CARE HOMES FOR OLDER PEOPLE
Kirkwood Care Home 35 Moorfield Road Ben Rhydding Ilkley West Yorkshire LS29 8BL Lead Inspector
Sue Dunn Key Unannounced Inspection 9th August 2006 10:00 X10015.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 Kirkwood Care Home DS0000030148.V306212.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. 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. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Kirkwood Care Home Address 35 Moorfield Road Ben Rhydding Ilkley West Yorkshire LS29 8BL 01943 600653 01943 604144 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) The Franklyn Group Ltd Miss Sarah Joanne Brown Care Home 20 Category(ies) of Physical disability over 65 years of age (20) registration, with number of places Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Kirkwood is a detached, domestic style, property standing in large well tended gardens in Ben Rhydding on the outskirts of Ilkley. It is situated close to the top of a quiet cul de sac and is indistinguishable from the other family houses on the street. The driveway provides parking for several cars. A small parade of shops (including a post office) and the railway station is a short walk from the home. All bedrooms are on the ground floor and all offer single occupancy. The home offers a genteel, comfortably appointed environment for independently minded people and makes every effort to accommodate different tastes and interests. The home can accommodate older people of either sex but traditionally the occupants have been ladies. The operations manager works closely with the registered manager. NVQ training for staff is ongoing, supplemented by a programme of general training covering a range of subjects relevant to the carer’s role. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The purpose of the inspection was to ensure the home was operating and being managed for the benefit and well being of the residents. One inspector undertook the inspection, which was unannounced. The inspection started at 10.15am and finished at 5.30pm A pre inspection questionnaire sent to the manager had been completed at the time of the inspection and was used to support judgements made during the inspection visit. Comment cards with pre paid envelopes were left in the home inviting people to express their views about the service. The report is based on information received from the home since the last inspection in January, observation and conversation with residents and staff, discussion with the manager, examination of two care files (which included case tracking) and an inspection of the premises. This included an inspection of some bedrooms and all communal areas. The weekly fees range from £315 to £495. Chiropody and hairdressing, personal toiletries and clothing, newspapers and magazines are not included in the fees. What the service does well:
The home has a pleasing atmosphere of domesticity, which is enhanced by the style of furnishings and fittings, table lamps, a well-stocked bookcase, fresh flowers and plants and bowls of fresh fruit and sweets. All rooms are on one level allowing ease of movement inside, and out into the well-tended garden. A freelance craft tutor visits the home as many of the service users enjoy craft and needlework activities. The work produced is of a good standard and gives people a sense of achievement and satisfaction. A water dispenser in the dining room ensures people can help themselves to cold drinks at any time. The home was free from unpleasant odours with the exception of the room discussed which would benefit from replacement floor covering. People are encouraged to bring personal possessions into the home. It is acknowledged that this may depend on assistance and the attitude of relatives therefore some rooms had been made more ‘homely’ than others. Personal clothing was laundered to a high standard. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 6 The manager and staff are polite, friendly and respectful and consult with service users on a day-to-day basis about matters which affect their lives. What has improved since the last inspection? What they could do better:
Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 7 The admission agreement could be improved by including details of the type of room to be occupied, as some are bigger than others and some have en suite facilities. There must be an up to date photograph of each service user on file. The staff must ensure that all information recorded in care files is accurate and specific enough to prevent assumptions being made, which might affect peoples’ care. The background information in one file was particularly good but less so in others. Staff should ensure they do not overlook information provided by service users, which may help to determine how they can meet emotional and intellectual needs. It should be possible to cross reference details of review meetings to a separate section of the care file to ensure this information does not become lost in the daily records. The home may wish to consider a small charge for visitors who wish to dine with service users in their own rooms. The complaints log should not be held in a public place. Some people spoke of the difficulty of holding a conversation when so many are hard of hearing. The installation of an induction loop system, which cuts out background noise may benefit some service users and make conversation easier. The rotas must be written in a way that gives an accurate and permanent record showing how the home is staffed at all times. The monthly reports on the conduct of the home must be available in the home for inspection or to be sent to the CSCI if requested. 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. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 5 (6 – NA) Quality in this outcome area is good. This judgement is based on inspection of pre admission assessments in three care files, discussion with the manager, staff, and service users and discussion with relatives on previous visits to the home. There has been a marked improvement in the content of pre admission assessments giving a clear indication of the home’s interest in meeting the overall needs of people who are admitted to the home. EVIDENCE: Three care files were inspected. Where possible assessments had been carried out before admission and stated where the assessment had taken place. The assessment information included place of birth and previous occupations. The content of one assessment was better than the other and should be used as a good example of how the home judged it could meet the person’s needs. A very good pen picture in one file gave background information about family relationships and dynamics, which was relevant to the person’s care needs.
Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 10 A good summary in the same file showed how needs would be met, including spiritual needs, and identified who would do what and when. The number of the room to be occupied was evident in the files of more recently admitted service users. One person’s contract was with the family for signing. Another admission agreement gave details of insurance arrangements but could have been improved with details of the type ( e.g., size, en-suite facilities) or number of room to be occupied. People are given the opportunity to have a short stay in the home before making the final decision to move in permanently. It was good to see that a service user who had been in and out of hospital several times had been re assessed to ensure the home could still meet her needs. Care plans and risk assessments were amended on each re admission from hospital. The home does not provide intermediate care. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. 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 feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 10 The quality outcome in this area is good. This judgement has been made from all the available evidence which included examination of three care files, discussion with the manager, staff and residents, observation of care practices and life in the home. Care plans and daily records gave a satisfactory picture of the personal and health care provided. Shortfalls identified in the recording could be overcome with routine monitoring and as staff become more familiar with the system. EVIDENCE: All the care plans had been reorganised and updated since the last inspection and showed a great improvement in the layout and content, making information about care easier to track through the files. Factual details had been completed, but care files were without a photograph. One care plan gave good guidance to staff on how to support personal and health care, pressure care and social needs. Weight was monitored monthly. However, the moving and handling risk assessment and information from the Waterlow tissue viability risk assessment gave contradictory information indicating the person carrying out the assessments had not read the pre
Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 12 admission information thoroughly. This could have led to pressure care being overlooked. A statement indicating a ‘tendency to wander’ should have been more specific as it indicated there was a possible risk, which wasn’t the case. GP, Chiropodist and district nurse visits had all been recorded with details of the action taken. However there was no information relating to a follow up visit which had been arranged. Details of a review meeting were recorded in the daily notes. It was only after reading through the full file that it became apparent why the person had not returned home as previously planned. It was recommended that such information be cross- referenced from the daily notes to a separate section in the care file to avoid important information being overlooked. The care plan should also be amended accordingly. Factual information in another file mirrored what had been recorded in the assessment. Staff could have taken advantage of background information volunteered by a very articulate service user and recorded the information as part of the pen picture to inform the care plan. This appeared to have been a missed opportunity. The file showed personal preferences and how the home had tried to accommodate the person’s dietary needs. The service user confirmed this. Daily records showed the staff celebrated special occasions, such as birthdays, with a card and gift. A person who had been in and out of hospital had the care plan updated on each re admission. All care plans were evaluated monthly. It is suggested that when gaps in records occur because a person is in hospital this be noted. Contact with other professionals and arrangements for the provision of special equipment were well documented. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. 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 maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality outcome in this area is good. This judgement has been based on all the available evidence which included, observation, discussion with the manager, care staff, the chef and residents examination of documentation and a sample of the meal served. The home provides a domestic style environment in which people are able to make choices and express their views. The staff try to accommodate the lifestyles of people adjusting to the compromises they felt had to be made when no longer living in their own home. The overall feeling was that the standard of cooking had improved. EVIDENCE: Service users use their own rooms and communal spaces freely throughout the day. Many ladies were said to go to their rooms after tea to watch their own televisions. Little assistance was needed. Knitting sewing and reading are regular pastimes. A care worker was playing cards with one person who couldn’t find anyone else to play with. A fortnightly craft group run by an external tutor took place on the day of the visit. The group of about seven people enjoyed the companionship this offers and were pleased with the very professional looking results of the afternoon’s activity. The tutor spoke highly of the home and the standard of care she had observed during her visits.
Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 14 One person said it was not possible to have a conversation without shouting as most people have hearing difficulties. Two people spoke of a weekly tea party, which they attend at a local church every Friday. A care worker said there had been a recent outing for fish and chips and a local playgroup visit to provide entertainment. Relatives and friends were free to visit and most service users go out regularly with family or friends. Some people had telephones fitted in their rooms to allow contact with the outside world. The overall feeling was that the standard of cooking had improved. A sample of the food on the day, which offered two choices, was tasty, hot and well presented; though one person said there was not enough ‘toad’ in the Toad in the Hole. One person had anticipated being able to invite visitors to dine with her in her room but said they were only offered a cup of tea. A menu- planning book for care homes is being used to review the menus in consultation with the chef and service users. A water dispenser in the dining room allows service users and staff to help themselves to cool drinks throughout the day. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 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’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality outcome in this area is good. This judgement is based on all the available evidence, which included information from the pre inspection questionnaire, inspection of documentation, speaking to the manager staff and service users. The home has an open approach to complaints and recognizes peoples right to grumble if they feel disgruntled. The complaints log is a record for the manager and should be held in a less public place. Staff have now had the recognized Adult Protection training. EVIDENCE: There have been no complaints since the last inspection. The complaints logbook is kept in the entrance hall. This allows anyone to read the contents and may prove a deterrent for anyone wishing to complain. The complaints log is intended as a record, kept by the manager, of any complaints and grumbles to show how they have been dealt with and should be kept in a less public place. Many of the service users have been found to be quite outspoken and comfortable about grumbling. The manager has shown herself willing to listen and attempt to find a satisfactory solution to any problems. Newer service users were not confident about the ‘rules’ and did not want to get into anyone’s ‘bad books’ by ‘speaking out of turn’ about matters which were seen as minor irritations. The manager’s office is very accessible and she is actively involved in care which gives people the opportunity for people to speak to her in private.
Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 16 All but two staff has attended the Adult Protection training since the last inspection. All new staff have Criminal Record Bureau checks before starting work. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 The quality outcome in this area is good. This judgement is based on all the available evidence including a tour of the building, examination of maintenance records, discussion with staff and service users and observation. A rolling programme of maintenance keeps the home to a satisfactory standard. EVIDENCE: The gardens were well tended providing a pleasant outdoor sitting area with visual interest and colour from the wide variety of plants and shrubs. The requirements and recommendations made after the last inspection visit had all been completed. Hold open devices, which release at the sound of the fire alarm had been fitted to the bedrooms doors of service users who like to keep them propped open. Radiator covers had been fitted and new commodes had been purchased. The latter look like normal chairs therefore are more discrete. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 18 The home was clean and odour free with the exception of one bedroom where there was an unpleasant odour. A member of staff thought the floor covering in this room was to be replaced. A hospital style bed with bed rails had been provided in one bedroom to meet the changing needs of the occupant. Most of rooms were well personalised by their occupants. Most people use their rooms during some part of the day Communal lounges were well furnished and comfortable. A bowl of fresh fruit and several bowls of sweets were dotted about for service users and visitors to help themselves. It is recommended that the manager apply for an induction loop system for one of the communal rooms, on behalf of a service user with the greatest hearing difficulty, to make conversation easier. It was evident that laundering is of a high standard with careful attention given to the care of personal clothing. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using all the available evidence, which included, information provided in the Pre inspection questionnaire, discussion with the manager and care staff, discussion with visitors, discussion with service users, examination of the training and recruitment and selection records. The staff-training programme is ongoing and staff confidence and knowledge has increased as a result of this. EVIDENCE: Two care staff, the manager, chef, catering assistant/carer, a cleaner and cleaner/handyman were on duty with 17 service users. Only three required assistance from staff to move about. The staff were described as ‘very calm and willing’. The rota was neatly written in pencil to allow for changes. However the rota must be written in indelible ink to provide an accurate and permanent record of how the home is staffed. The examination of a staff file showed thorough recruitment and selection with a record of the interviewing process. The manager stated that she always interviews with another person, as previously recommended. It is recommended that the questions used at interview and interview notes should relate more closely to the job description. There was evidence of two written references and a CRB (Criminal Record Bureau check). A member of staff stated that her induction training took a week and covered fire procedures, Health and Safety and COSSH. She still has to cover dementia and Adult protection. All but two staff had completed this.
Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 20 Another care worker had completed NVQ2, moving and handling, first aid, health and safety, adult protection, dementia and palliative care training. She felt NVQ had taught her not to make assumptions about people. The home’s staff were said to deal with discriminatory comments and be supportive of overseas staff. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. 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 the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36, 37 & 38 The quality outcome in this area is good. This judgement is based on all the available information, which included the pre inspection questionnaire, Examination of the documentation, discussion with the manager and staff discussion with service users and observation. The home is managed in the interests of the service users. Documentation is detailed enough to provide evidence of the care and attention to Health and Safety. EVIDENCE: The manager has a social work qualification, which meets the requirements, but has chosen to do the NVQ 4 in Management. After changing NVQ provider she is more satisfied with the approach as she finds it more challenging. The operations manager has done a personal development appraisal with her. The monthly reports on the conduct of the home were not available in the
Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 22 home for inspection. Copies of these reports must be available in the home or forwarded to the inspector. The deputy and assistant managers have completed the supervision-training course. A care worker said that supervision has been taking place monthly. This covers fire safety and the care standards and was thought to be rather repetitive. It is suggested that a selection of care files be looked at and discussed as part of the supervision process. The manager was said to be open to suggestions and ideas from staff to improve practice. The following records were checked and found to be in order: Fire training and log of alarm tests Monthly water checks Maintenance book Have Quarterly questionnaire system Accident records. Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 23 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 2 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 4 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 3 2 3 Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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. 2. Standard OP7 OP7 Regulation 17 12,17 Requirement Timescale for action 31/10/06 3. 4. OP27 OP37 OP37 17 17,26 The must be an up to date photograph of each service user on file Information recorded in care files 30/09/06 must be accurate and specific enough to avoid assumptions being made which might affect care outcomes Staffing rotas must provide a 30/09/06 permanent record of how the home is staffed Monthly reports on the conduct 30/09/06 of the home must be available in the home or forwarded to the CSCI on request RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP7 Good Practice Recommendations The information in the admission agreement/contract should give more details about the room to be occupied It is recommended that details of review meetings be kept
DS0000030148.V306212.R01.S.doc Version 5.2 Page 25 Kirkwood Care Home 3 4 5 6 OP13 OP15 OP16 OP22 OP37 in a way which makes the information easy to cross reference with the daily notes and care plan The home should consider giving service users opportunities to invite their visitors for a meal The complaints log should be kept in a less public place The home should look at the benefits to residents of installing an induction loop system in the communal lounge The staff rota should be written in indelible ink Kirkwood Care Home DS0000030148.V306212.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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