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Inspection on 05/03/08 for Kirkstall Court Care Home

Also see our care home review for Kirkstall Court Care Home for more information

This inspection was carried out on 5th March 2008.

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

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

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

What the care home does well

What has improved since the last inspection?

What the care home could do better:

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 5th March 2008 09:25 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.V359757.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.V359757.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.V359757.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 01/02/08 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 older people 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. Copies of inspection reports are also available at the home. 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 by at the March 2008 visit. Fees are reviewed in April each year. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit by two inspectors who were at the home from 09.25 until 17.15 on 5th March 2008. The pharmacy inspector was also at the home from 09.25 until 12.30 on the same day. 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. At the September 2007 visit serious concerns were identified regarding the nutritional needs of people living at the home. We sent a warning letter to the provider telling them what they had to do to put things right. We told the local authority about our concerns. They stopped placing people at the home and put safeguarding procedures in place. People at the home had their care reviewed by the local authority in October 2007 and again in January 2008. Safeguarding procedures were lifted in February 2008. Since September 2007 we have carried out four additional inspections, known as random visits, to check progress in addressing shortfalls. The pharmacy inspector carried out one of these additional visits on 1st February 2008. The reports of these visits are available from us on request. 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. Survey forms were sent out to the home before the inspection providing the opportunity for people to comment on the service, if they wish. Information provided in this way may be shared with the provider but the source will not be identified. A small number of surveys were returned from relatives. Their comments are included in the report. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The appointment of the current manager in November 2007 and her deputy in January of this year has resulted in significant changes seen at this inspection. They have provided stability at the home and clear leadership to the staff. The home now has the foundations in place to develop and improved the service and the quality of life for the people living at the home. • ‘They have had a lot of issues to deal with since they came which they have dealt with, with professionalism, sincerity and thoughtfulness. They make a good team which helps us do our jobs more effectively’ ‘New manager seems to be more determined to get things right’ • The staff have all had training in nutrition and they now understand how to manage this important aspect of care. People were offered snacks and drinks throughout the day and the mealtime was well organised. The food was appetising and clearly enjoyed by everyone. There has been a lot of training for staff and they are generally more knowledgeable about how to look after this client group properly. • ‘We are a good group of workers who care deeply for our residents’ Some work has been started to update and improve the care plans so that staff will have easier access to information on how to look after people. There is a commitment to the involvement wherever possible of the person and/or their relatives in this process. The rehabilitation service provided for people with Korsikoff’s dementia continues to develop. The occupancy levels of this small unit are improving and staff continue to provide a good level of person centred care on this unit. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 7 What they could do better: Whilst the current management team has provided stability in the short-term people have yet to be convinced that this will be sustained. There have been numerous managers over the years and the issue of long-term stability at the home is one that concerns the people living at the home, their relatives and the staff. People said: • ‘often any improvement is short term’ • ‘We have to keep mentioning our concerns over and over again’ The manager will need to continue to develop good reliable communications with people and their relatives so that they are reassured that they are listened to and improvements will continue and be sustained. The continued lack of activities and occupation for people at the home also needs to be addressed. • ‘The lack of stimulation needs to be tackled as a matter of urgency. Many of the residents sit in their chairs all day and apart from going to the table for meals or to the toilet have no conversation or anything to interest them’. An appointment of a member of staff to develop this area had been made subject to satisfactory checks. The manager needs to make sure that this person has the training they need to fulfil this role effectively. There were some areas for improvement regarding the administration and management of medication that the manager was addressing. The improvements in care records need to continue to make sure that peoples’ care needs are clear and staff have the detail they need to look after people properly. Further details can be found in the body of the report. Requirements and recommendations appear at the end of the report. 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.V359757.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.V359757.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. Standard 6 does not apply to this service. (Older people) 2. (Adults 18-65) People who use the service experience adequate quality outcomes in this area. All people have their needs assessed before they are admitted to the home. The written information available to people and their families gives them the information they need to decide if they want to move into the home. We have made this judgement using available evidence including a visit to this service. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 10 EVIDENCE: There have not been any admissions to the older person unit since the last key inspection whilst the home has worked to address the serious shortfalls identified at that time. There have been admissions to the dementia unit and the quality and depth of information collected before people move onto the unit is very detailed. The current manager has been in post since November 2007 and is fully aware of improvements that need to be made at the home. She and her staff are working to improve the information available to people who may be considering moving into the home in the future. The Statement of Purpose and Service User Guide are both being reviewed. There is information about the home in the entrance area including the most recent inspection report. Kirkstall Court Care Home DS0000001350.V359757.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. (Older people) Standards 6, 9, 16, 18, 19 and 20. (Adults 18-65) People who use the service experience adequate quality outcomes in this area. Records do not consistently provide evidence that the healthcare needs of people are met. The lack of detail provides opportunity for the individual care needs of people living at the home to be overlooked. There have been improvements made to storage of medication however some practices still place people at risk of not receiving their medication safely and as prescribed. This may have an affect on their health and wellbeing. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 12 We have made this judgement using available evidence including a visit to this service. EVIDENCE: Champion Crescent. There was some good information in the care plan sampled, which showed how the care given on a daily basis was still effective in meeting the person’s needs. It was clear in these care records that the person living in the unit is in control of his life, makes his own choices and decisions and that staff listen and respond to his concerns. For example, this person told staff that he wanted to see his GP because he felt that his night medication was making him ‘groggy’. A visit was arranged and negotiation between the person and his GP resulted in an agreement to reduce the dosage rather than discontinue the medication altogether. Older Person’s Unit. We received mixed comments from people which could reflect the ongoing concerns about the management of the home and that people need to see consistency and sustainability of any improvement. People said: • • • • • • • • ‘More thought and care should be given to ensure residents are properly and nicely dressed….finger nails kept short and clean. Feet should be washed regularly’. ‘At times when I have been upset and worried by my friends health they have always been very supportive’. ‘The services of a chiropodist are urgently needed’. ‘Meets the minimum physical needs but the staff do not have the time to satisfy any other needs’. ‘Many times I feel she has not had her face washed her hair combed or teeth cleaned, battery changed in her hearing aid or switched on’. ‘It provides someone to be there 24hurs and a trained and experienced nurse is always present’. ‘Lack of communication between carers and/or nurses means that sometimes needs or treatments are not always continued’ ‘If the support and care given when there is an emergency (if a resident is taken ill) was carried through to the daily routine I feel things would improve’. We looked at a selection of care plans and could see an improvement in the level of information recorded in those plans that had been updated. However, there is still much more work to do to bring the care plans to an acceptable level. Daily records are poor because they do not show how the plan of care is being followed and carried out. One person’s care plan stated that she should Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 13 have a weekly bath or a shower and daily bed baths. This person’s relative had concerns that her mother’s personal hygiene plan was not being followed. Poor recording means that the home has no way of disputing this. Another person’s dietary care plan had some good information for staff about offering specific nourishing snacks and drinks. We saw staff offering this person these snacks but information in the daily record was scant stating, ‘diet taken’. The number of people with low weight has reduced and the management of this issue has improved greatly. It was possible to see from records where there was still weight loss that there were reasons for this such as a recent chest infection. The majority of the care plans were dated from 2006 and needed full review and update. One person had spent some time in hospital and there should have been a full review of care needs following discharge back to the home. This had not happened. Work had started on updating everyone’s care plans with the involvement of the person themselves and/or their relatives. It was difficult to determine the effectiveness of the monthly evaluation of care plans because those that had been updated had not yet been evaluated. However, the evaluation of those care plans not updated were ineffective because they did not contain a full review of the person’s care over the previous month. Staff said that they felt care plans had improved in the last three months. They said that these were now easier to read and sequenced so that they knew where to find information. Comments in surveys completed by relatives show concerns about the lack of chiropody treatment for people living in the home. A member of staff said that the home did have problems accessing chiropody treatment for people but this has been rectified. Records showed that a chiropodist has recently visited the home. Other records in people’s care plans showed visits by GPs (General Practitioners) and the community dietician. A letter was seen from the dietician referring to ‘positive outcomes’ for those people were had been referred with serious weight loss after training for staff and the successful ‘implementation of many of the catering guidelines’ recommended. A new member of staff described how she protects the privacy and dignity of people such as speaking to people with respect, closing curtains when assisting people with personal care and knocking on doors before entering a person’s room. One visitor said that she was concerned that her mother’s hair looked unkempt, but another visitor said that things were improving and that any dignity concerns are now the ‘exception rather than the rule’. Other visitors said that people were always ‘nicely’ dressed. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 14 Since the last pharmacy inspection the manager has developed an audit system to check medication administration. This is an example of good practice and helps to make sure that people are receiving their medication correctly. The details required on the audit were not always completed for example the date or total quantity was missing. Staff must understand the importance of completing these forms so an accurate audit can take place. The current and previous months’ Medication Administration Record (MAR) charts were looked at. Since the last pharmacy inspection the use of ticks to record administration of creams has stopped. However the standard of accurate record keeping remains poor. There were a large number of gaps on the MAR charts. The recording and administration of antibiotics for one person was poor. The printed MAR entry had 28 capsules received at a dose of one four times a day. A second handwritten entry was made to record completion of the course. This entry had no medication details such as the dose or name of the antibiotic and the administration times had been written as three times a day. The records of administration against the handwritten entry were three times a day, which means the person was not getting the course of antibiotics as prescribed. There was also a discrepancy in the quantity of antibiotic remaining, the MAR chart had 25 records of administration but only 1 capsule remained. It is important that records for administration are accurate to make sure that medication is given as prescribed. The quantity of medication from one monthly cycle to another is not recorded on the new MAR. This means it is difficult to have a complete record of medication within the home and to check if medication is being administered correctly. One MAR chart had medication not given because there was no stock available. A system must be in place to check the quantity of medication so that a prescription can be ordered in plenty of time to prevent people being without their medicines. The code ‘O’ was still being used on some MAR charts without a definition on the chart to explain why the person had not received their medication. It is important that a clear reason is given so there is accurate information on a person’s medical treatment. The prescriber, who may wish to review the medication, may also use this information. Accurate administration remains poor. For example one person prescribed Calcium tablets morning and evening only had the morning dose recorded as administered. It is important that medication is given as prescribed so that a person’s medical condition is not affected. The date of opening of medicines with limited use once opened is now recorded. However one tube of eye ointment listed on the MAR had a start date of 23 January 2008. Records of administration were made up to 25 Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 15 February 2008, which is 34 days of use. Eye drops and ointment should only be used for 28 days once opened, as there is a risk after this time of bacterial growth making them unsafe to administer. Systems must be in place to make sure that medication is safe to administer. The administration of Buprenorphine patches has improved. The records made in the controlled drugs register show that the patches are being administered as prescribed. The monthly prescriptions are now sent to the home for checking before going to the pharmacy. This is good practice as it helps to make sure the supply from the pharmacy is correct. Kirkstall Court Care Home DS0000001350.V359757.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): 12, 13, 14 and 15. (Older people) 12, 13, 15 and 17. (Adults 18-65) People who use the service experience adequate quality outcomes in this area. People are supported in maintaining contact with their family and friends and visitors are made welcome at the home. People are provided with a nutritious diet. We have made this judgement using available evidence including a visit to this service. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 17 EVIDENCE: Regular visitors to the home said that they were ‘always made to feel welcome’ and there was a pleasant and relaxed atmosphere in the lounge areas. When describing some of the improvements in recent months staff spoke about their training on nutrition. They said that to increase calorie intake they are offering people milk shakes with cream or ice cream. They said that people enjoyed these and this had significantly reduced the amount of prescribed food supplements people needed. We saw staff spending time with people offering snacks and a variety of drinks at different times. Care records showed that people who were previously at risk of poor nutrition are now gaining weight. Three visitors said that the food had improved recently, one said that the presentation of the food was better, another said, “A kitchen assistant now serves food and things seem to be a lot more organised.” One person pointed out a bowl of fresh fruit in the lounge, and another said that people are no longer kept waiting for their lunchtime meal. One visitor said that blended food or soft diets sometimes look unappetising. We looked at the blended food that was served and found that it was nutritious and looked tempting. However, moulds representing the food being served might improve presentation. Some people living at the home said that the menu is changed and they are not told about this until the meal is served. This seemed to be the case on the day of this inspection when the meal served was not the one that was shown on the menu. The meal however, which was sausage casserole, potatoes, broccoli and cauliflower, followed by apple crumble and custard looked appetising. One visitor was offered a meal, which he later said was ‘very tasty’. People living at the home said that they are offered alternative choices, such as a jacket potato, a salad or an omelette. One person refused her meal. Staff were kind and patient, gently encouraging her to think about what she would like to eat. When eventually she asked for some chicken soup, staff quickly went to the main kitchen and organised this. One member of staff spoke about the importance of spending time with people and said that although staffing levels have recently increased a further increase would enable staff to spend more 1-1 time with people. We were told that an activities organiser has been recruited and will start work when all the necessary pre-employment checks have taken place. Comments received by us underline the importance of addressing the issue of occupation and stimulation for the people living at the home. People said: • ‘Residents need to be kept more alert and their boredom relieved in some way’. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 18 • • • ‘Not many residents are in a position to live the life they would choose. Perhaps more understanding of this would help the residents’ ‘The lack of stimulation needs to be tackled as a matter of urgency. Many of the residents sit in their chairs all day and apart from going to the table for meals or to the toilet have no conversation or anything to interest them’. ‘Always made to feel welcome’ People living at the home said that they are free to get up and go to bed when they want. One person said that she likes to be up and dressed early whilst another said that she prefers to stay in bed until 10am. Similarly they all spoke about going to bed at different times. One person however, said that ‘everything is rushed’, and that staff expected her to do things ‘too quick’. There was no evidence of this during this inspection. Staff spent time with people and one care worker said that recent training had made her aware that rushing people was a form of abuse. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 19 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. (Older people) 22 and 23. (Adults 18-65) People who use the service experience good quality outcomes in this area. People living at the home can feel that their views are listened to and taken seriously. People can feel safe at the home. We have made this judgement using available evidence including a visit to this service. EVIDENCE: There are copies of the complaints procedure, in large print, displayed in the home and the manager said that a copy of the procedure has been given to everybody. There was also information available about advocacy services. The manager also keeps a log of any complaints received. Comments we received probably reflect the lack of consistent management at the home over the years. People said: • ‘often any improvement is short term and one has to keep complaining’. • ‘We have to keep mentioning our concerns over and over again’ Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 20 A new member of staff explained how training about different forms of abuse has made her think about the way she works with people and the words that she uses. This person was confident about recognising any safeguarding issues and knew how and when to report any suspicions of abuse or neglect. Following the last inspection local authority safeguarding procedures were put into place. The home has cooperated fully to improve and address concerns. Safeguarding procedures were lifted in January following a further review of the care of people living at the home. A senior care worker on Champion Crescent said that people living in the unit had been included in a recent safeguarding training session for staff. She said that she felt this was a valuable exercise in helping people living in the unit recognise their rights and said that they enjoyed being included. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 21 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. (Older people) 24 and 30. (Adults 18-65) People who use the service experience adequate quality outcomes in this area. Overall, people live in comfortable and safe surroundings although some areas are in need of refurbishment. We have made this judgement using available evidence including a visit to this service. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 22 EVIDENCE: Champion Crescent provides a comfortable environment for the people there for rehabilitation. The conservatory has ramped access to the attractive paved area that has raised flowerbeds. Blinds have not yet been provided for the conservatory, which gets very hot in sunny weather. There continues to be 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. The manager spoke of plans to provide French doors and a patio, hopefully in time for the summer. The manager also spoke of general refurbishment plans including new carpets for the corridors and a new front door. A number of beds in the home have been replaced and those beds that were seen with bed rails that were integral to the bed. By re-arranging furniture in one lounge, staff have created a small, homely, family type room that increases interaction between people. Visitors said that they were pleased with the changes and said that they felt staff are now ‘more motivated’ and had recognised that by moving furniture they could create a better environment for people. A visitor in another part of the home said that she has noticed an improvement in the cleanliness of the home. We saw staff wearing protective clothing and using hand-washing gel when necessary. One new staff member said that she has had training on hand hygiene. The laundry area was clean and tidy and looked well organised. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 23 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. (Older People) 32, 33 and 35. (Adults 18-65) People who use the service experience adequate quality outcomes in this area. People are looked after by a trained and knowledgeable work force. Overall, the numbers, skill mix and deployment of staff makes sure that people needs are consistently met. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Care workers said that staffing levels, both nursing and care staff, have improved recently. There are now usually two nurses on shift, but because of annual leave there was only one at the time of this inspection visit. The manager said that a bank nurse had been contacted but was unable to work. More bank staff have been recruited and are awaiting completion of preKirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 24 employment checks. This will help to make sure that staff numbers are maintained at an appropriate level and any shortfalls through sickness or annual leave are covered. Some comments received again reflected the lack of consistency and clear leadership at the home over the years. People said: • ‘Some of them do their best but this is not continued by other staff who need more training and this leads to a drop in standards’. • ‘Some of the carers are brilliant but they are let down by the ones who need to have more commitment and TRAINING. There is a training plan in place that covers all mandatory topics. Staff are enthusiastic about training and observed practices demonstrated the positive effects of training. Staff were knowledgeable about care needs and practices. People said: • ‘We are a good group of workers who care deeply for our residents’ • ‘Staff are encouraged to partake in all training’ A new care worker confirmed that she completed an induction programme and initially worked alongside a more experienced worker. She said that whilst waiting for her pre-employment checks to be completed she attended some mandatory training sessions such as safeguarding and moving and handling. Although only in post for 4 months she is now registered for NVQ (National Vocational Qualification) level 2 and two other staff members were proud to have completed level 2 and enthusiastic about starting level 3. A sample of staff files was looked at and good recruitment practices were in place. Induction training is under review although a basic programme is in place. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. (Older people) 37, 39 and 42. (Adults 18-65) People who use the service experience adequate quality outcomes in this area. The new manager has provided stability at the home as well as clear direction and leadership to make sure that the home is run in the best interests of the Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 26 people living there. We have made this judgement using available evidence including a visit to this service. EVIDENCE: Mrs Karen Overend has been managing the home since November 2007. She is an experienced nurse and manager and has been registered with us previously. She is applying to be registered as manager of Kirkstall Court and must make sure that her application is received by us without delay. Since January 2008 she has had the support of a full time deputy and the positive effects of a consistent and clear management team are beginning to be seen at the home. People said: • ‘Whatever it takes to keep them here. We need the stability they are giving us’ • ‘They have had a lot of issues to deal with since they came which they have dealt with, with professionalism, sincerity and thoughtfulness. They make a good team which helps us do our jobs more effectively’ Care staff said that they feel the manager and her deputy are approachable and listen to what they have to say. They said that they have regular staff meetings and are asked to contribute to the agenda. They also said that the manager and deputy manager know what is happening in the home and if staff are very busy they are not afraid to help out. During this visit the manager assisted staff at lunchtime and seemed to lead the team by example. Three visitors said that staff are now listening and acting on what relatives have to say. People said: • ‘New manager seems to be more determined to get things right’ There is a system of in-house audits, which are used by the manager to monitor the service and facilities at the home. In addition the provider carries out the required regular monthly visits and produces reports, which are available at the home. A full audit was carried out in February 2008 over a two day period. Meetings have been held recently with relatives and people living at the home. The notes of these meetings demonstrate openness about issues affecting the home. Staff meetings are also held and notes are also kept of these meetings. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 27 The manager now has 33 hours of administrative support, which enables her to concentrate on her managerial responsibilities of improving the quality of life for people living at the home. Small amounts of money are handled for a small number of people and clear records are kept. Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 28 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 2 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Requirement Medication must be administered as prescribed and an accurate record made each time that it is given. This will make sure that people receive their medications correctly and the treatment of their medical condition is not affected. Timescale of 01/03/08 not met. A system must be in place to check expiry dates of medicines and to add the date of opening when necessary. This makes sure medication is safe to administer Timescale for action 06/05/08 2 OP9 13(2) 06/05/08 3 OP31 Timescale of 01/03/08 not met. CSA The manager must make sure Part II, that her application to be section 11, registered as manager of the paragraphs home is submitted to the CSCI (1) and (5) without further delay. (a) 06/05/08 Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 30 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 OP7 Good Practice Recommendations Work should continue to make sure that information about people’s care needs is available to staff so that people are looked after properly. Otherwise care needs could be overlooked. Wherever possible people and/or their representatives should be involved in the development of care plans. 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. Codes used to record why medicine administration has not taken place should be clearly defined so detailed information on a person’s medical treatment can be obtained. The quantity of medication that is carried over from the previous month should be recorded on the MAR chart. This helps to know how much stock there is and when checking if medication has been given correctly. Areas of the older persons unit are in need of decoration and some refurbishment. This work needs be done to make sure that people continue to live in comfortable surroundings. Accessible outdoor space should be provided for people living on the older persons unit. 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 OP9 4 OP9 5 OP19 6 OP33 7 OP35 Kirkstall Court Care Home DS0000001350.V359757.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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.V359757.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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