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Inspection on 09/02/09 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 9th February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

The provider wrote in the AQAA- "1. Providing a homely atmosphere whilst providing for the clinical need of the people who reside with us. 2. Rehabilitating people with ARBI back into the community 3. Maintaining good relationships with the people who use our service, including purchasers and relatives. 4. We have a positive and open atmosphere where everyone is treated equally" 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. There are good links with the local college for people to access relevant courses. The staff are pleasant and welcoming and relate well to people who live at the home. Visitors are made very welcome at the home. There is good support at the home from other healthcare professionals. The GP visits every week and the community matron also provides regular support. This means that people`s healthcare care needs are met. Staff understand the importance of nutrition for the elderly and snacks and drinks are provided, including home baking and smoothies. People said"Staff are generally helpful" (privacy and dignity) "is high priority to management and staff at Kirkstall Court" "xxxx usually eats well"

What has improved since the last inspection?

The provider wrote in the AQAA- "1. We have introduced dental care for all residents 2. We have introduced oral hygiene and foot-care care plans 3. We have improved the overall service we give to people with dementia 4. We have increased the morale of staff which has directly affected the overall care delivery. 5. We have greatly improved the way we listen and respond to service users and relatives/significant others. 6. We have improved the overall environment for all of our residents and visitors." There is now access to a decked area from the main lounge on the older person`s unit, which is a significant improvement. The provision of activities has improved and there is a regular programme for people living at the home. The provider has looked at ways of making training more accessible. e-learning now takes place and means that staff have the knowledge they need to look after people properly.

What the care home could do better:

The provider wrote in the AQAA- "1. Produce better documented evidence that we do the job we say we do. This will be developed in regards to policies and procedures andthe way staff understand these, training feedback, for example. We envisage that this will involve checklists and getting staff to sign these to indicate understanding. We will then change the format of our supervision forms to address further knowledge issues. 2. We still need to improve the P.A.L system and we are committed to carry this through. 3. We need to improve the way we address individual`s spiritual needs and to ensure that these are met in a more individualised way." The manager has continued to provide stability at the home. However, there have been changes of personnel in key posts over the year as well as a number of new care staff. This means that people who are familiar with the home have yet to be fully convinced that this will be sustained. Efforts need to continue to make sure that stability and consistency is maintained for the people living at the home. Care records need to be reviewed to make sure that they provide detailed and relevant information. This is so that care needs are not overlooked by staff and that there is evidence of the care given to people. Staff need to be provided with update and guidance on using tools for risk assessment to make sure that they are used effectively. This is to make sure that care needs are not overlooked and that any identified risks are minimised. Staff need to make sure that food diaries contain full information about people`s intake. This is to make sure that people`s nutritional needs are properly met. Requirements and recommendations appear at the end of the report.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kirkstall Court Care Home 119-129 Vesper Road Leeds Yorkshire LS5 3LJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Catherine Paling     Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Kirkstall Court Care Home 119-129 Vesper Road Leeds Yorkshire LS5 3LJ 01132591111 01132257444 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dukeries Healthcare Limited Name of registered manager (if applicable) Mrs Karen Elaine Overend Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of users who can be accommodated is: 38 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: either whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Physical disability - Code PD Dementia Code DE Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 4 of 32 care home 38 Over 65 0 30 0 38 0 1 Brief description of the care home Accommodation for people is provided over three floors with single rooms, all of which have en-suite facilities. There is a passenger lift providing access to the upper floors. 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 427 pounds and 67 pence on the elderly care unit up to 800 pounds on Champion Crescent. This information was provided at the February 2009 visit. Fees are reviewed in April each year and the home should be contacted directly for up to date information about charges. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our 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 one inspector who was at the home from 09:50 until 16:45 on the 9th February 2009. 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. Care Homes for Older People Page 6 of 32 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 deputy manager, the staff and the provider. An Annual Quality Assurance Assessment (AQAA) had been completed by the home before the visit to provide additional information. This is a self-assessment of the service provided. Survey forms were sent out to the home before the inspection providing the opportunity for people at the home, visitors and healthcare professionals who visit 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 by the time of this visit. Comments received appear in the body of the report. The last inspection of this service was 3rd March 2008. What the care home does well: What has improved since the last inspection? What they could do better: The provider wrote in the AQAA- 1. Produce better documented evidence that we do the job we say we do. This will be developed in regards to policies and procedures and Care Homes for Older People Page 8 of 32 the way staff understand these, training feedback, for example. We envisage that this will involve checklists and getting staff to sign these to indicate understanding. We will then change the format of our supervision forms to address further knowledge issues. 2. We still need to improve the P.A.L system and we are committed to carry this through. 3. We need to improve the way we address individuals spiritual needs and to ensure that these are met in a more individualised way. The manager has continued to provide stability at the home. However, there have been changes of personnel in key posts over the year as well as a number of new care staff. This means that people who are familiar with the home have yet to be fully convinced that this will be sustained. Efforts need to continue to make sure that stability and consistency is maintained for the people living at the home. Care records need to be reviewed to make sure that they provide detailed and relevant information. This is so that care needs are not overlooked by staff and that there is evidence of the care given to people. Staff need to be provided with update and guidance on using tools for risk assessment to make sure that they are used effectively. This is to make sure that care needs are not overlooked and that any identified risks are minimised. Staff need to make sure that food diaries contain full information about peoples intake. This is to make sure that peoples nutritional needs are properly met. Requirements and recommendations appear at the end of the report. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with enough information about the service to help them make an informed choice about moving into the home. People have their needs assessed Evidence: The provider wrote in the AQAA - 1. We ensure that prospective residents have a well planned admission wherever possible. Relatives are encouraged to accompany residents and spend time helping them settle in. 2. We have a comprehensive service user guide which is specific to both the elderly and the younger clients we have at the home. 3. We always insist on a copy of the prospective residents care plan and wherever possible, a more comprehensive assessment. The latter is especially important within our rehabilitation service for people with Alcohol Related Brain Injury. 4. Residents are encouraged to participate in the assessment process. All prospective residents are seen by either the Home Manager or the Deputy Manager prior to admission. Information is gathered from a variety of sources wherever possible and Care Homes for Older People Page 11 of 32 Evidence: the people who contribute to the assessment are documented. 5. Prospective residents are encouraged to spend time in the home. This is sometimes not possible if they are hospitalised for medical reasons. As Champion Unit takes residents from a wide area of the UK residents nearly always visit us first so they can get a feel for the service we provide and also to meet with staff and peers. All prospective residents are discussed with the care team to ensure that staff feel able to meet the persons needs. On this basis, some admissions are not taken. 6. Individual members of staff are allocated to new residents so that they can begin to feel comfortable about their new surroundings. 7. Contracts are given to all residents, and a copy is contained within the service user guide. The contract gives information regarding the fees charged. We looked at the admission process for someone recently admitted to the older persons unit. The pre-admission assessment format was a detailed document but was not fully utilised. The information recorded for this person was brief and did not provide full detail of the care needed. A further assessment is completed within 48 hours of admission to the home which is then reviewed and updated every 3 months. The information we saw on this further assessment was not specific enough in some areas. For example, needs assistance to use was recorded about getting to the toilet without full detail of the sort of assistance needed. Information about the home was currently under review and we were told that it would be produced in a more user friendly format to make sure that information about the home is accessible to everyone. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information in the care records does not always provide clear evidence that care needs are understood and met. This means that there is a risk of care needs being overlooked. People are protected by safe medication procedures. Evidence: The provider wrote in the AQAA - 1. Our care planning documentation is simple to use for care staff, and it covers all aspects of the ADL. We refer to both strengths and weaknesses of individuals. Care plans are written for each need and evaluated every month or sooner if the need is more acute. 2. People at the home are supported to take risks in their daily lives. We do this by involving as many people as possible to allow residents to make informed decisions and also by ensuring that risks are appropriately documented. 3. The Assessment includes the 6 strands of diversity which are gender, age, sexual orientation, race, religion and disability. Part of the assessment includes a comprehensive life history. 4. We record how an individual prefers to communicate and ensure that this is written down in care planning documentation. We include individuals relationship circles and staff may also be Care Homes for Older People Page 13 of 32 Evidence: included within them should the resident or relative wish. 5. Relatives are all aware that they can access care plans and we ensure that this is facilitated at all times with the approval of the resident themselves. We have a notice to this effect in our service user guide and also on our residents notice boards. 6. Residents are encouraged to attend recruitment interviews and ask questions. Their views are taken into account when considering prospective employees. 7. Aids used at the home are continually assessed to ensure that needs are being met. Specialist advice is sought to ensure we use the equipment effectively. 8. Residents are encouraged to manage their own healthcare, including dental care and GP visits. Residents can choose their own GP and have access to all facilities within the NHS that are provided by the community. We arrange for healthcare professionals to attend the home if the resident is unable to attend a clinic. 9. We have a robust medicine administration policy and staff are trained in order to ensure that they are competent to take responsibility in this area. We also ensure individuals are regularly assessed using the company competency for medicines administration. Medication is audited weekly to ensure compliance to local and company policies. 10. The wishes of individuals about dying and terminal care are discussed as openly as possible and are planned for should the resident or family wish to do so. Staff can refer to many religious beliefs within the care manual which assists them to understand many individuals needs with respect to diet and dying for example. Facilities are provided to allow relatives to stay at the home if they wish to be present at a family members bedside, and they are also encouraged to help with the care that they receive. We looked at a small sample of records from both the older persons unit and from the dementia unit. Champion Crescent - The sample of records we looked at were detailed and showed the involvement of the person in their care and rehabilitation. There was information about targets for the person to work towards and we saw reviews of care. Care plans include clear instructions about care so that staff know how to support the person. Risk assessments had been completed and there was evidence of input from other healthcare professionals such as the general practitioner (GP) and community nurses when necessary. Older persons unit - We saw care plans in place for people that are written following the activities of daily living. There have been attempts in developing a more person centred approach to the care planning. However, staff need further training and support to fully understand the process. They need to make sure that care plans make sense and provide clear information of how to care for someone. Care plans are written by staff in the first person making statements about the individuals care. For Care Homes for Older People Page 14 of 32 Evidence: example, As I am having vascular dementia Im prone to confusion so I might not be able to use call bell. This person would not have described their condition in this way. The plan should have described the effect of the confusion and given staff guidance on how to support and monitor this person when they were not able to call for assistance. This person has been at the home for sometime and staff should know his preferences and the help and support he needs. The records did not provide evidence of their knowledge and how they look after him. Another person told us about their personal circumstances which had a clear impact on their health and wellbeing. This person did not think staff were aware and we did not see detail in their care records. We saw care plans that were undated, some that were unnamed and others not signed. There was a range of risk assessments in place. Staff need ongoing guidance on the completion and scoring of the risk assessments to make sure that they use these tools effectively. For example, one risk assessment for skin damage did not make any reference to a broken area to the buttocks that was noted on the manual handling assessment. This person was also very restricted in their mobility and had been underscored. There is a risk of care needs being overlooked if these tools are not fully utilised. People do have their health care needs met. The general practitioner (GP) visits the home every Thursday and the community nurses also provide support. The community matron also visits the home regularly. There is still a small number of people with low weights. They are being managed with the involvement of the GP and dietician. Staff have also had training and food diaries are kept for those most at risk. The food diaries are detailed for the daytime but do not record any intake at supper time or overnight. In addition, it is of some concern that refused or sleeping was recorded for someone at breakfast time when the food diary suggests that they had not had any food or drink since tea-time the previous day. People said - (Do staff listen and act on what you say?) Varies depending on staff member Staff are generally helpful (privacy and dignity) is high priority to management and staff at Kirkstall Court We saw staff approach people in a patient manner and dignity was respected. We saw safe medication practices. All aspects of medication administration is monitored internally by means of an audit. Any shortfalls indentified through the audit Care Homes for Older People Page 15 of 32 Evidence: were highlighted for the staff to act on. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported in maintaining contact with family and friends and to make choices. People are provided with a good and varied diet that takes into account individual choices. Evidence: The provider wrote in the AQAA - 1. Users on Champion Unit develop their own activities plan and lead groups such as angling and rambling. We enable younger adults to achieve their goals, follow their interests and be integrated into Leeds, in a way that is directed by the person rather than the staff. 2. The goal on all care plans is to respect individuality, choice, and dignity. This is central to the service we provide. Staff are aware of the need to promote human rights within the home and we have a high number of staff at the home who possess NVQ level 2 or more. 3. We include many activities into our home life, which includes domestic activity such as cleaning and washing up. 4. Residents on Champion Unit are supported to be as independent as possible and take responsibility of cleaning, shopping and budgeting, even if this means they will need a lot of support to do so. 5. Meals at the home are very nutritious and cater for a wide range of tastes and dietary requirements including vegetarian, vegan and diabetic. We have fresh fruit available on all units in the home Care Homes for Older People Page 17 of 32 Evidence: and residents are supported to help themselves to this and other snacks. Meals are unrushed, and seen as central to the residents day. We endeavour to provide flexible meal times. Those who require support to eat get the assistance they require, however, residents are encouraged to eat independently wherever possible whilst being able to rely upon staff should they need it. Kitchen staff have access to NACC policies to ensure high quality food is provided for a variety of individuals. 6. Residents are involved as much as possible within the local community such as attending church, and local facilities such as parks and the cinema. This fosters good relationships with neighbours and other community members. People who live on Cahmpion Crescent are encoraged to spend their time in a productive way as part of their rehabilitation programme. They are given some household tasks on a rotational basis to help them re-learn life skills. The unit has had a change of leadership and has a more procative feel. Each person has scheduled activities which include computor courses at the local college, excercise classes and courses such as Food for Life. People who live on the older persons unit are supported in making choices about how they spend their time. Some people were having their breakfast at 10:30. Whereas this seemed to have been their choice staff need to be mindful that the main meal of the day is served at luchtime and if people have their breakfast too late they may not be able to eat a big meal at lunchtime. During the morning people were offered drinks, home made buns and smoothies. There were no staff in the downstairs lounge supervising people for significant periods of time. The televison was on but people did not seem to be interested. There is an activities organiser but he was on leave at the time of our visit. Displayed information and Newsletters provided evidence of activities taking place at the home. On the day of the visit there was musical entertainment during the afternoon which people enjoyed. The range and provision of activities does seem to have improved with a variety of organised activities available. The provision of stimulation for less able people still needs to be addressed. The lunchtime meal was relaxed and unhurried with people able to eat at their own pace. The food looked good and people seemed to enjoy it. Regular visitors to the home felt that there have been improvements at the home with the current manager. People said Care Homes for Older People Page 18 of 32 Evidence: Very occasionally (activities you can take part in) xxxx usually eats well Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an accessible complaints procedure at the home that is made available to everyone. People are protected by safeguarding procedures. Evidence: The provider wrote in the AQAA - 1. We welcome complaints and suggestions about the home, and however trivial, we will ensure issues are followed up to a satisfactory conclusion for all parties concerned. 2. Staff at the home take residents opinions seriously and strive to respond to their issues. 3. The complaints procedure is at reception. It is available in larger print within the service user guide. 4. Each complaint made is fully investigated and the complainant is supplied with a full report following conclusion of the investigation. 5. The home keeps records regarding the nature and incidence of complaints as part of the audit process, so that we can pay attention to any themes within complaints such as care issues for example. 6. Policies and procedures regarding safeguarding adults are available to all staff, and we have a whistle blowing policy which can be used at any time. The policy states that people can complain anonymously should they so wish. 7. Access to external agencies and advocacy services is promoted. 8. We ensure that staff are trained with regards to safeguarding adults. 9. Individuals staff are also trained regarding how to respond to challenging behaviours by a fully qualified practitioner. 10. We ensure that individual residents have care plans in place if they do not have keys to their own room. 11. The home utilises other methods before considering bed rails and recliner chairs. If these Care Homes for Older People Page 20 of 32 Evidence: are used then we have a plan of care which involves the resident and their families wherever possible. 12. We will always refer to the relevant authorities if we suspect a safeguarding adults issue. Having an open and transparent system in this respect means that we can address issues quickly and be more proactive in our approach. Our links with external agencies are strong, and we rely upon this to keep residents at the home safe. 13. CRB, POVA checks and references are central to the homes employment policies. 14. The home is run in a resident centred way so that we can ensure we work in a person centred way. There is a clear complaints procedure that is displayed in the home. Everyone gets information about how to complain when they are admitted to the home. Our survey results indicated that everyone knew how to make a complaint and who to complain to if they were not happy. The provider told us that the local safeguarding team had visited the home at the end of 2008 and had been satisfied with improvements at the home. Staff have in-house training in safeguarding vulnerable adults. Four senior staff are to attend local authority safeguarding training to make sure that information about local safeguarding arrangements is available to staff at the home. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe, comfortable and well maintained environment. Evidence: The provider wrote in the AQAA - 1. The living environment at the home is age appropriate. The Champion Unit environment is more focussed upon the younger people who use that service. Not only this, but with the nature of the illness, clients have whiteboards in their rooms for example as cues for their daily lives. 2. We are happy to be part of the community of Kirkstall, which has excellent community facilities within a short walking distance. 3. Residents and relatives are encouraged to bring in their own possessions so that they can personalise their own spaces. 4. The home is fully accessible to people of all disabilities. 5. We have a good infection control policy and we attempt to work closely with the local hospital, especially if we have a potential outbreak. 6. All the rooms in the home are single, with ensuite facilities. The home has been purpose built. Residents have a choice regarding where they would like their room. Bedrooms are above average size. 7. In Champion Unit residents are responsible for all household chores. This includes provision of meals. 8. The home has a large selection of communal areas to ensure that there is enough choice with regards to where to spend time and receive visitors. 9. Staff and residents have ensured our bathrooms are as homely as possible, even though they contain bathing aids. 10. The home has sufficient toilets to meet immediate need. Care Homes for Older People Page 22 of 32 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. There have been some improvements to the environment as part of the ongoing refurbishment of the home since our last visit. There is now access to a decked area from the main lounge on the older persons unit, which is a significant improvement. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by trained and competant staff. People are protected by safe recruitement procedures. Evidence: The provider wrote in the AQAA - 1. We have a comprehensive personnel Manual which contains all the tools necessary for recruitment. This includes job descriptions, standard letters of acceptance, rejection, and invitations to interview. We also have sample questions and person specifications. 2. Rather than merely filling vacancies we endeavour to choose the right person for the job. This may mean we wait longer for the right candidate. 3. Residents are involved in the recruitment process on both Champion Unit and the main home wherever possible. 4. We try and plan for the future needs of the home. We have a permanent advertisement placed at the job centre so that we always have applicants on file should the need arise. 5. The core of the staff team have been working at the home for many years. We have a relatively stable team in this respect although people do leave, but this is often not related to the actual home, but personal circumstances. 6. The staff have begun a new elearning programme which covers the induction process plus statutory training elements for updating established staff. The e-learning also includes dementia care. 7. We ensure residents views are gathered and acted upon both on a daily basis and through our annual quality audit which is available in reception. 8. We have a robust Care Homes for Older People Page 24 of 32 Evidence: probationary period for all new staff. 9. We take minutes of recruitment interviews and hold these on file. 10. All minutes of meetings are available for staff even if they did not attend. All staff have the opportunity to attend. We hold senior staff meetings every month, and each week one senior from each unit attends meetings with the Home manager to discuss clinical and staffing issues. This ensures that the home manager is kept up to date on a formal basis. There were enough staff on duty on the day of the visit. Three of the care staff on shift had only been at the home for between one and three weeks. Two of them had no previous experience of care. Both said that they worked with more experienced staff as part of their induction, which must present problems with a high proportion of new staff on one shift. A new role of senior carer has been created recently to provide more effective monitoring of care and greater support for the care staff. Although staffing levels are improved there are still some occasions when shortfalls impact on the care of the people at the home. Regular visitors to the home told us about this with the most recent example being the previous day when staff sickness meant that people had to all go to the downstairs lounge as there were not enough staff to monitor two lounges. The provider has introduced e-learning programmes to staff. This means that staff can underatke training at their own pace at a time convenient to them. The provider reported that this had been very effective and staff were adhering to the programme of learning given to them. The majority of care staff have achieved a National Vocational Qualification (NVQ) in care at level 2 with some staff now moving onto level 3. We looked at a small number of personnel files and all the required checks are completed before people start work at the home. Staff said I was given very good support during my induction I get all the support from my manager during appraisals, I also feel if I had a problem or anything to discuss I can talk to her In the past...we could be short staffed,...we are now fully staffed and individual needs are fully met We work as a team and have a very good manager Care Homes for Older People Page 25 of 32 Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and is run in the best interests of the people who live there. Evidence: The provider wrote in the AQAA - 1. The home manager has the required qualifications and experience, so we are confident that she is able to meet the stated aims and objectives. 2. We have a care manual which includes areas of care such as communication with people with dementia, activities, promoting sleep etc. These are readily available on each unit for staff to refer to. 3. Our supervision sessions focus upon areas such as the aims and objectives of the home, and work performance. 4. We use the AQAA itself to inform us of our own quality assurance document. This document is performed annually by the company. 5. The home has a clear line of management support. This includes the director of operations, finance director and head of clinical governance. The home is part of a small group of 4 homes. 6. The home has an up to date insurance policy which meets any type of loss or liability 7. We Care Homes for Older People Page 27 of 32 Evidence: have efficient systems to ensure the effective safeguarding and management if residents monies and valuables. People are supported to manage their own money wherever possible. 8. We do not act as appointee for individuals. 9. Residents contribute to their own financial records wherever possible. Otherwise this is the relative/ significant others. 10. We record all accidents and if required, complete regulation 37 information. We have appropriate Health and Safety policies in place. The home employs a maintenance person who documents all safety checks such as nurse call and fire checks. 11. We have clear lines of management in the home, and are currently developing a senior carer development programme with staff involvement. The registered manager was not available at the time of the visit and the new deputy manager was in charge of the home. She had only been at the home for a short time but has previous experience of the management of a care home. The manager has provided clear leadership and direction at the home. Staff and the people living at the home spoke highly of her committment. There was a whole range of audit tools in place at the home to monitor the service and facilities. Satisfaction surveys are circulated and the results of the 2008 survey were available to all attached to the service user guide. Surveys for 2009 had just been distributed. Regular meetings are held with staff people at the home and their relatives. The most recent meetings had been used to introduce the new deputy manager. A representative of the provider visits the home at least monthly as required and produces a report. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must contain 25/05/2009 detailed and relevant information about how to look after people. This is so that staff understand how to look after people properly and care needs are not overlooked. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The pre-admission format should be fully utilised to make sure that the assessment information is detailed enough to provide evidence that care needs can be met at the home. Food diaries should contain full information about peoples intake. Staff should make sure that people are offered food and drink regularly. This is to make sure that peoples nutritional needs are properly met. Staff should be provided with update and guidance on using tools for risk assessment to make sure that they are used effectively. This is to make sure that care needs are not overlooked Page 30 of 32 2 7 3 8 Care Homes for Older People and that any identified risks are minimised. 4 12 The activities programme should be further developed to make sure those less able people are provided with occupation and/or stimulation. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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