dementia (Korsakoff’s syndrome) live in this mews building, while older adults, older people with dementia and younger people with physical disabilities live in the main part of the house. Information about the service can be obtained from the home or form the providers website. Charges for care are as follows Older Adults -£363 per week Older Adults - High dependency -£385 per week Older Adults with dementia - £422 per week People with a mental health disorder - £353 per week Younger Adults with dementia - £531 per week Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key inspection of the year. The first key inspection was held in May 2006 and a further inspection to check out the progress of improvement was held on 29th August 2006. The follow up letter from this visit is not available on the website but copies of this can be requested by contacting the Penrith office. A number of matters of concern were noted in August and action taken. The lead inspector, Nancy Saich, asked the manager for information before the inspection and also sent out questionnaires. These were not received back at the Penrith office. This report is based on what the inspection team saw and heard on the day of the visit. Three inspectors went out to the home, the lead inspector, Cath Wilson and Margaret Drury. They arrived at around ten in the morning and stayed until late afternoon. They spoke to a number of the residents and staff and spent some time with the area manager who was in the home on the day. The registered manager was not in the home on the day but she contacted the lead inspector the next day. The inspectors made their judgements by talking to residents and staff, observing how these two groups were together and by reading files and documents that backed up what they saw and heard. On the 25th October a second visit to the home was made as part of this key inspection. Angela Branch the pharmacy inspector conducted this. She checked out the medication held in the home, spoke to the manager and staff and looked at daily notes and residents care plans. These visits and other information gathered led the four inspectors to make judgements in nearly all areas that showed this home has poor outcomes for residents. There are a number of repeated requirements that still have not been met and the Commission for Social Care Inspection is taking steps to ensure that action is taken in these areas. What the service does well: The home has a good brochure and statement about the care and services they intend to give. A number of residents thought the staff were • • • • “ Very nice”. “Hard working” “Nice to me and help me to manage”. “Friendly and chatty.” Two residents are supported to safely manage their own medication. Some parts of the home are well decorated with nice furniture. Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 7 The company have a business and financial plan that lasts until the end of October 2006. What has improved since the last inspection? What they could do better: The home needs to make sure that any new resident will fit into the home, that they keep within the terms of their registration and that staff are fully aware of the new person’s needs before they come to stay. The registered manager must make sure that the written plans of care help staff to understand exactly what residents want and need and the steps they need to take to make sure this happens. She must also make sure that risks are managed properly to make sure residents can take normal risks in a safe way. The registered manager needs to make sure that she keeps on developing the contacts she has with mental health professionals. She needs to make sure that the medication is handled correctly and that medicines are available when residents need them. The registered manager needs to ensure that care plans with regard to medicines administration are improved so residents needs are met particularly for “when required” medicines. She must make sure that residents have choice as to when they received their medicines. She also needs to help staff to understand why care is delivered in specific ways and make sure she helps them to develop their awareness of what the right approach is when people have difficulties with things like memory and behaviour. The inspectors judged that residents weren’t getting enough outings or activities and weren’t being helped to deal with some of their needs through things like group work. This has been something that the Commission for Social Care has required for at least a year and this still hasn’t been dealt with. The registered manager needs to keep helping residents to have as much choice and control as they can manage. The inspectors thought that there were Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 8 a number of things that could be done with individual and groups that would at least make people feel they had more choice. The food on the day was nicely presented but more work needs to be done on making sure everyone has good nutrition that meets their needs. Some residents said that they wanted more response from the staff when they had ‘grumbles’ or ‘niggles’ about their daily lives. There had been an incident in the home where two people might have been at risk of abuse. This hadn’t been reported to Social Services when it happened. Staff had told the lead inspector but still weren’t sure of exactly how or when to report an incident to Social Services. On the day of the visit some areas of the home were not as clean as they might be. Some repair work hadn’t been done. The call bell system didn’t work for some hours during the day. Some residents had locks on their doors, some didn’t. One person found the lock difficult to use. The staff had locked a fire door as one person was at risk of leaving the house. They did this, as the external doors didn’t have special locks to stop people wandering outside unsafely. One bed needed clean sheets and pillowcases. Residents clothing was hanging up in a corridor. The inspectors felt that staff had a lot of residents to care for as well as other duties to carry out. They wondered whether the roster made the best use of available hours so that residents had enough staff on through out the day. They thought that the company needed to try harder to make sure they recruit good staff that can help with some of the things the home is failing to do well. The registered manager needs to makes sure she works on all the things that are outstanding legal requirements. She also needs to make sure she is leading a staff team who understand what the Commission for Social Care Inspection judge to be current good practice and to act on these things. She needs to use Guardian Care’s quality assurance system to pick up on the things that aren’t meeting good standards of care. She also needs to find ways of involving residents in future planning for the home. The registered manager wasn’t making sure residents money was being handled correctly. The company had looked at this and dealt with some matters but need to make sure this is done correctly. They must help residents to open their own savings account. The registered manager admitted that she wasn’t able to meet with each member of her care team six times a year and that she was behind in the records of these ‘supervision’ meetings. Written records in the office were not all filed away so that things could be found easily. The company need to consider whether they have a home and grounds that are secure and safe for residents and staff alike. The registered manager must make sure that staff don’t lock fire doors and that all stored items are locked away safely and don’t pose a fire hazard. Kirksanton Care Centre DS0000057674.V317188.R02.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.V317188.R02.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.V317188.R02.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. There was evidence to show that the home didn’t always get it right when they were admitting new residents. EVIDENCE: The company had sent the lead inspector a revised ‘Statement of Purpose’. This explains to new residents, social workers and health workers what the home aims to do. This new document had less emphasis on the care of people Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 12 with alcohol related dementia but the home does continue to care for these people. The inspectors met with a number of people who hadn’t been in the home very long. They were concerned because two people had been admitted who might not have been suitable for the kind of care that the staff are able to give. One of these residents had not settled and had to move on elsewhere. A new person was coming to the home the next day and staff knew very little about the needs of this person. They said the manger had been out to see the new resident but there were no notes from her available for them in the file. When the pharmacist visited she noted that there still wasn’t enough information about this person’s health needs to ensure the best care and that there were some difficulties that could have been dealt with before admission. Kirksanton Care Centre DS0000057674.V317188.R02.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 poor This judgement has been made using available evidence including a visit to this service. There are some serious problems related to care planning, medication and the delivery of care that puts some residents at risk. EVIDENCE: Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 14 Each person had a written plan that covered some basic care needs. The inspectors read a good number of these ‘care plans’. They thought that there was a lot of written information and that for some people’s needs the plans were acceptable. They did however think that the plans didn’t give enough direction to staff on what to do when people had complex needs. The care plans fail to help staff deal with things like behaviour and memory problems, emotional needs or working with individuals on future planning. The inspectors also felt that the staff were not really checking if the plans were working. For example some eight or nine months after coming to the home one person still had a plan about ‘settling in’. The inspectors were looking for evidence to show that residents were offered alternatives and that when planned care wasn’t working they tried different things. They did not find much evidence of this happening Plans did show risks but didn’t always show how the staff should manage these risks. This has led to people either having restrictions placed on what they do or being allowed to do things that might be unsafe. Residents do see their doctors and the local district nurses visit. There are some specialists who visit the home to give advice on how to care for people with mental health needs. The inspectors judged that to give the best care there needed to be more input and more advice sought when things were going wrong. Staff weren’t really sure whether this advice had been sought or acted upon for people with mental health needs. The pharmacy inspector went out to visit the home on 25/10/06 and she found that the records for administration of medicines were good so it was clear what residents had been given. If medicines were not given this was usually documented, however, where several medicines were not given the reason was not clear for each one. Medicines that were refused by residents were not clearly recorded for disposal and they could not be accounted for. Sometimes changes made on one record were not transferred to the next record so that residents are at risk of receiving medicines that have been changed or discontinued. Residents were able to look after and administer their own medicines if they chose to do so and where this was assessed as safe. Some medicines were not available when residents needed them and this increased the risk of ill health. For example, medicines were given to a resident that could cause stomach ulcers but the medicine used to protect the stomach was not given for two days because it was not available. Care plans regarding medicines management were often inadequate and did not show how residents’ needs were to be met. This increases the risk to residents’ health from inappropriate treatment or inadequate monitoring. The care plans and daily records poorly described the administration of “when required” sedating medicines and this increases the risk of residents receiving medicines that are not needed or inappropriate. For example, one resident was prescribed a sedative “if absolutely necessary for agitation”. On two recent occasions it was given the records did not say why and on one occasion the record said the resident was “fine”. A resident was prescribed a medicine to thin the blood and prevent clotting. The manager was not aware of the Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 15 reason for this medicine or the risk of bleeding and warning signs to watch for and this must be included as part of the care plan. The same resident had received less stomach protecting medicine than was prescribed for four days further increasing the risk of bleeding. It was not possible to track all changes to residents’ medicines to show they had been checked with a doctor, or other health care professional, and implemented accurately. For example, the records for a resident included a direction from a doctor to reduce and discontinue a sedative some months previously. Current medicines administration records showed that this was still being given and no reason could be found for this. On another occasion the service contacted a resident’s relative to find out if they could increase the dose of a sedating medication but the advice of a doctor was not sought. Residents were not always given their medicines at the time they chose. One resident who was prescribed painkillers “when needed” said that some staff were reluctant to administer them if it was not time for the regular medicines round. A number of residents thought the staff were: • • • • “ Very nice”. “Hard working” “Nice to me and help me to manage”. “Friendly and chatty.” The inspectors did see some polite, respectful, friendly interactions but they saw some interactions that showed that staff weren’t really confident about how to treat people with dementia or learning disability. In the Mews some of the younger adults felt they were always being ‘told what to do’ and staff did feel that this was the best approach. The inspectors judged that the care staff did this in a polite way but needed more guidance about approach and attitude. Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 16 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, 14, 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents in this home don’t have enough activities, entertainments or therapeutic activities to help them have the best lifestyle possible. EVIDENCE: There had been a worker in the home who arranged some activities but this person has left the home. The company are still trying to find a replacement. Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 17 The company has stated that they would provide transport for the residents, as the home is very isolated. They still don’t have a mini-bus or other form of transport. One person said she had given up some of her activities in Millom, as she couldn’t afford to pay taxis back and forward. Some people carried on with their own hobbies and staff did try to provide activities when they could spare the time. Residents said the staff were too busy to do much. The people in the Mews said they hadn’t been out anywhere and weren’t doing anything much. There was a daily rota for household chores and some people said they didn’t want to just do housework. A lot of people said they were bored. At least two people talked about wanting to go for a drink and how they missed going to the pub. There was no evidence to show that any one had attempted to do the kind of work that is needed to help people who suffer from addiction. The inspectors felt that the staff did try to help residents but didn’t really have the kind of expertise they needed. Residents said they didn’t have much say in what went on in the home. There had been some residents meetings but some residents said that the issues they talked about weren’t dealt with. There were no activities programme seen around the home and staff and residents didn’t think there were plans for outings or parties. The staff said they didn’t use any of the special techniques for helping people with dementia and weren’t really aware of how they might start this. There are some people in the home with learning difficulties and one of the inspectors felt that more could be done with these people in terms of communication and activities. One or two residents might benefit from practicing new skills. At least one person hoped to live more independently but there was no plan to check out their skills for living alone. The food served on the day was reasonably well presented and residents thought that the food was fine. The inspectors thought the menus needed to be looked at again just to make sure they were giving real choices and good nutritional balance. They also thought that some people might need nutrition noted in their care plans in a more detailed way. Kirksanton Care Centre DS0000057674.V317188.R02.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, 18 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The arrangements in the home mean that residents may be subject to abuse and staff are not sure of how to deal with this. EVIDENCE: There had been no formal complaints received by the company or by the lead inspector. When the inspectors asked residents they said they didn’t have anything specific to complain about but that some of them had a lot of ‘grumbles’ that they felt weren’t really listened to or acted upon. The registered manager needs to think about how to help people feel less unhappy about day –to-day concerns. Guardian Care has good policies and procedures about how to protect vulnerable adults. Something happened in the home that meant that the manager or the person in charge should have reported the event to Social Services. This only happened after the lead inspector discovered what had happened. She asked staff to report this but they needed a lot of support from the company to carry this out. Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 19 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): 19,22, 26 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Some parts of the home and grounds were unhygienic, unsafe and poorly maintained and could pose a threat to residents’ safety and well-being. EVIDENCE: Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 20 Guardian Care has invested a lot of money in the home and this shows in the décor and the new furniture that has been provided. However some areas of the home are not of a good standard. There was evidence to show that domestic routines need to be stepped up and that maintenance needs to be kept up to date. In the Mews the residents needed more easy chairs in the smoking lounge. This room needed a smoke extractor. The walls and ceiling of this room were badly stained with nicotine and a whole strip of wallpaper was missing. Chairs in the kitchen were dirty and greasy with dropped food and the hot trolley was dirty with old food. The Mews kitchen door had neither handle nor lock but instead had a hole where these should be. Some of the newly painted walls were marked and there was rough plaster in the main lounge. Residents’ clothes are hung up on a rail in the hall. Staff said the night staff put these away so this means that peoples’ dresses and shirts hang on this rail all day near to toilets and with food passing by. Outside there was a store full of old equipment, tools and things like pots of paint. This was unlocked and might pose a fire hazard. One of the inspectors checked on the linen on a bed and the sheets and pillowcases needed changing, as they weren’t clean. A number of residents in the home were at risk of wandering off into the grounds and beyond into the open countryside. None of the external doors are alarmed yet and this means that staff had been forced to lock a fire door to keep one person from being at risk. However this problem has created new problems of fire safety. Not all residents have locks on their bedroom doors. One person had asked for a lock as ‘someone keeps coming in and messing around’. Another person was put at some risk and had their privacy invaded because they didn’t have a lock on their door. The lock that was put on one of the doors was a little difficult for a person with dementia to manage. Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 21 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): 27.29,30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The way the home is staffed means that the hours available are not used to the best effect and this hampers the team in their delivery of quality care. EVIDENCE: The inspectors had a look at the most up to date rosters. Usually there are four care staff and a senior carer on duty. The senior deals with all the medicines for all of the residents. There are at least 23 people with some form of dementia and a number of people who are wheelchair bound and who need help with all personal care. The ten people in the Mews need at least two people to help them get a good quality of life and this leaves two people to deal with 25 older people with Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 22 different problems. The senior carers have to deal with general queries, medicines and written records as well as giving care. The three inspectors thought that staff did try hard but they saw evidence to show that because they had so much to do some things weren’t being done properly. In the afternoon there are five staff and a senior and this helps a bit more but the inspectors wondered whether better use might be made of the available hours. The roster showed that a number of staff still work twelve hour days and the inspectors wondered if this was the best way to cover all hours of the day –especially when most homes have busy times that last for only a few hours around getting up, going to bed, eating meals and during activities. They also discovered that there was enough money to employ someone who could deputise for the manager. During the inspection there was no one in over all charge of the home. Two key jobs – an Activities Organiser and Deputy Manager – had not yet been filled although the home has poor outcomes for activities and the management of the home. Staff had received good levels of training through out the past year. Some staff had really benefited from the training and were able to talk about how they had brought the benefits back to the workplace. Others couldn’t remember much about it and hadn’t had a chance to talk about their development. The inspectors didn’t ask about future training, as they wanted to give the registered manager time to make sure that staff are using their learning in the work place. Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 23 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): Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 24 31,32,33,34,35,36,37,38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The management arrangements in this home are failing to keep residents safe and provide them with good quality care EVIDENCE: There are several issues that the manager is failing to deal with. A number of outstanding requirements from other visits have not been met and new problems have been seen at inspection. The inspectors felt that although the staff were friendly and open they lacked the kind of leadership that helped them to know exactly how things would be managed in the home. Some staff were not quite sure about the philosophy of care, thinking that they had to control some people and needed help to understand how they could give residents their rights but also keep them safe. The whole team needs to look at how and why they give care the way they do. Guardian Care continues to develop a good system so they can make sure that residents get good quality care. There was very little evidence to show that these checks on quality were being done on a regular basis at Kirksanton. If they were then some of the things seen at inspection would have been noticed and put right. The inspectors thought there was scope to involve residents in making more decisions and choices about the home – or for families to be more involved. The home does have a business and financial plan and the inspector has asked that the company review how well this has worked and send the next one to the Commission for Social Care inspection. The inspectors checked on money kept on behalf of residents and on savings for residents. They found a number of things that were not right. They were concerned that some residents still didn’t have their own savings accounts. One person had been discharged and their money was still in the company account. Residents can’t get their own money when the manager or the administrator isn’t in the home as senior carers don’t have access to this money. Guardian Care has looked at the management of money in the home and taken some action but the lead inspector wants them to look again in more depth at how things are being managed. Staff in homes should get the chance to talk to a more senior person at least six times a year. This was not happening. The manager said she hadn’t got round to it despite this being something that the home must do to stay within the law. Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 25 The area manager was in the home on the day and she couldn’t find some of the records that the inspectors needed to look at. This was either because the work hadn’t been done or because the record keeping was poor. There was a lot of paperwork in the office that may have helped with the inspection but it wasn’t properly filed away. There had been a problem with security in the home - especially in the office. There was evidence to show that this had been improved slightly but the inspectors thought the company should do a full security review of the buildings and grounds. The home must also make sure that they follow good fire safety procedures and do not lock fire doors. A fire exit door was locked on the day of the first visit as the staff couldn’t stop someone wandering out of the front of the home. The inspectors judged that health and safety matters were not being managed as well as they might be and they think the company need to look at how things are being organised. Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 26 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 3 2 X 3 2 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 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 1 20 X 21 X 22 1 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 2 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 1 33 1 34 1 35 1 36 1 37 1 38 1 Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 (1) Requirement The registered manager must ensure that new service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party. The registered manager must ensure that the care plan for each person includes enough up to date detail to help staff care for all aspects of a person’s needs. The registered manager must ensure that medicine administration records and disposal records are accurate The registered manager must ensure a continuous supply of medicines The registered manager must ensure that care plans are up-todate and contain appropriate detail relating to medication and health care such as clear documentation of specific health and medication management issues DS0000057674.V317188.R02.S.doc Timescale for action 01/12/06 2. OP7 15(1) & (2) 01/12/06 3. OP9 13 (2) 01/12/06 4. 5. OP9 OP9 13(2) 17(1)(a) 17(3) 01/12/06 01/12/06 Kirksanton Care Centre Version 5.2 Page 28 6. OP9 13(2) 7. OP10 12 8. OP12 16(2n) 9. OP14 13 (4) 10. OP18 13 (6) 11. 12. OP19 OP22 23 (2) (b) 23 (2) (n) updating following medication changes care plans are in place for use of when required medicines including sedatives The registered manager must clearly document, and implement, all medication changes made by doctors or health care professionals responsible for the treatment of residents The registered manager must ensure that staff are guided on approaches to care in the way that is in line with current best practice. All residents must receive appropriate support in social, recreational and leisure pursuits This is an outstanding requirement from 31/08/05 and was extended to 15/08/06 and not met on 29/08/06 or on 16/10/06 The registered manager must ensure that where any restrictions are placed on residents the appropriate documents are in place on individual files. This is an outstanding requirement from 30/06/06and was not met on 30/09/06 or on16/10/06 The registered manager must make sure that any potential abuse is reported promptly and that any member of staff left in charge is confident in how to do this. The registered manager must make sure that the home is safe and well maintained at all times The registered provider must ensure that there are specialist locks (to external doors and DS0000057674.V317188.R02.S.doc 01/12/06 01/12/06 16/10/06 16/10/06 01/12/06 01/12/06 01/12/06 Kirksanton Care Centre Version 5.2 Page 29 13. OP26 23 (2) (d) 14. 15. OP26 OP27 23 (2) (p) 18(1a&b) 16. OP29 18 (1) (a) 17. OP31 9 (2) (b) (1) bedrooms) provided so that residents have privacy and that they are kept safe The registered manager must make sure that there are domestic routines in place that keep the home clean and fresh. The registered person must ensure that there is an extractor fan in the smoking room A review of the staffing arrangements must be completed to ensure there are enough staff on duty and that they are deployed to the benefit of residents (This is an outstanding requirement from 15/08/05 that was extended to 15/08/06 and not met on 29/08/06 or on 16/10/06) The registered person must consider ways to ensure they can recruit staff with sufficient skills, knowledge and experience to give residents a better quality of life. The Registered Provider must ensure that the Registered Manager has sufficient competency and skill to ensure that outcomes for service users are consistently met. The registered person must ensure that their quality monitoring system meets the objective of improving the delivery of care and services. The registered person must send the inspector copies of the statements for the ‘holding account’ for the last twelve months. Guardian Care must provide details of how individual residents money is managed. DS0000057674.V317188.R02.S.doc 01/12/06 01/12/06 16/10/06 01/12/06 01/12/06 18. OP33 24 (1) (b) 01/12/06 19. OP34 25 (2) 01/12/06 20. OP35 20(1) (a) and (b) 16/10/06 Kirksanton Care Centre Version 5.2 Page 30 21. OP36 18(2) 22. OP37 17 23. OP38 23 (4) (b) This must include details of how the ‘holding’ account for personal allowances is managed and how arrangements are made to open individual savings accounts. (This is a repeated requirement with a completion date of 30/09/06) All staff must have detailed, 16/10/06 regular written supervision that addresses all their needs in a timely fashion. This is an outstanding requirement from 31/08/05 that had been extended to 15/08/06 and was not met by 30/09/06 or 16/10/06. The registered manager must 01/12/06 make sure than records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. The registered manager must 01/12/06 make sure that fire exit doors are not locked. She must make sure she has taken advice from the fire officer. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP8 OP15 OP16 Good Practice Recommendations It is recommended that the registered manager works on developing and improving the contacts with local mental health professionals. It is recommended that the home continue to review the menus to ensure good nutritional meals are served and that some residents have nutritional plans in place. The registered manager needs to make sure that residents DS0000057674.V317188.R02.S.doc Version 5.2 Page 31 Kirksanton Care Centre 4. 5. 6. 7. OP19 OP26 OP32 OP38 have a way of having their minor complaints and ‘grumbles’ dealt with. It is recommended that Guardian Care complete a full security review and that the company involve both Crime Prevention and the Fire Service. It is recommended that residents clothing be put away in their own rooms as soon as possible. The registered manager needs to consider whether her approach to the role helps creates an open, positive and inclusive atmosphere. It is recommended that external stores are kept locked to help with safety matters and to reduce the risk of fires. Kirksanton Care Centre DS0000057674.V317188.R02.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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.V317188.R02.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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