CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE
Kirksanton Care Centre Kirksanton Millom Cumbria LA18 4NN Lead Inspector
Nancy Saich Unannounced Inspection 8th May 2006 10:30 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.V289262.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People 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.V289262.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kirksanton Care Centre Address Kirksanton Millom Cumbria LA18 4NN 01229 772868 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) www.guardian-care.com Guardian Care Homes (UK) Limited Mrs Christine Marina Munroe Care Home 43 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (11), Old age, not falling within any other of places category (18), Physical disability (4) Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 43 service users to include: - up to 11 service users in the category of 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 4 service users in the category of PD (Physical disability under 65 years of age) - up to 18 service users in the category of OP (Older person over 65 years of age not falling within any other category. 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 younger adult category PD does not apply to the Mews building, which may accommodate younger adults (DE) only with the exception of the named condition below. Two named service users in the categories of DE(E) (Dementia over 65 years and OP (Older person over 65 years of age) may be accommodated In a double room within the Mews building included within the overall number of registered places. 19th October 2005 2. 3. 4. 5. Date of last inspection 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 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 now 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 live in this mews building, while older adults, older people with dementia and younger people
Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 5 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.V289262.R01.S.doc Version 5.1 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced ‘key’ inspection. The lead inspector Nancy Saich was accompanied by Margaret Drury, Inspector on a site visit on 8th May 2005. The lead inspector also asked the home for information prior to the visit and asked that questionnaires be returned. The questionnaire return was poor and the manager only provided some of the information that had been requested. During the visit to the home both inspectors toured the building, talked to most of the residents individually or in groups and spent time with the staff on duty. They spoke to the manager during the visit. They read documents and files that backed up what was said and what they saw. What the service does well: What has improved since the last inspection?
The home is now much better at making sure they only admit people who are in the categories they are registered for. They make sure that they can give new residents the care they need and that they will fit in with the rest of the residents. The written plans that show how residents want to be cared for are much better in that they give lots of details of how to look after the whole person. There had been an improvement to the way the home organised outings and activities for some of the residents. (They do need to keep working on this and this is discussed in the next section) The home has also improved the way they ask people what they want and need. The residents have a little more contact with the local community and there are more opportunities for people to have contact with their families. The staff have really improved the way they deal with complaints and how they protect people from abuse. Residents said they could relax and not worry because they trusted the staff to give them this kind of help. Guardian Care have invested time and money into making the home much nicer for residents. The bedrooms, lounges and dining rooms have been redecorated and new furniture bought. The improvement here has been very dramatic and residents said they loved their nicely furnished and decorated rooms. The home was much cleaner and tidier than it was in the past and residents were happy with the general cleaning routines.
Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 7 The company and the staff team are now much better at measuring what the residents think are matters relating to quality in the home. Health and safety arrangements have improved in relation to fire and food safety and the general maintenance and upkeep of the home. What they could do better:
The home now needs to make sure that one person has support from the local mental health team. Serious errors in medication were found during the visit and this means that residents are not as safe or cared for as they should be. The manager must make sure that residents get their medicines in the way that the doctor has prescribed, that all tablets are accounted for and that the staff sign for all the tablets they give to residents. The home needs to keep on improving things like activities and lifestyle choices for all individuals so that every person has activities and choices that match their age and physical or mental health problems. Some residents have restrictions on certain aspects of their lives. There may be good reasons for this but the home needs to make this very clear to the residents and staff and have paperwork that backs up why the restrictions are in place. The menus need to be looked at again so that residents’ nutritional needs are met and that individual needs are catered for. The shared bathrooms in the house have been redecorated but some do not have matching bathroom suites and suitably adapted and up to date baths and hoists. Improving these would make a difference to residents’ comfort and wellbeing. The garden still needs to be landscaped so that residents can have safe and attractive grounds to spend time in. Guardian Care need to review how they staff this home and need to look at how many staff they need to care for the people who live in the house and how many hours they put into activities. The manager had not taken up two references for a new member of staff. She must always do this before a new member of staff works with vulnerable residents to make sure there are no risks involved in letting any new person into the home. Some things seen during this ‘key inspection’ showed the inspectors that the manager had made some important changes in the home. There are a number of areas where work still needs to be done to make sure residents get the best possible service. The company needs to continue to give her support so that she can manage the home to the benefit of the residents. The manager and the company need to improve the way they deal with residents’ money as currently there are mistakes and problems that might mean residents are not being protected financially. Staff were not getting the opportunity to sit down with their supervisor to talk formally about their work. This hadn’t been done for six months although there had been a lot of changes in the home during this time. The manager must Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 8 make sure that all staff are given this support so that they can develop as workers and give residents the best care possible. 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. Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 9 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.V289262.R01.S.doc Version 5.1 Page 10 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 to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The manager now only admits new residents who she is sure she can care for and who will fit in with the existing groups. EVIDENCE: This home was subject to a statutory requirement notice that included an unmet requirement about Standard 3. This requirement is now judged to have been met. The two inspectors spoke to the most recently admitted residents and read their care files. They found that the files were detailed and that the manager had considered the persons need before admitting them to the home.
Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 11 New residents had been seen by a social worker. People with a mental health need had a diagnosis from a psychiatrist or a psychiatric nurse. There were no new residents who did not fit into the registered categories of the home. Residents said that they or their families had been given the chance to visit the home before they came in and their first few weeks were considered to be a trial period. One person who did not want to stay in the home had an advocate and a social worker and was being helped to look at future plans. Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 12 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 to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There have been improvements in the way care is provided but the serious problems with medication mean that resident’ safety and well being are at risk. EVIDENCE: Unmet requirements about Standard 7 and 8 in the past have meant that the home has been subject to enforcement action. Standard 7 has been met but
Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 13 there is still a concern about one person’s care and this means that Standard 8 remains unmet. The inspectors read a number of the written plans that describe how residents want and need to be cared for. They looked at five plans in a good deal of depth. These written plans had improved since the last inspection. Residents were much more aware of their plans and they gave staff very specific things they had to do. One particular plan was very detailed about how to help a person with behavioural difficulties. Residents said that they saw the doctor or nurse when they were ill. A G.P visited on the day and was happy with the way things were in the home. The inspectors judged that most residents were getting good health care. People with mental health needs were seeing the psychiatrist or the community nurse on a regular basis. However one person with a mental health problem had still not seen a psychiatrist. The inspectors looked at how the home manages medicines on behalf of residents. They found that although some medication was being ordered, stored, given out and disposed of correctly there were two major errors found. One person had been given their tablets wrongly. This medicine was very strong and the resident had been given too much on at least two occasions and had an effect on the resident. The other error showed that either the resident had not been given an important drug every night when they should have or that the night staff had not signed for this tablet. Unfortunately because the record showing how many tablets had come in to the home was not right it was difficult to see what had gone wrong. This may have had a very serious effect on the person. Residents said that staff treated them very well and the inspectors saw a group of staff who were kind, considerate and respectful. None of the residents had any problems with the staff and said they were “lovely”, “kind”, and “excellent”. Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. 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 the service. The home has improved activities for residents but needs to keep on looking at how they help people to make choices that will improve their lifestyles EVIDENCE: This home has a complex mix of residents who all have very different needs. Some residents said they were a little bit bored and the younger adults in the Mews were keen to talk in a group about their previous problems with alcohol.
Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 15 Some people wanted a lot of activities and had to go out of the home to meet their needs. The inspectors watched the activities organiser and thought she was working really well with the residents but that due to her part time hours and the needs of all the different people in the home the activities still don’t meet the claims that the home has made about being “ a specialist unit for people with Korsakoffs…” They also felt that special activities were needed for other individuals with learning disabilities or with mental health needs. There was still a problem with transport for residents but Guardian Care say that they will shortly be providing the home with a mini-bus so that the residents can go out when they wish. There is an outstanding requirement in place about activities that was part of enforcement action. This has still not been met fully and the company must take further action to make sure that they comply with this so that all of the residents get the right kind of activities to help them to live a fuller life. Residents said they were happy with the way they were being asked about their needs and choices. They said that they were asked daily and could go to residents meetings and that staff asked them about their care plans. Residents said they had more contact with the local community and there was evidence to show that the staff were helping people to have meaningful contact with partners and family members. Some residents weren’t sure that they could control their lives as much as they wanted. One or two people said they wanted meals in their rooms and sometimes staff didn’t want this to happen. Residents in the Mews said they were not allowed cigarette lighters. The inspectors thought that if there were genuine reasons for these restrictions then the paperwork needs to back it up and this wasn’t in place. The residents were happy with the food and said that they had enough choice. Younger people in the mews were able to make themselves snacks in between meals in their new kitchen. The inspectors saw a record that showed what foods the residents had been given and they judged that the menus might be a little more varied. The manager may also want to look at ways to improve the diet for people who are either over or under weight or who have previously had bad eating habits due to drinking too much alcohol. This is the second time that this has been recommended and the company representative said that improved guidance was going to be introduced shortly. Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has really improved how they listen to residents concerns and how they protect them from harm. EVIDENCE: There had been no formal complaints about the home since before the last inspection. Residents had no major complaints. They said they would talk to staff or the manager or the person who came from the company. All staff had received training about abuse and they all had a good understanding of how to protect vulnerable people. Standard 18 had been subject to enforcement action but the inspectors judged that because staff knew what they were about and new policies were in place this outstanding requirement had been met. Residents said they were listened to and that staff acted on their worries. They all said that there was nothing unpleasant going on in the home. Two people had need of special protection and this was written into their plans and staff managed this well. Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 17 Staff had also handled a resident with some behavioural problems in a very positive and protective way so that both the person and the other residents were properly protected. Residents wanted this to be mentioned in the report. Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Once the garden is landscaped and bathrooms improved this home will have a very good environment. EVIDENCE: Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 19 In the past this home was in a very bad state of repair and décor and was, in some areas, quite dangerous for residents. Guardian Care has made tremendous changes in terms of safety and standards. They have made some bedrooms much bigger and put in lovely ensuite showers and toilets. They have redecorated all bedrooms, shared areas and halls in the main building. They were in the process of replacing the bathroom suites in all of the apartments in the Mews and the manager said that the Mews was to be decorated and new carpets laid. All of this has led to a very nice home for residents and they are all happy with the work that has been done. At the last visit in March 2006 the lead inspector and her manager told Guardian Care that they had done so much work they judged that the requirements on the environment had been met. It was therefore unfortunate that the company had not refurbished the bathrooms in the main house to a good standard. The bathroom suites did not match – with white baths and avocado sinks and cisterns painted white over avocado. The old overhead hoist was still in place as was an old drop sided bath. Staff said that people with dementia used this bath and the inspectors thought that some people would not recognise this as a bath. These rooms need to be improved and a new requirement was made. The garden still needed landscaping work. The manager said this was planned for the middle of May so the timescale for this improvement has been extended. Residents were happy with levels of hygiene and the way their clothes and bedding were washed and ironed. In general the home was cleaner and tidier than it had been in the past. Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. 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 the service. Staffing provision may not always meet the changing needs of a complex group of residents. EVIDENCE: The inspectors asked the residents and staff about staffing levels. The people who lived in the Mews thought that two staff on duty by day meant they were cared for well and had plenty of time for them. Some people wanted more time from the activities organiser. The people who live in the main house have a mixture of mental health or learning disability or physical disability. Some people are frail due to age or ill health. The house was filling up and there were more residents than there had been at the last inspection. Residents and staff thought that now was the time to increase the staffing hours. The inspectors agreed with this and want to see a review of the staffing in the house.
Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 21 The residents were very happy with the staff team and they thought they were very caring and ‘well trained’. A good proportion of staff are qualified in care at level 2 or 3 of the National Vocational Qualification. One person’s recruitment had been done well but another had a problem in that references hadn’t been taken up in a thorough way. The manager must make sure she protects residents by completing all the necessary checks before staff start to work with vulnerable residents. The home had been subject to a legal requirement about not meeting staff training. This had been met in terms of the training of staff in looking after people with dementia and dealing with behavioural problems but still need further training on understanding other types of mental health and learning disability. One or two matters were noticed that made the inspectors question whether staff competence was always dealt with in the best way. This is discussed under Standard 36. Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Some of the management systems in the home had improved but staff need more formal supervision and there are problems with the way residents money is handled. Both these things may have an effect on residents care.
Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 23 EVIDENCE: Christine Munroe manages the home and staff and residents spoke well of her. She has a registered managers award at NVQ level 4 and is currently working on a certificate in dementia care. She is a person of good character and integrity. Inspectors judged that ‘getting to grips’ with managing a care home has been demanding for her. The inspectors judged that she had moved the home on in many ways and that she was open and able to talk about her weaknesses and her strengths. They judged that Guardian Care need to continue to support and guide her in the management task until such time as the home has better outcomes for all the residents. There was plenty of evidence around the home to show that things like residents meetings, care plans and checks on all the systems were been routinely done so that quality could be measured. The company have a new quality system that everyone was working on. The inspectors looked at the money held on behalf of residents. Two of the accounts looked at showed that money hadn’t been accounted for properly. These records didn’t show a second person witnessing what was taken out on behalf of the resident. Arrangements for residents’ savings weren’t satisfactory. All of this means that the way residents finances are handled needs improved. The inspectors looked at a number of staff records and found that none of the staff had met with their supervisor on a formal basis for six months to talk about how they do their job and what they need to do it better. New staff had not had this formal ‘supervision’. They also judged that the records from November 2005 did not give enough details of either very good work or problems staff might have. Again this might mean that residents’ care is not as good as it could be as staff need good direction and guidance. The records about fire and food safety were checked and these were now in order. There were no hazards seen on the day of the visit and things like infection control were being looked after properly. Staff were working on their certificates in health and safety. Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 24 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 X 2 X 3 3 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 2 22 2 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 3 34 X 35 1 36 1 37 X 38 3 Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 25 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 OP8 Regulation 13(1b) Requirement The registered person must ensure that all residents receive appropriate health care including psychiatric care. This is an outstanding requirement from 31/08/05 that has been extended. The registered manager must make sure that residents are given medication at the times, amount and frequency that has been prescribed and that all medication is always properly accounted for. All residents must receive appropriate support in social, recreational and leisure pursuits This is an outstanding requirement from 31/08/05 that has been extended. The registered manager must ensure that where any restrictions are placed on residents the appropriate documents are in place on individual files. All bathrooms and toilets must have good quality fixtures and fittings that meet the needs of residents.
DS0000057674.V289262.R01.S.doc Timescale for action 15/08/06 2 OP9 13 (2) 30/06/06 3 OP12 16(2n) 15/08/06 4 OP14 13 (4) 30/06/06 5 OP21 23 (2) (j) 30/06/06 Kirksanton Care Centre Version 5.1 Page 26 6 OP22 23 (2) (n) 7 OP27 18(1a&b) 8 OP29 19 (4) 9 OP30 18(1c) 10 OP31 10 (1) 11 OP35 25 (3) 12. OP36 18(2) All the hoists and other equipment used for assisted bathing must be reassessed and replaced where they are found to be inappropriate for the dignity of residents. 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 has been extended New staff must not start to work with residents until two appropriate references are taken up. A revised training plan must be provided showing how staff will be trained in understanding the needs of people with learning disabilities and the needs of people with functional and organic mental illness This is an outstanding requirement from 31/08/05 that has been extended. Guardian Care must prepare a management plan that will ensure that the manager is able to fulfil her job role. Guardian Care must complete a full audit of the money held on behalf of residents. This must include arrangements for savings accounts. All staff must have detailed, regular written supervision that addresses all their needs in a timely fashion. This is an outstanding requirement from 31/08/05 that has been extended. 30/06/06 15/08/06 30/06/06 15/08/06 30/06/06 30/06/06 15/08/06 Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 27 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 OP15 Good Practice Recommendations It is recommended that the home review the menus to ensure that choices are both nutritionally sound and significantly different to allow for real choice. Kirksanton Care Centre DS0000057674.V289262.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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