Inspection on 10/02/06 for The Kensington

This inspection was carried out on 10th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

The Kensington 13/01/09

The Kensington 18/01/08

The Kensington 08/12/06

The Kensington 07/10/05

The Kensington 31/03/05

The Kensington 05/10/04

The Kensington 17/03/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE The Kensington The Kensington Care Home 340 Pelham Road Immingham North East Lincs DN40 1PU Lead Inspector Beverley Hill Unannounced Inspection 10th February 2006 09:30 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 The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Kensington Address The Kensington Care Home 340 Pelham Road Immingham North East Lincs DN40 1PU 01469 571298 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) Mrs Gurdial Kaur Kelley Position Vacant Care Home 37 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (37) of places The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That the home is able to accept two service users under the age of 65 years That the lower age limit of the two service users under the age of 65 years is 60 years of age 7th October 2005 Date of last inspection Brief Description of the Service: The Kensington Care Home is a combination of old and new single storey buildings. The home is situated in the centre of Immingham close to local amenities, post offices, pharmacies, newsagents and public houses. The home is on a main bus route giving access to Grimsby, Cleethorpes and outlying villages. The home is registered to support and provide services to thirty-seven people who fall into the category of old age, six of whom could experience problems associated with dementia. The district nursing services provide any nursing input services users need. The accommodation comprises of thirty-three single rooms, sixteen of which are en-suite and two double rooms. Eleven of the single en-suite rooms are part of a new build that was completed at the beginning of 2004. The home has six bathrooms, two of which are equipped with walk-in showers and one of them has a Jacuzzi bath facility. There are two main lounges, one of which is situated in the new build, a separate dining room and a further small lounge, that is used for service users who wish to smoke. The home also has a small seating area close to the entrance that can be utilised as a quiet area for people to see their visitors. The gardens are well maintained at the front and rear of the home. The rear garden is a raised section accessible via a ramp and steps. In addition the home has an enclosed courtyard with garden furniture and a raised pond that that has been newly stocked with fish. There is ample car parking space at the front. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. The Inspector spoke to the manager and four care staff members that were on duty at the time of the inspection. Throughout the day the Inspector spoke to nine people who lived at Kensington and two relatives. The inspector looked at a range of paperwork in relation to staff training, care plans, activities, complaints, quality monitoring, staff and service user meetings, medication records, supervision records and maintenance of equipment. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to. The Inspector completed a tour of the building and checked that all the things that needed to be done from the last inspection had been done. What the service does well: What has improved since the last inspection? The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 6 The home has had seven months of progress in all areas of the home. The care service users received has continued to be improved and progress has been made in the monitoring of the quality of the services provided. Since the employment of the new manager last July staff training has improved. Staff reported having access to more training and records confirmed this. Training, supervision, guidance and support have affected the way staff members feel valued and in turn have positively affected their morale and the general atmosphere in the home. Staff members were more aware of social histories, hobbies and interests of service users and planned activities to suit people. What they could do better: 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 Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 7 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 The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 8 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): 4 The home demonstrated its capacity to meet the current needs of service users. EVIDENCE: The home completed assessments of service users needs prior to admission and formulated care plans in order to meet those needs. This process was described in the homes statement of purpose. Following assessment the home formally wrote to service users or their representative stating their capacity, or not, to meet the potential service users needs. The home had moving and handling equipment suitable for service users needs and specialist equipment such as pressure mattresses and cushions were obtained from the district nursing services. The home had improved its training plan and staff members were keen to participate. Staff undertook mandatory training and a range of service specific training including dementia care awareness. The staff team had a good skill The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 9 mix and 74 of the care staff team had completed NVQ training up to levels 2 and 3. The home had contacts with district nurses and community psychiatric nurses for specialist advice. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 10 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): 9 and 10 Service users health and welfare needs were met in a way that respected their privacy and dignity. Discrepancies in medication instructions for two service users, although minor, could place them at risk of receiving the wrong dose. EVIDENCE: Generally medication and its stock control was well managed, however there were some areas to address mainly regarding discrepancies between what was written on the medication administration record document for two service users and what was written on the medication itself. The manager was to raise these issues with the GP and pharmacist to clear up the confusion and to ensure clear instructions for staff. All but one service users medication was signed into the home and this needs to be addressed. Medication was signed on administration and Temazepam medication was stored and recorded as a controlled drug for good practice. One service user self-medicated a part of their medication and had a risk assessment and care plan in place for this. Service users spoken to stated that staff helped them to maintain their privacy and dignity. Comments were, ’staff don’t interfere, they knock on bedroom The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 11 doors, I dress myself and yes privacy is kept well’, ‘they don’t open my letters’, ‘I can see my visitors in private’, ‘the staff are excellent, they do everything they can for you’, ‘staff are attentive to seeing that visitors find the person they need to’. Staff members spoken to described how they maintained service users privacy and dignity by knocking on doors before entering, checking if the person needs assistance and making sure curtains and blinds were shut and the door closed during personal care tasks. All stated that mail was delivered unopened to the person and visitors were seen in private if they choose. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 12 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 and 14 The home provided a good quality of life for service users by providing social stimulation and promoting choice. EVIDENCE: The home employed an activity coordinator and an activity plan was completed with individual logs of service users who chose to participate. The manager confirmed that the staff team were generous with their time outside of working hours to participate in trips, fundraising activities, seasonal fetes etc. Staff confirmed this in discussions and described Christmas celebrations and previous organised activities and outings that they willingly attended when not on duty. Activities ranged from exercises to music, seed planting, baking (the home had two bread-making machines for this), quizzes, dominoes, puzzles, reminiscence, sing-a-longs, hand to eye coordination games, knitting and crochet, trips out and visiting entertainers. Two staff members entertained service users with their weekly line dancing experiences. Service users spoken to describe a range of activities they participated in and these reflected some of the activities mentioned above. Some people chose not to participate or enjoyed watching rather than actually participating and this was respected. One person described how they had recently gone for a meal The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 13 out and to listen to old time music songs with other service users, how they had stayed for three hours and how they enjoyed it. Some relatives and staff made up a fundraising committee and there was evidence of their hard work. Service users confirmed that routines were flexible for rising and retiring, breakfast and other meals could be taken in their bedroom or the dining room, and there were choices about food and drinks throughout the day. One person continued to maintain their independence by self-medicating part of their medication and management of finances and another chose to maintain a small patch of the rear garden as their own for bedding plants and the enjoyment of bird watching. Some service users chose to install their own telephones and bedrooms were personalised to varying degrees by their own furniture, ornaments, pictures, and in one case a fridge. The home had a separate lounge for service users who chose to smoke. Staff members demonstrated an awareness of promoting choice in discussions with the inspector. Social assessments and histories were completed with assistance from families unless the service users were able to complete them. These were used to look at the range of activities the service user wants to participate in. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 14 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 The home provided an environment where service users and visitors felt able to complain in the knowledge it would be dealt with. EVIDENCE: The homes complaint procedure was clear and displayed in the entrance. It had appropriate timescales for resolution and included contact details of other agencies. The home had a complaint form, which included aspects of the complaint and what action was taken to resolve the issue. There have been no formal complaints since the last inspection and minor niggles that were brought up in meetings had been addressed. Service users spoken to knew who to complain to and staff members were aware of how to deal with complaints. The lack of complaints was a reflection of the improvements in the care provided and the CSCI had received information from a district nurse who had noticed the improvements and wanted to have this acknowledged. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 15 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 and 20 The home provided a safe, clean and tidy environment with comfortable communal facilities and access to secure outdoor areas. EVIDENCE: The home had three communal sitting rooms, one of which was specifically for people who wished to smoke. The home also had a separate dining room. The rooms were nicely decorated and furnished. The home was based around a courtyard, accessible via doors from the corridors, which had seating and a well-stocked, raised pond. Since the last inspection the proprietors had purchased items for the home, including a new dishwasher, fat fryer and cooker for the kitchen, five new mattresses and five new bedroom carpets and a large storage shed. The manager confirmed that one of the lounge carpets was due for replacement next week, new gates had been ordered for the side of the house and a patio door was to replace one of the dining room windows so it opened out onto the courtyard. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 16 The environment was clean and tidy with no malodours in the areas inspected. The home was suitable for its purpose and was well maintained. The Fire Officer had visited in January 2006 and the Environmental Health Officer in May 2005 and neither had issued any requirements. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 17 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): 30 Improvements in the training provided to staff means that service users are cared for by knowledgeable and competent staff. EVIDENCE: The home had a training plan that covered mandatory and service specific training and individual staff records were maintained. The home used a range of training avenues, which included in-house training, external facilitators and distance learning. The home had accessed the training provided by the local authority and had obtained agreed funding for several staff members to complete NVQ training. To date 74 of staff were trained to NVQ Level 2 and 3, however a further five staff were due to start NVQ Level 2 and four staff were due to start NVQ Level 3 later this month. The deputy manager was progressing through NVQ Level 4 in care. All staff had completed mandatory training, protection of vulnerable adults and a one-day dementia awareness course with an external facilitator. Eight staff members were progressing through a more comprehensive, level 2, certificated course in Dementia Care. Updates in moving and handling were due in April 2006. The manager was a moving and handling instructor. Staff administering medication had completed an accredited medication course and three staff members were booked onto a four-day first aid course with the local authority in March 2006. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 18 Two kitchen assistants were booked onto a certificated Essential Food Hygiene course later in the month and the cook was progressing through a distancelearning course on, ‘Nutrition in the Care Setting’. Staff spoken to state they had access to training courses and in discussions described the range of courses they had participated in or had planned for them. They felt training had improved and the manager was proactive in securing training. They confirmed training issues were discussed in supervision and one staff member described how this was discussed and highlighted one day and organised very soon afterwards. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 19 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): 33, 34 and 36 Service users views were listened to and their safety and wellbeing promoted by the style of the manager and well supervised staff. EVIDENCE: Since the last inspection it was noted that the home had improved communication with CSCI with regards to notifications of visits to the home made by the proprietors. The proprietors had still to produce a business and financial plan for the future year. This was important as the home had a number of vacancies, although this situation had improved somewhat over the last few weeks. The home was progressing with a new quality assurance system that was started in October 2005. This consisted of questionnaires on the service provided sent out to service users, relatives and friends, staff and professional visitors to the home. It also involved audits of the environment, housekeeping, meetings, complaints, accidents, medication, finances etc. There was evidence The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 20 of action plans produced as a result of shortfalls in provision and further checking out at meetings that improvements had been made. Results were on display on the notice board and an annual service review was planned at the end of the process. Results of quality monitoring surveys must be forwarded to the CSCI for examination. Staff members were supervised well and issues covered included training, values and attitudes and work and management related issues. Although the deputy manager and senior care staff supervised a number of staff the manager signed off all supervision forms to ensure they were aware of issues raised. There was evidence that training needs highlighted in supervision were acted upon. Since the manager commenced their post in July 2005 staff had received supervision every six to eight weeks and were on track to receive six supervision sessions per year. Staff members spoken to confirmed positive support, guidance and supervision from the manager and stated the staff morale was high, service users seemed happier and staff had received good feedback from relatives. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 21 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 X X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 2 X 3 X X The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 22 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 OP34 Regulation 25(2) Requirement The registered person must produce a business and financial plan for the future year to evidence financial viability and forward to the CSCI (previous requirement of 31/01/05 not met) The registered person must ensure that the discrepancies in the MAR and medication instructions for two service users is rectified with clearer instructions for staff. The registered person must ensure that all medications are signed into the home. The registered person must ensure that a review of the quality of care provided is forwarded to CSCI. Timescale for action 31/03/06 2. OP9 13(2) 10/03/06 3. 4. OP9 OP33 13(2) 24(2) 10/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 23 No. Refer to Standard Good Practice Recommendations The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 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 The Kensington DS0000035288.V285416.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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