Inspection on 08/12/06 for The Kensington

This inspection was carried out on 8th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Kensington 13/01/09

The Kensington 18/01/08

The Kensington 10/02/06

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 8th December 2006 09:00 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 The Kensington DS0000035288.V295667.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. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 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 (15), Old age, registration, with number not falling within any other category (37) of places The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is able to accept two service users under the age of 65 years The lower age limit of the two service users under the age of 65 years is 60 years of age 10th February 2006 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, fifteen 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 shared 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. There are gardens to 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 stocked with fish. There is ample car parking space at the front. According to information received from the home on 2.10.06 their weekly fees are between £329 and £372. Items not included in the fee are toiletries, hairdressing, chiropody and transport. Information about the services the home provides is kept in each of the service users bedrooms. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day. Throughout the day the inspector spoke to service users to gain a picture of what life was like for people who lived at The Kensington. The inspector also had discussions with the proprietor, the manager, care staff and catering staff. The inspector looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. The inspector also checked with service users to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. The inspector also observed the way staff spoke to service users and supported them, and checked out with them their understanding of how to maintain privacy, dignity and choice. Prior to the visit to the home the inspector had sent out a selection of surveys to service users, some family members, a selection of staff members and professional visitors to the home. Those returned were analysed and comments checked out during the inspection. Those returned from service users had positive comments about the care and support received. Comments were, ‘I want to live here until I die I like it very much’, ‘It’s the best care I’ve had’, ‘on the whole the home is very good’, ‘there is always someone around’, ‘the girls are very good’, ‘I really enjoy the meals’. Other surveys from relatives commented on the lack of information they received and staff availability although all stated they were satisfied with the overall care. Surveys received from staff indicated how much they enjoyed working at the home, how they felt supported by the manager and that training was a priority. Surveys from professional visitors all had positive comments and one care manager stated, ‘The Kensington is a model of good dementia care. It operates a person centred approach and in my experience is the best provider in North East Lincolnshire for dementia care. Management and staff are to be commended for their high quality care and supportive attitude’. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home had completed the requirements issued to them at the last inspection. Improvements have been made to the environment with new carpets in the dining room, one of the lounges and several bedrooms, new chairs, replacement windows in the dining room, new laundry equipment and a new water purifying system. The proprietor and manager had produced an annual review of services detailing the achievements of the home during the last year and what they hoped to achieve in the next year. Since the last inspection the manager ensured that all medications received into the home, including those for people on short stays, were signed into the home. Results of surveys completed about the services provided was made available to service users and sent to the Commission. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 7 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 summary of this inspection report can be made available in other formats on request. The Kensington DS0000035288.V295667.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 The Kensington DS0000035288.V295667.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided prospective service users with information about the home and issued a contract of residency when admitted. Service users had assessments of need completed prior to admission and the home obtained copies of assessments completed by care management. This enabled the home to have full information about the service user in order to meet needs. EVIDENCE: The home had produced a statement of purpose and a service user guide with information about the services it provided. The statement of purpose had been updated to reflect the homes capacity to support an increased number of people with dementia care needs. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 10 Staff advised that potential service users or their relatives were given a pack of information during any introductory visit to the home or it was sent out to people when they made initial enquiries. The deputy manager stated this worked well and gave people the opportunity to read information at home and to come back to them with queries. Copies of the service user guide were in each of the bedrooms. The home had also produced an annual service review. This was a new addition to the information provided by the home to prospective service users and their relatives and included information on staff training, what the home has achieved in the last year, financial information, how they monitor quality, environmental improvements and what the home plans to achieve in the next year. Copies of the statement of purpose, service user guide and annual service review were held in the reception area. The manager stated that all service users had received a contract of residence, which was signed by the service user or their representative. Documentation seen by the inspector confirmed this. The home evidenced that service users were only admitted after an assessment of need had been carried out by the manager and by care management when funded by them. One service user survey confirmed they were given information about the home whilst they were in hospital prior to their admission. On the whole the home received copies of care management assessments. The assessments enabled them to make a decision as to whether the persons’ needs could be met. The assessments were used to formulate care plans to meet service users’ needs. After the assessment the manager formally wrote to the service user or their representative stating the homes capacity to meet needs. The Kensington DS0000035288.V295667.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs were met in a way that respected privacy and dignity and medication was managed appropriately. More explicit information in care plans about how staff members support people to maintain existing skills would reflect what is actually done in practice. EVIDENCE: On the whole care plans detailed service users needs and the tasks staff needed to complete to meet them. They were evaluated monthly and there was evidence of reviews held with relatives and care management. The care files included a range of information on personal history, moving and handling needs, risk assessments for falls, bed rails, memory impairment and skin integrity, and likes, dislikes and preferences. Areas of the care plans, for example personal care, made reference to the need for staff to promote dignity and choice and to maintain previous standards of personal appearance. The care plans also detailed the need for ongoing family contact. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 12 One care plan examined had not detailed areas of care to support the service user to maintain their current level of independence and skills. Areas such as dressing, nutrition and promoting continence were not included in the care plan as staff assisted only minimally but there was a need to continually monitor all areas of health and personal care to ensure the level of independence was maintained and this must be included in care plans. There was also evidence of access to professional health care staff, outpatients’ appointments and local facilities such as opticians and dentists. There was evidence that the home was proactive in providing health care. For example they had obtained sitting scales to weight people regularly, some care staff had received training in foot care at a local hospital and were able to cut toe nails safely and a simple piece of equipment had been obtained via the primary care trust to assist people with constipation and lessen the need for invasive treatments from the district nurses. The equipment had had positive results. Service users spoken to stated they felt well looked after and surveys received from relatives stated they were satisfied with the care. Some relatives did feel they were not always informed of important health matters or were informed after the event. This was discussed with the manager to investigate and address. A survey received from a visiting professional was very complimentary about the home, ‘The Kensington is a model of good dementia care’, and ‘managers and staff are to be commended for their high quality care and supportive attitude’. Service users spoken felt their needs were met in a way that respected their privacy and dignity, ‘the staff are quite patient, they don’t rush you’, ‘we can dress ourselves, the staff are there if we want them’, ‘yes they knock on doors before coming in’. Staff members were knowledgeable about service users’ needs and had a good understanding of promoting choice, privacy and dignity. The inspector observed staff members’ interaction with service users in various positive ways, for example, supporting a service user to eat their lunch and encouraging independence with this, chatting whilst supporting someone to walk safely and administering medication appropriately. Generally the medication was managed well. All medication was stored appropriately and there were no missed signatures after administration. There was a recent recording error with one medication and this was noticed during the inspection and rectified. Closer auditing of the medication during administration was required to prevent a reoccurrence. The staff confirmed they received good support from the local pharmacist and used a monitored dosage system for accuracy. Staff who administered medication had completed an accredited medication course. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 13 One person managed a part of their medication. A risk assessment had been completed and a discussion held with their GP. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provided nutritional meals and flexible routines, which enabled service users to make choices about aspects of their lives. EVIDENCE: Care files included information about social histories, preferences and hobbies and individual logs were maintained when service users participated in activities. The deputy manager had activity responsibilities and discussed the range of activities the home provided. Although there were set events these were changed during daily discussions with service users. Most people spoken to felt the range of activities met their needs. These included visiting entertainers, outings to local facilities and in-house provision such as crafts, table games, reminiscence therapy, bingo and numerous exercise activities. One person advised that it was difficult for the staff to meet their personal needs regarding social stimulation as these were of a particular nature. This was discussed with the manager who confirmed attempts had been made to contact organisations but the service user had chosen to decline the support. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 15 Service users spoken confirmed that routines were flexible and visitors were welcomed at any time. The inspector witnessed people having choices regarding rising, meals, drinks, smoking, activities and where to sit. Bedrooms were personalised and people could choose to bring in their own items of furniture and telephones. Some people chose to manage their own finances and one person managed a part of their medication. Staff had a good understanding of how to promote choices and this was reflected in the care plans. The main meal on the day of inspection was sampled and was prepared and presented well. Staff members were seen supporting one person to eat in a discreet and appropriate way encouraging independence and menus examined confirmed that choices were available. Catering staff confirmed they saw each person daily regarding their choices for lunch and at tea and had knowledge of the service users requiring special diets. Fresh fruit was in evidence and the home used a balanced mix of fresh and frozen vegetables. All sixteen service user surveys received indicated they enjoyed the meals always or usually. Comments were, ‘the meals are very good’, ‘I really enjoy the meals’, ‘we are looked after and get good meals’ and ‘the meals are very nice’. One survey did state, ‘the meals are a bit on the small side and fresh vegetables always would be more nutritious’. This was mentioned to the manager to ensure people were asked if they required seconds. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to complain about services and are protected from abuse by the general openness within the home, staff members’ knowledge of policies and procedures and adult protection training. EVIDENCE: The home had a complaints procedure displayed in the home and a complaints/niggles book with the signing in book in the entrance. Staff members were aware of the procedure and the documentation used to record niggles, concerns or more formal complaints. Service users spoken to knew who to speak to if they had any complaints and some named the manager in person. Surveys indicated that people had felt able to make complaints. The home had a policy and procedure on the protection of vulnerable adults from abuse and all staff had completed training. Staff members spoken to gave comprehensive answers to questions about abuse and how to respond if they suspect it has occurred. The manager was aware of how and to whom a referral had to be made and had recently put this into practice in an appropriate way. A referral had been made to the local authority regarding an allegation made by one service user that a fall and leg injury had been caused by staff action. This had been investigated by the adult protection team and found not proven. The Kensington DS0000035288.V295667.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On the whole the home provided a safe, clean and comfortable environment for service users. Replacement of damaged crockery would enhance the quality of mealtimes for service users and prevent any spread of infection. 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 decorated for the festive season and staff members were in the process of planning for the annual ‘Christmas Fayre’, which was used as a fund-raising event for the benefit of service users. The home was based around a secure courtyard, accessible via doors from the corridors, and had seating and a well stocked, raised pond. The rear garden was accessed by steps and a ramp. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 18 Bedrooms were personalised to varying degrees with pictures and ornaments. Some people chose to furnish their room with their own small items of furniture and all the bedroom doors had privacy locks. As some bedrooms had hard flooring instead of carpets, service users were given the choice of which flooring best met their needs. Most of the bedrooms had lockable facilities. Service users spoken to were satisfied with the cleanliness of the home and individual bedrooms, ‘the cleanliness is excellent’, and all sixteen service user surveys received stated the home was clean and fresh either always or usually. Since the last inspection the proprietors had continued their investment in the home by purchasing new laundry facilities, replacing carpets in one of the lounges, the dining room and several bedrooms, window replacements, new chairs for the green lounge and settees for the quiet area in the entrance, new beds that could be raised and lowered and several smaller items that need replacing on a regular basis. This had considerably improved the environment, which was clean and tidy with no malodours in the areas inspected. The home was suitable for its purpose, had sufficient bathing and toilet facilities and was well maintained. Some of the crockery used was noted to be chipped and in need of replacement. The manager is to audit crockery and replace items quickly. One of the cookers in the kitchen was no longer used and needed removing and a water boiler secured to the work surface by the proprietor needed professional attention. The proprietor stated this was due for repair the following week. An area near the dishwasher was in need of cleaning and was completed during the inspection. The Kensington DS0000035288.V295667.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of service users were met by a well trained, staff team and their wellbeing and safety was ensured by a robust recruitment policy and procedure. A review of staffing and deployment of staff is required to address any shortfalls in numbers at specific times. EVIDENCE: The home generally had sufficient staff on duty to meet the needs of service users but there tended to be a gap in the mornings. Three care staff members were on duty from 8am until 9.30am until a forth staff member arrived. This was a busy period and staff felt rushed. The manager was on duty from 9am but was supernumerary. During the course of the visit to the home the manager resolved this issue and the forth staff member was arranged to start at 8am. Of the seven surveys received from relatives three felt there was not enough staff and one appeared unsure. Information received in the homes preinspection questionnaire indicated that when the needs of service users were calculated more staff hours were provided that was actually required. However in light of information from surveys and staff the manager will review staffing levels. The sixteen service user surveys and seven relatives surveys received were analysed and generally comments were positive about the care staff provided and their availability. Some people did comment that staff members were very The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 20 busy at times and one person did not always feel they received the care and support required. Some comments were, ‘sometimes you have to search staff out’, ‘the staff are very good’, ‘it’s the best care I’ve had’, ‘I want to live here until I die, I like it very much’, ‘there is always someone around’, ‘I’m not always kept informed of important matters’, ‘I’m not always consulted about my relatives care’. These issues were mentioned to the manager to follow up. However all the relatives’ surveys returned indicated they were satisfied with the overall care provided. The inspector observed the staff approach people in a friendly way and there was time to sit and talk to them. Mealtimes were unhurried. Discussions with staff and examination of records indicated that staff training was a priority for the manager, who was proactive in seeking out training courses for staff. The home had a training plan, which included mandatory and service specific training and updates had been completed. Training was a mixture of in-house courses such as moving and handling, as the manager was a moving and handling trainer, external facilitators for courses such as fire training and national vocational qualifications, and distance learning for health and safety, infection control, basic food hygiene and dementia care. The home was also able to access training courses provided by the local authority. One senior staff member was undertaking a, ‘training for trainers’ course in managing challenging behaviour. Staff administering medication had completed accredited training. Induction followed a basic orientation programme then skills for care standards during the next three months. Staff spoken to and surveys received stated training was a priority and they felt equipped to complete their roles. One staff member said, ‘the manager is very up to date with training which has benefited carers and the residents’. The home had surpassed the target of 50 of care staff trained to NVQ level 2 or above, which was a big achievement. Staff recruitment records were examined and indicated that all appropriate references and checks, including criminal record bureau checks were in place prior to the start of employment. The Kensington DS0000035288.V295667.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed, which promoted the health, welfare and safety of service users who lived there and staff who worked there. EVIDENCE: The manager had made good progress with their own training and the registered managers award was due to be completed at the end of December. They managed the home well and staff spoken to described the manager as supportive and approachable, ‘the manager is always available’, ‘the manager is very good, listens to you and resolves issues, you can talk to the manager’ and ‘the manager is excellent with the residents’. Staff stated they received regular formal supervision and documentation supported this. The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 22 Service users knew the managers first name and said they would see her if they had concerns. Meetings were held for service users, relatives and staff to put forward their ideas and the homes proprietors visited regularly, although there was evidence that reports of these visits, as required by regulations, were not always completed. The manager completed a newsletter and distributed this to service users and relatives, as many were unable to make the planned meetings. The quality of the service provided was monitored with questionnaires to service users, relatives, staff and visiting professionals. Monthly checks were made, for example, on the environment, care plans, accidents, medication and the laundry and any shortfalls from audits or questionnaires were addressed in action plans. Information about quality monitoring was on display in the quiet area in the entrance. In discussions it was clear that the manager had sound ideas about the needs of service users and these ideas were put into practice. For example it was recognised that dementia care training would equip staff with important skills and this had been organised for all staff. Links had been made with the primary care trust regarding reducing the amount of falls generally and reducing the need for district nursing intervention for one person. The manager and proprietors had produced an annual service review with information about what the home had achieved over the last year and plans for the next year, for example with staff training and improvements in the environment. There was evidence of financial investment in the home and this had led to noticeable improvements in management, staff training and the environment. Service users finances were not assessed at this inspection, however the finances were managed appropriately at the last inspection and the home were still awaiting instruction from care management about the financial management of two service users who were unable to manage their own finances. Risk assessments were completed to ensure people could make choices and participate in activities safely. Documentation was kept up to date and equipment was maintained. During the inspection a bed rail was noted to have a loose connection. This was addressed before the inspector left the building. The manager advised that staff checked bed rails on a daily basis but will in future ensure the auditing of bed rail equipment is documented. The home had purchased several hospital style beds that came with specific bed rails to attach when required. The Kensington DS0000035288.V295667.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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 3 X 3 2 2 The Kensington DS0000035288.V295667.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. Standard OP7 Regulation 15 Requirement The registered person must ensure that all care plans reflect the need to maintain existing skills. The registered person must ensure that care is taken when tallying amounts of medication remaining and policies and procedures followed regarding this. The registered person must ensure that any chipped crockery is replaced and the unused cooker removed from the kitchen. The registered person must ensure that staffing levels consistently reflect the needs of service users. The registered person must ensure that monthly reports of visits to the home are completed and available for inspection. The registered person must ensure that maintenance checks of bed rails are documented. Timescale for action 31/01/07 2. OP9 13 12/01/07 3. OP19 23 31/01/07 4. OP27 18 31/01/07 5. OP37 26 31/01/07 6. OP38 23 31/01/07 The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The manager should review the process of informing relatives about important events affecting their loved ones in view of comments made in surveys that they were not always informed. The registered manager should continue to work towards completion of the Registered Managers Award. 2. OP31 The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Kensington DS0000035288.V295667.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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