Inspection on 04/09/07 for Kirkstall Court Care Home

This inspection was carried out on 4th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Kirkstall Court Care Home 09/02/09

Kirkstall Court Care Home 05/03/08

Kirkstall Court Care Home 11/09/06

Kirkstall Court Care Home 02/11/05

Kirkstall Court Care Home 10/05/05

Kirkstall Court Care Home 11/11/04

Kirkstall Court Care Home 22/04/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Kirkstall Court Care Home 119-129 Vesper Road Leeds Yorkshire LS5 3LJ Lead Inspector Catherine Paling Key Unannounced Inspection 4th September 2007 10:10 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 Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kirkstall Court Care Home Address 119-129 Vesper Road Leeds Yorkshire LS5 3LJ 0113 2591111 0113 2257444 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) Dukeries Healthcare Limited vacant post Care Home 38 Category(ies) of Dementia (8), Learning disability over 65 years registration, with number of age (1), Old age, not falling within any other of places category (30), Physical disability (1) Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The place for LD(E) is specifically for a named service user. The place for PD is specifically for the service user named in connection with the variation application dated 25.6.4 11th September 2006 Date of last inspection Brief Description of the Service: Kirkstall Court is a purpose built home, dating from 1991. The current providers have been registered since June 2000. The home provides personal care with nursing for up to 30 men and women, over 65 and very much serves its local community. In addition there are 8 places for the rehabilitation for under 65s with alcohol related dementia. Accommodation for people is provided over three floors with single rooms, all of which have en-suite facilities. There are two passenger lifts, one of which goes to all floors with the second going to the first floor. The home is on the main bus route into Leeds city centre, four miles away. It is also close to local shops and a post office. The local pub is a short car journey away, close to Kirkstall Abbey and museum. There are seating areas outside the home, which are accessible to people by means of a ramp. Information about the home and services provided are available in the form of a statement of purpose and service user guide for the elderly unit and for the dementia care unit, which is known as Champion Crescent. The current scale of charges range from a minimum of £436 on the elderly care unit and from £750 for Champion Crescent. This information was provided at the visit in September 2007. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit and two inspectors were at the home from 10.10 until 17.00 on 3rd September 2007. One inspector visited the home again on 4th September to complete the inspection visit and was at the home from 09.55 until 15.50. As part of the inspection process an ‘expert by experience’ was also at the home on the 4th September from 10.20 until 14.00. An ‘expert by experience’ is a person who has experience of using a service. Because of this they can help an inspector get a picture of what it is like to live in the home. They produce written information for the inspector some of which is included in this report. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. A number of documents were looked at during the visit and all areas of the home used by the people who lived there were visited. A good proportion of time was spent talking with the people at the home as well as with the manager and the staff. An Annual Quality Assurance Assessment (AQAA) had been completed by the home before the visit to provide additional information. This is a selfassessment of the service provided. Survey forms were sent to the home prior to the inspection for the manager to distribute providing the opportunity for people at the home; visitors and healthcare professionals visiting the home to comment, if they wish. Information provided in this way may be shared with the provider but the source will not be identified. A number of surveys were returned and comments are included in the body of the report. What the service does well: The home is well placed within the local community and there is a range of local amenities within easy reach. This is of particular benefit to those people admitted to the Champion Crescent unit for rehabilitation. The staff are pleasant and welcoming and relate well to people who live at the home. Visitors are made welcome at the home throughout the day. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 6 Accommodation is provided in single rooms with en suite facilities. What has improved since the last inspection? What they could do better: The home remains without a registered manager. The current manager is the third since September 2006 and has not yet applied for registration with the commission for Social Care Inspection (CSCI). The constant changes in management at the home mean that staff do not have clear and consistent guidance and there is a lack of continuity for the people at the home. Of serious concern at this inspection were problems with diet and fluid provision for people on the older persons unit. People were not being provided with enough diet and fluid throughout the day. For some the gap between their evening meal and breakfast could be up to 18 hours. Fluids were not freely available and there were no nourishing snacks. The management of diet and fluids needs to be reviewed to make sure that people have enough to eat and drink. Admission documentation was incomplete and this means that there is a risk that care needs could be overlooked. The manager needs to make sure that full details about people are available so that people can be confident that their need can be met at the home. Some changes have been made in the care records but further work is needed to make sure that staff have enough information to care properly for people. The manager also needs to make sure that they provide clear evidence of the care that is provided. The manager and the provider need to review the staffing levels and skill mix. Care staff were not being properly supervised by the nursing staff. This means that people are at risk of not having their care needs properly met. Staff need to be provided with the training in areas such as nutrition of the frail elderly so that they understand peoples’ needs and look after them properly. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 7 The concerns about nutrition had been raised at the inspection of September 2006. After that inspection the manager at the time produced an action plan that was not implemented. Following this inspection a safeguarding meeting was held involving the local authority and the home produced an action plan. The CSCI have taken legal advice and enforcement action is planned to make sure that the nutritional needs of the people at the home are met. Other requirements and recommendation have been made and appear at the end of the report to address other shortfalls. 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. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 8 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) Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 9 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): 3 (Older people); 2 (Adults 18-65). (Standard 6 (OP) does not apply to this service) People who use the service experience adequate quality outcomes in this area. People are provided with information to enable them to make an informed choice about the home. Incomplete documentation means that there is a risk that the care needs of people moving into the home could be overlooked. We have made this judgment using available evidence including a visit to this service. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 10 EVIDENCE: Information provided by the home manager in the AQAA said that there was an up to date Statement of Purpose and Service User Guide in the older persons unit and Champion Crescent, the dementia unit. The most recent inspection report was also readily available in the entrance area. It was also said that there was an ‘extensive pre admission assessment tool incorporating social needs as well as care needs’. The records of two people who had recently been admitted to the older persons unit were looked at. One person had been admitted in June 2007. The local authority assessment document was dated August 2005, therefore the information was not up to date. The assessment referred to the person needing home care support, when in fact they had been transferred from another care home. The manager said that she had carried out a pre-admission assessment but this was not in this person’s individual care file and the manager was unable to produce it. Records completed on admission were incomplete, for example there was no information about their religion and no information about who should be contacted should they become ill or have an accident. The nurse or carer completing this record had circled YES to the question ‘Can these people be contacted at night’, which is confusing when the people had not been named or identified. There was a good life history of the person but the personal life plan, which should have included information about likes and dislikes, preferred days and times for bathing and ‘what I want from people who support me’ had not been completed. In the case of another person who had been admitted from outside the area there was information from the placing authority. The manager said that a senior nurse from the company had carried out a pre-admission assessment but there was no record of this in the home. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 11 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 and 10 (OP); 6, 9, 16, 18, 19 and 20 (Adults 18-65) People who use the service experience poor quality outcomes in this area. Records do not provide evidence that the healthcare needs of people are met. The lack of detail and difficulty in accessing the relevant information within records provides the opportunity for the individual care needs of people living at the home to be overlooked. The lack of medication update for nurses and some practices put people living at the home at potential risk. We have made this judgment using available evidence including a visit to this service. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 12 EVIDENCE: Information provided in the AQAA stated that comprehensive care plans are produced and that residents health care needs are fully met. However a significant number of people at the home were found to be underweight and several had been identified as having skin damage. Concerns raised about the nutritional management of people living at the home had been raised in the report of September 2006. A sample of care records was looked at. Some changes have been made since the last inspection but it was clear that a great deal of work has yet to be done to make sure that these documents are an accurate reflection of care and are seen and used as working documents by the staff. Risk assessments are in place including a nutritional risk assessment, a falls risk, the risk of skin damage, the use of bed safety rails as well as for manual handling and moving. The nutritional risk assessment did not provide clear information about the risk or clear instruction about what action to take. In one person’s records the nutritional risk assessment had been completed on admission in June 2007, and had not been reviewed. This person had had a significant weight loss in August, which had not led to a review of the nutritional risk assessment and the care plan had not been updated. There was no evidence of any investigation of the weight loss. The dietary care plan says that nutritious snacks should be offered between meals but there was no detail about the type of snacks and there was no record of these being offered. The dietary care plan was not dated and had not been evaluated. There is a plan in place for continence management that notes that after consultation with the General Practitioner (GP) this person would be cutting down on dairy products to see if this improved loose bowel movements. There was also an instruction to ‘ensure high fluid intake to try and prevent UTIs’ (urine infections). There was no detail about what constitutes a high fluid intake, or how it would be monitored or recorded. None of this information appeared in the dietary care plan. This person had been identified as being at high risk of skin damage and there was evidence of the tissue viability nurse (TVN) being involved to advise on a grade 2 pressure sore. This had now healed but the wound care plan was still in place. This plan should be removed and a prevention plan put into place. One carer said that this person usually went to bed in the afternoon to relieve the pressure on their bottom, but wanted to stay up today to listen to the Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 13 entertainment. The effect of this was that this person sat in the same position in the chair all afternoon. Bed safety rails were in use and a risk assessment was in the records. However, this was undated and unsigned. Only one section was completed which asks whether the bed rail was the most appropriate solution to prevent a fall from bed. The ‘YES’ response was circled with no further details, as the rest of the form had not been completed. Bed safety rails were in use for another person. In this case there was a specialist overlay mattress in place as part of the plan for the prevention of skin damage, which is placed on top of the ordinary mattress. This has the effect of making the bed high and higher bed safety rails are needed. The risk assessment asked the question ‘do the dimensions and overall height of the mattress compromise the safety of the bed rail – is an extra height bed rail needed?’ The nurse carrying out the assessment had responded ‘no’. The safety of this person was compromised as an ‘extra height’ safety rail was needed. There was a care plan in place for pressure area care. This plan and the other for this person were undated and unsigned. The plan gave instructions to check that the specialist mattress was on the correct setting but did not say what this should be. The mattress was set for someone with a weight of between 70 and 100kgs, the person weighed 50kgs. The continence management care plan made reference to an indwelling catheter. There were no instructions about how to care for this, the size or how often it should be changed apart from ‘to have a high fluid intake’. There was no indication of how much fluid was needed and how this would be monitored. There was no information about fluid intake on the nutrition care plan. Daily records note that one person was a smoker. There was no risk assessment in place and no care plan showing where they smoked or the amount of support and assistance needed. One recent entry stated ‘has burns on right middle finger – (the person) says these are cig burns’. This suggests that this person had been left to smoke unsupervised. Observation of this person throughout the afternoon indicated that this is unsafe practice. Care plans were written in the first person but did not appear to be written in language that might be used by a person living at the home. For example, ‘I am sometimes confused and need to be encouraged to eat/drink an adequate nutritional diet by measuring before and after eating and drinking’ and ‘to check and monitor my skin integrity’. Care plans included an instruction to evaluate ‘monthly’. This is vague and had not happened in many cases. Where evaluation had been noted it was not effective and did not constitute a full review of the effectiveness of the plan of care over the previous month. For example, ‘no change to assessment’. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 14 There continues to be information about areas of care relevant to all people at the home included in individual files. For example, respecting residents’ privacy and safe medication practices. These are fundamental and staff should be working to clear and robust policies and procedures, which should reflect such basic expectations of staff. As previously identified this has the result of making it hard to access the specific detail and information about care needs. People at the home have access to other healthcare professionals and records are kept of GP visits. Surveys returned from healthcare professionals who visit the home included comments such as the need for ‘better nursing; better nutrition; better respect’. A small number of relative surveys received did provide some positive comments; ‘My aunt is very happy with her care and very content’ and ‘Staff are very caring towards my aunt and always look after little things’. Observations and records provided evidence of a significant number of people at the home who were seriously underweight. Over half the people living on the older person’s unit weighed less than 50kgs with a number of those weighing less than 40kgs. Concerns were raised at the inspection of September 2006 about the number of underweight people at the home. An action plan put into place by the provider at that time has not been effective. The standard of recording in individual care records on Champion Crescent was high and demonstrated person centred care with a detailed record of needs, clear rehabilitation plans and the progress made. A recent report to CSCI had been made regarding a serious medication error, which, although not initially the fault of the home, had not been picked up by nursing staff as quickly as it should have been. The appropriate action was taken by the home and the local Primary Care Trust has been involved. Observed medication practices were satisfactory. The nurses are responsible for the administration of medication but there was no evidence at the home of regular update for the nursing staff. The most recent were dated 2005. The manager said that she was accessing update via the pharmacist and that they had conducted a recent medication audit. The manager said that repeat prescriptions were sent directly from the GP surgery to the chemist. This is poor practice and should be reviewed. All scripts should be checked and signed at the home before being sent to the chemist for dispensing. The medication room that was re-sited last year remains in need of decoration. The medication fridge is badly positioned directly next to the hand washbasin next to the wall. This means that it has to be pulled partly off the side to gain access to the lock at the side. The flex to plug it in has to go around the Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 15 washbasin where the electrical socket is sited, at the side of the sink. This is a serious health & safety risk. Kirkstall Court Care Home DS0000001350.V347127.R01.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): Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 17 2, 13, 14 and 15 (OP); 12, 13, 15 and 17 (Adults 18-65) People who use the service experience poor quality outcomes in this area. The provision of diet and fluids is not adequate and people are at risk of dehydration and malnutrition. People are able to maintain contact with family and friends. Records and practices mean that religious and cultural needs are at risk of being overlooked. A range of activities is provided taking into account the needs of some of the people at the home. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information provided by the manager in the AQAA said that there was an activities person employed and some activity took place every day. The activities person is also the hairdresser and also provides eleven hours of administrative support to the manager. She said that she had not had any specific training in the development of activities for this client group. A weekly programme was seen and includes activities in the morning and afternoon. External entertainers are provided and one of the people at the home provides musical entertainment twice a week on his accordion. People living at the home said that they enjoyed the musical entertainment. Activities take place in the downstairs lounge and although some people are brought downstairs to join in there is little stimulation for those preferring to sit upstairs. The activities organiser said that she was at a loss of the type of activity to offer to the mentally frail people who remained upstairs. Visitors are welcomed at the home at any time and many take advantage of this either for convenience or to provide support for their relative over a mealtime. Peoples’ religious and cultural needs were not always recorded. The daily records for one person showed that relatives have been asking about Holy Communion. Information recorded on admission about religion and whether they were practising or not was blank. There was no care plan for spiritual, cultural or religious needs. Comments received from relatives through surveys said that there was a good atmosphere at the home and that activities were well organised. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 18 There was a wider range of activities for individuals on Champion Crescent as part of the individual rehabilitation programmes. These included swimming and theatre trips. The people living on Champion Crescent have some involvement in the development of their own menus and the preparation of their food. However, the absence of proper kitchen facilities for their use does limit this. The manager identified in the AQAA that over the last twelve months the menus had improved, that fortified snacks were now provided between meals and drinks were regularly available for people on the older person’s unit. She also stated that plans for further improvements included staff training in nutrition and maintenance of good nutrition and fluid intake. During the visit the provision of diet and fluids was observed closely in view of the number of underweight people at the home. The management of diet and fluids was poor and had not improved since many of the same issues were identified at the inspection of September 2006. On the first day of the visit there was no cook on duty and the manager was in the kitchen. At 10.50 one person was sat alone at the dining table with a cooked breakfast and a hot drink in front of him. After he had struggled for some time he asked for his bacon to be cut up. An agency carer was working unsupervised in this lounge/dining area. She had only worked one other shift at the home. She did not know the names of people sitting in this area. This service user struggled to eat his breakfast making several attempts to get the fork to his mouth but his bacon and egg fell off the fork. He was clearly in need of assistance. The agency member of staff who was working unsupervised failed to see this. After half and hour this person had only eaten about a quarter of his meal and his drink was cold and the meal was taken away. Initially he looked hungry and was really trying to eat and with proper support would probably have eaten much more. He had not had anything to drink. A regular member of staff confirmed that this would have been the first food offered since teatime the previous day. At lunchtime the same person was sat at the dining table, asleep, and had his meal placed in front of him. A visitor asked the carer to help him. The carer spoke to him asking him to eat and then walked away. He did not eat anything. This person’s care records showed that he had a urine infection and was on antibiotics. His daily records for this day said ‘meals and fluids encouraged’. On the second day of the visit the Expert by Experience observed the same person trying to eat his breakfast at 11.30 and he refused his lunchtime meal. The nutritional risk assessment for this person indicated a reducing risk. Observation indicated he was at nutritional risk and was not having sufficient diet and fluids. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 19 The daughter of one person who preferred to stay in her room said that one day last week staff forgot to bring her breakfast. Nobody had realised until 10.45am when her daughter arrived to visit. The person was unable to call and tell staff herself as the call bell had not been left within reach. The call bell lead was seen tied around the side of the bed near the wall, out of reach. On the day she did not have her breakfast until 10.45 she said that it had been a long time to go from teatime the previous day. She said that supper drinks are offered depending on which staff are on duty and it was just tea or coffee, never a milky drink. Another person was brought into the dining area by a carer in a wheelchair. The carer put a protective tabard on her without any explanation. A bowl of porridge was given to her at 11.00 and a cup of tea. She was eager to drink and her lips were cracked and dry. She was helped to eat her porridge and then left her with two quarters of a sandwiches and a beaker of tea. She only ate part of the sandwich as the rest was out of her reach. The remaining food and drink was taken away without any further encouragement to eat or drink. A supplement drink had been brought to the table at the same time as her breakfast. It remained unopened and was not given to her when she was taken away from the table. This person was not brought to the table at lunchtime and was given a plate of dinner to balance on her knee. This meant that she had to balance the plate and eat her meal with a spoon. There was no evidence of her food being supplemented. This person had a very low weight. Records of food and fluid intake did not include records of any supper, nutritious snacks or supplements. They were not specific about what was actually eaten. Another fluid chart in her bedroom showed that supper consisted of a drink of tea or water and that her fluid intake was higher during the night than in the daytime. It was of concern to see people serving out lunch for their own relatives. This is poor practice. One person, not a carer took food to someone who was not her relative and returned very quickly saying ‘she doesn’t want it’. It seems clear that staff are not proactive in making sure that people receive enough diet and fluids. The liquidised option for people was all mixed together and then poured from a jug into bowls. This produced a brown ‘mush’ that looked unappetising and did not give people the opportunity to experience different flavours or to establish exactly what people had eaten. The quality of the food had improved since the last inspection and people at the home said it was better. However some people said that it was always sandwiches for tea and choice was limited. One person said ‘they can’t get the basics right’. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 20 Staff, including catering staff, had not received any training in the nutritional needs of the frail elderly. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 (OP); 22 and 23 (Adults 18-65) People who use the service experience poor quality outcomes in this area. Complaints are not always dealt with appropriately and people living at the home cannot always feel that their views are listen to and taken seriously. Some practices and the lack of staff training in adult protection procedures put people living at the home at potential risk. We have made this judgment using available evidence including a visit to this service. EVIDENCE: According to information provided in the AQAA all the residents have a ‘voice’ and the home will listen and act to resolve issues immediately. The manager also referred to the weekly Residents Forum. Notes were seen of these meetings and gave clear evidence that issues are not dealt with promptly with the same issues appearing in the notes week on week. Survey information also gave a mixed picture of how aware people are of the complaints procedure. Those on Champion Crescent gave a positive response Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 22 saying that ‘on the whole’ they could approach staff at any time and had been told about the complaints procedure. Responses from relatives and people on the older person’s unit suggested that not all were aware of the procedure but most would just tell someone if they had a complaint and ‘so far concerns have been dealt with promptly’. During the course of the visit comments were made saying that there was no point saying anything as nothing changed. Records of the Residents Forum supported this view. The complaint procedure is displayed in the entrance area but it is small print and easily overlooked. The manager said that there had not been any complaints since she came into post in May 2007. The complaints log showed one complaint since the last inspection concerned with missing items of clothing. It had been resolved properly in the end but had not been well handled by the previous manager. Information gained through the course of the inspection suggested that not all complaints and incidents were being recorded. For example, there was an incident that should have been reported to CSCI and could have resulted in a safeguarding referral. The AQAA states that all staff have had adult protection training. However, training records do not support this. Certificates in staff files about adult protection training did not include information about the course content or who delivered the training. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 23 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 and 26 (OP); 24 and 30 (Adults 18-65) People who use the service experience adequate quality outcomes in this area. The home is in need of decoration and some furnishings need replacing. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 24 Although a refurbishment programme was only completed last year the overall impression is that the home is in need of redecoration. Surveys returned commented on the need for decoration and new dining and lounge furniture for the older person’s unit. The carpet in the upstairs lounge was stained. There is no access to the garden from the older person’s unit and plans to provide a patio area and access doors off the main lounge have not materialised. The gardens around the home are overgrown and do not provide a pleasant outlook. One survey stated ‘No garden or access to outdoors…this is important…people of all ages need fresh air and the outdoors’. Champion Crescent provides a comfortable environment for the people there for rehabilitation. The conservatory has been replaced and there is ramped access to the attractive paved area that has raised flowerbeds. Blinds should be provided for the conservatory, which gets very hot in sunny weather. Overall the standard of bed linen was poor with thin and torn sheets and bedding seen in use. Pillows were stained and in one case chair cushions were on a bed under a pillow. A number of profiling beds have been purchased and following feedback about bed safety rails a further six were ordered, to be delivered before the end of the week. It was hoped that this would also address the problem of some replacement mattresses being too long for the bed bases. Staff were double bagging clinical waste but there were some poor practices seen regarding infection control. Un-bagged pads were seen being stored down the side of toilets and bar soap was seen at the sink in the medicine room. Toiletries were seen stored in one shower room together with a large tub of unnamed E45 ointment, suggesting communal use. One communal bathroom was being used for storage of seven boxes of pads. One sluice room as out of order and had been for some time. The ventaxia was out of order in the other sluice room, which smelt. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 (OP); 32, 34 and 35 (Adults 18-65) People who use the service experience poor quality outcomes in this area. The numbers, skill mix and deployment of staff does not guarantee that people needs are consistently met. The staff are not always being provided with the right level of training to make sure that they can look after the people at the home properly. We have made this judgment using available evidence including a visit to this service. EVIDENCE: There was one nurse on duty for the day shift with five carers in the morning and four in the afternoon. One nurse and two carers covered the night shift. Agency staff are used to maintain these levels. The home manager works Monday to Friday. It was not clear why there was a reduction of one carer in Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 26 the afternoon. Following feedback to the operations director she instructed the manager to increase the afternoon staffing so there would be five carers throughout the day. The care staff are supported by a team of domestics and a handy man. An activities person is employed for twenty two hours a week. This person also provides hairdressing services and eleven hours of administrative support to the manager. There is one full time cook and a care worker who has a background in catering has recently been moved to work in the kitchen. There was no kitchen assistant. On the first day the cook was off and the manager was cooking. Since the current manager started work at the home she has had to address some difficult and longstanding staffing issues. These have now been resolved and the manager said that she is now in the process of recruiting more staff. Records demonstrated that good recruitment procedures are followed and all the required checks are carried out before a new member of staff starts work at the home. Over the course of the visit there were long periods of time when people were left unsupervised, particularly in the upstairs lounge. Care staff also appeared to be working without supervision of the nurse in charge. Comments received through surveys and on the day raised general concerns about the number of staff and how they are deployed. • ‘The care staff on the whole are very good but ……they are working under pressure…..residents needing to wait for attention. Looking at carer/residents ratios would be a good idea’. • ‘I have had to wait about 20mins to be assisted to the toilet’ • Improvements would be – ‘increasing staffing levels’ • ‘Sometimes agency staff on duty and I do not know if their training is correct’. There were some positive comments about the care staff: • • ‘The carers I know are skilled and experienced’. ‘The normal staff do listen and act, the agency staff tend to ignore me’. In the light of these comments and our observations the provider has been asked to review staffing levels, skill mix and the deployment of the staff throughout the day. Staff training records were looked at together with a spreadsheet provided by the manager. Moving and handling training was done by means of staff watching a video, which means there was no practice component. Two people had a certificate of attendance at Protection of Vulnerable Adults (POVA) Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 27 training session. The certificates did not include any detail of the course content, or who delivered the training and was therefore of dubious value as evidence of training. The spreadsheet indicated that not all staff have done moving and handling or safeguarding adults training. There was no record of anyone having had training on infection control, dementia training or the safe handling of medication. Only two staff had completed food hygiene training and none of the staff including the catering staff had had training in the nutritional needs of the frail elderly. Not all staff have had fire training as required. The manager acknowledged that the training records were confusing and hard to follow as the spreadsheet did not correspond with other records. Out of the twenty one care staff employed, fourteen have achieved a National Vocational Qualification at level 2, or above, in care. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 28 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): Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 29 31, 33, 35 and 38 (OP); 37, 39 and 42 (Adults 18-65) People who use the service experience poor quality outcomes in this area. The instability of the management of the home means that staff are not provided with clear, consistent leadership and that there is no continuity for the people living at the home. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The current manager has been at the home since May 15th 2007. She is an experienced nurse and holds the Registered Managers Award (RMA). She has yet to register as manager with the CSCI. Following this inspection a letter was sent to her reminding her of the legal requirement to register. There have been numerous managers at the home and this manager is the third since the inspection of September 2006. Comments received from healthcare professionals visiting the home describe the effect of this constant change: • ‘They have had a lot of problems recently. I’m hoping the new manager may be able to turn it around – but they have had countless managers in the last few years – no stability in nursing staff and questionable competency in many of the nurses. However, there were positive responses from people who said that it was ‘far easier to get information since the new manager took over’. The new manager said she was aware of the shortfalls at the home and had produced a confidential report of her concerns for the operations director. A full audit of the home was carried out in July 2007. The subsequent report and action plan also identify the problems at the home. The AQAA completed by the manager prior to this visit did not reflect any of this and the information provided was misleading. The company has appointed a support manager and she also produces reports on behalf of the provider as required under regulation 26 of the Care Homes Regulations 2001. There is also a clinical development manager who, as part of her responsibilities, has audited the care plans. The manager has little administrative support. The activities person provides eleven hours of administrative support. Some people’s monies are handled at Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 30 the home, these are mainly concerned with payment for hairdressing and chiropody services. Clear records are kept. There is a resident’s forum that meets on a weekly basis. Notes of these meetings are kept and demonstrate that the same topics appear on a regular basis without being resolved. These topics include maintenance issues as well as some care issues. For example, problems with the plumbing and the use of agency staff. Records were seen of a resident and relatives survey carried out in May 2007. There was overall satisfaction although there were some comments about having to wait too long to go to the toilet and the menu being repetitive. The in house audit carried out on 27th July 2007 identified many areas of concern. Several of these issues were identified as still being of concern at this inspection. For example, people being left with food and drink and not being given assistance. An action plan had been produced but it had not been effective at addressing concerns around nutrition. There is a call system at the home. However, there is no means of staff being able to communicate between the floors or with the kitchen. This means that staff spend time having to leave the floor if they need to summon help or to get alternatives for people to eat at mealtimes. The manager said that training was up to date but records did not provide evidence of this. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 31 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 2 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 2 STAFFING Standard No Score 27 1 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 X 33 2 34 X 35 3 36 X 37 X 38 2 Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 15 Requirement Information about people’s care needs must be accessible to care staff to make sure that people are looked after properly. Otherwise care needs could be overlooked There must be evidence that people and/or their representatives are involved in the development of care plans. 2 OP8 12(1)(a) Timescale of 15/01/07 not met. The registered provider must make sure that the staff are able to effectively assess and manage the nutritional needs of the service users. Failure to do this means that the health and welfare of people living at the home is at risk. The complaints procedure must be made accessible and be available to everyone. This will make sure that if people are not happy with any aspects of the service they know how to complain and who to complain to. All complaints received at the DS0000001350.V347127.R01.S.doc Timescale for action 07/01/08 12/11/07 3 OP16 22 10/12/07 Kirkstall Court Care Home Version 5.2 Page 33 4 OP18 13(6) home must be properly recorded. Records must be kept to demonstrate that they have been dealt with properly. The provider must make sure all 05/02/08 staff have received appropriate training in relation to adult protection. 03/03/08 5 OP19 Timescale of 05/02/07 not met. 23(b)(d)(o) Areas of the older persons unit are in need of decoration and some refurbishment. This work must be done to make sure that people continue to live in comfortable surroundings. 6 OP27 18 Accessible outdoor space must be provided for people living on the older persons unit. The staffing arrangements must 01/11/07 be reviewed to make sure that there are enough staff and the right skill mix to meet the needs of the people living at the home. This must also include a review of how staff are deployed and supervised to make sure that staff are working effectively for the benefit of people at the home. Arrangements must be made to make sure that all designations of staff have received the training they need to meet the needs of the people living at the home. This is to make sure that that there is proper provision for the health and welfare of people living at the home. The manager must make application to the CSCI without DS0000001350.V347127.R01.S.doc 7 OP30 18 12(1)(a) 03/03/08 8 OP31 CSA Part II, 30/10/07 Kirkstall Court Care Home Version 5.2 Page 34 section 11, paragraphs (1) and (5) (a) further delay to be registered as manager of the home. Timescale of 30/10/06 not met. 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 OP3 Good Practice Recommendations Pre-admission documentation should be available at the home. Admission documentation should be fully completed to make sure that care needs are not overlooked. Guidance and advice should be given to the activities organiser to help her provide stimulation and activities for those less able people living at the home. In the interests of infection control, continence products should not be stored at the side of toilets. Systems should be in place for proper maintenance of equipment used for odour control. The outcome of audits carried out as part of the quality assurance programme should be shared with all interested parties. Action plans produced to address shortfalls should also be made available. Consideration should be given to invoicing residents for hairdressing and chiropody to keep the holding of peoples’ money at the home to a minimum. 2 3 OP12 OP26 4 OP33 5 OP35 Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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. Kirkstall Court Care Home DS0000001350.V347127.R01.S.doc Version 5.2 Page 36 - 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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