Inspection on 17/01/06 for The New Close

This inspection was carried out on 17th January 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 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 New Close 08/08/06

The New Close 07/09/05

The New Close 29/11/04

The New Close 21/04/04

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

CARE HOMES FOR OLDER PEOPLE The New Close Conyngham Lane Bridge Canterbury Kent CT4 5JX Lead Inspector Nicki Dawson Unannounced Inspection 17th January 2006 08:30 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 New Close DS0000023607.V278747.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 New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The New Close Address Conyngham Lane Bridge Canterbury Kent CT4 5JX 01227 780070 01227 830710 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) Kent Community Housing Trust Mrs Susan Keiper Care Home 63 Category(ies) of Dementia - over 65 years of age (63) registration, with number of places The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The residents shall be 60 years of age and over Date of last inspection 7th September 2005 Brief Description of the Service: The New Close is a residential care home providing care for up to 63 people, aged 60 and over, with dementia. The home is situated in a cul-de-sac in the village of Bridge, near Canterbury. The village has a number of shops, including a post office, pharmacy and small supermarket. The New Close is owned by Kent Community Housing Trust, which manages 22 residential care homes for older people in Kent and in addition provides a range of home care services. The New Close is an extended bungalow, providing ground floor accommodation for all residents. Extensive gardens surround the home and there is a large parking area to the front of the property. The home has been divided into two by a coded door entry system, with separate staff teams for each wing. This enables staff to have free access to all areas of the home and limits the access for residents, to ensure their safety. Each wing has a dining room, a number of small lounges and a visitor’s room. Resident’s rooms are accessed from the lounge areas. There are 55 single rooms, of which 23 are en-suite and 4 double rooms. The home contains a large number of toilets and 7 bathrooms with disabled facilities. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors, Nicki Dawson and Lisbeth Scoones undertook the unannounced inspection. It commenced at 8.30 am and took just under ten hours. The inspector spoke with three relatives, two team leaders, one senior carer and three carers. The inspectors shared lunch with the residents, toured the home, observed the medication round and spent time in the office looking at records and speaking with the registered manager and deputy manager. The registered manager has just returned to the home after being seconded for six months to another residential care home, owned by Kent Community Housing Trust. What the service does well: What has improved since the last inspection? What they could do better: The needs of residents have been assessed, but the plan of action that guides staff in how to meet these assessed needs has been taken out of residents care plans. This information is vital in ensuring that the needs of residents are met. One resident did not receive their prescribed medication, since the home had run out of stock. This could potentially place the resident at risk. The deputy manager explained that the staffing levels at the home have been reduced since the last inspection, due to there being a significantly reduced number of residents at the home. However, it is uncertain how the previous or present levels of staffing were assessed. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 6 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 New Close DS0000023607.V278747.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 New Close DS0000023607.V278747.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): 3 Prospective residents have their needs assessed before moving to the home. EVIDENCE: The home’s admission policy states that, “prior to (the) arrival (of the prospective resident) the duty manager will gather all available information and prepare a service user plan”. The file of a resident who had recently been admitted to the home was viewed. It contained an initial assessment undertaken by home, which had been completed prior to the admission of the resident. The home had also obtained an assessment from the local authority. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 9 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, and 9 The health and social care needs of residents are assessed, but staff are not guided as to how to support residents on a daily basis in order to meet these assessed needs. Systems have been put in place to monitor the level of falls for residents, but need to be reviewed regularly to be effective. There has been a general improvement in medication practices, but they require further strengthening to ensure that safe systems are in place for residents. EVIDENCE: Resident’s individual plans of care were sampled and contained a social history, and an assessment of daily living needs, including health, mobility, likes and dislikes. The part of the care plan which identifies the action to be taken by staff or others to address each assessed need, had been removed from the plan. The registered manager explained that this was in line with the KCHT policy and agreed to reinsert this essential information. Potential risks in daily living are first identified when the resident is admitted to the home and a strategy is written as to how each potential hazard should be managed. The support provided by staff on a daily basis is written in resident’s daily notes. Most of the entries were detailed and explanatory. However, some were only generalised statements, such as, “personal care given” which are not helpful in ensuring continuity of care. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 10 Appointments with health care professionals are clearly recorded. It was observed that two residents lacked adequate dental care. A moving and handling assessment had been undertaken for each resident. Each resident has a falls assessment and a record is kept of any falls and accidents not resulting in injury as well as those resulting in injury. There has been a significant reduction in the incidence of falls resulting in a hospital admission, since the last inspection. The home has developed an action plan for those residents who have frequent falls. This is good practice and could be further developed by reviewing the action plan on a regular basis to see if the plan has been effective in reducing the number of falls. Selected aspects of the ordering, storage, disposal and administration of medications were inspected. Two staff were observed administering medication. They did so by taking time to carefully explain to each resident was about to happen. The medication administration records were mostly well maintained. However, a number of hand written entries had not been signed or countersigned to ensure accuracy. One resident had not received a prescribed medicine the previous night since the home had run out of stock. Staff explained that new stock was due to arrive that day. The homes medication policy is comprehensive, but needs to be developed with regards to the covert administration of medication. There have been a number of changes made to the storage of medication, which has improved practice. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 11 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 and 15 It is hoped that with the employment of an additional part-time activities organiser, that residents will be provided with more opportunities for stimulation. Residents are enabled to maintain contact with family and friends. The meals are appealing and wholesome, offering both choice and variety and catering for special dietary needs. EVIDENCE: It was observed that the daily routine of the home although structured, has a certain amount of flexibility. Currently, there is one activities organiser at the home on a Monday to Friday. During the inspection residents were observed in small groups participating in a range of activities. Entertainers are booked to visit the home and the activities organiser said that they try to stimulate the more dependent residents with foot massage and hand massage. These activities are highly commendable, and it is hoped that with the recruitment of an additional part time activities person, that there will be more time to engage a larger number of residents. Some relatives were not aware that any activities took place within the home. At the last inspection it was recommended that the snoozelum room was re-established to provide a stimulating environment for all residents. Residents, who wish, are able to attend communion on a monthly basis. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 12 Relatives are free to visit the home at any reasonable time and may see their relative in private. A group of relatives attend a well-established relatives group that they have formed themselves and from which they gain additional support. The inspectors observed breakfast time and joined residents for lunch. The food was well presented and residents were clearly enjoying their meals. Residents, who need support to eat, were assisted in a dignified manner and there was a relaxed atmosphere. The menu for the week is displayed outside the kitchen. Residents are consulted about the choice of food in advance and also have the opportunity to change their minds if they prefer to eat the alternative when mealtimes arrive. At the last inspection it was noted that the cook is aware of the special dietary needs of the residents and that she runs a very organised kitchen. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 13 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): 17 and 18 Staff know how to follow the home’s complaints procedure and have been trained to recognise and report any suspicion of abuse. EVIDENCE: Staff said that they would take action to deal with any complaints that were within their remit. They said that they would record any complaints that were beyond the scope of their capabilities and pass them on to a more senior member of staff. Relatives said that they were able to voice their concerns to a member of staff or the manager, if they were unhappy about any aspect of their relatives care. The home keeps comprehensive records of complaints, together with the action taken to address the complaint. Staff said that they had received training in the protection of vulnerable adults and demonstrated that they would record and report any suspicion of abuse. It is recommended that staff receive an annual update on adult protection awareness. A record is kept of resident’s physical or verbal aggression directed at other residents or staff. Seventeen staff have undertaken training in supporting residents who exhibit additional challenging behaviour. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 14 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, 23, 24 and 26 Residents live in a comfortable, well-maintained home and benefit from all amenities being situated on the ground floor. The home is clean, pleasant and hygienic. EVIDENCE: The New Close is an extended, detached bungalow, set in large grounds, next to a primary school, in a cul-de-sac in the village of Bridge. The home is divided into two by a coded entry door, separating the home into two wings of up to thirty residents. This enables staff to supervise residents more easily. Each wing has a dining/lounge area and one or two additional lounge areas, and a visitor’s room. Resident’s rooms are accessible from the lounge areas and are located in groups of ten. After undertaking an assessment to promote resident’s safety, resident’s bedroom doors are locked during the day. The home has extensive gardens, including a small, enclosed garden and a sensory garden, which is accessible from one wing of the home. There are plans to ensure that residents from both wings of the home can access the garden. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 15 Selected bedrooms viewed were decorated according to individual needs and tastes. New bedroom furniture had been fitted since the last inspection and furniture and fittings were of a good standard. The home benefits from sixteen toilets, seven bathrooms with disabled facilities and a shower room. The home was clean and free from offensive odours on the day of the inspection. There is a separate laundry and drying room with sluicing and hand-washing facilities. Residents’ clothes are named and there is a place for storing miscellaneous unmarked clothes. Relatives said that sometimes residents clothes went missing and that when this happened, staff tried to locate the missing garments. There is one laundry person on duty from 8am to 2pm each day and two staff one day a week. It was observed that there was still washing in the machine once the laundry staff had gone off shift and that this would now be the responsibility of the care staff. The manager said that she would look into the issue to ensure that care staff were not taken away from their care duties. Staff have undertaken training in infection control and demonstrated that they had a good understanding of the important principles in minimising the spread of infection. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 16 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 and 30 The home needs to demonstrate to the Commission for Social Care Inspection, how it calculates it’s current levels of staffing to ensure that residents’ needs are met. Staff have a good understanding of the care needs of people with dementia. EVIDENCE: At the last inspection, the majority of staff said that there were not sufficient numbers of staff on duty to meet the needs of all the residents. There are currently fifteen resident vacancies at the home, and as a result, the deputy manager explained that there has been a reduction in staffing levels. Staff said that they were still stretched, particularly at certain times of the day, “we cope, but it is a struggle”. Staff said that this is because there are a number of residents who require two carers to assist with their mobility and personal care needs. It is required that the home demonstrates to the CSCI how they assess the staffing levels in the home, based on the assessed needs of the residents. The home has reduced the number of staff vacancies since the last inspection, but there is still one full-time and two part-time care posts vacant. Agency staff, from the same agency continues to be employed on a regular basis. There is a written training plan for the whole staff team with a list of training that is due to be undertaken. All staff are trained in dementia and in additional some staff have undertaken training in working with people with challenging behaviour. Staff were observed communicating with residents in an effective and sensitive manner. Relatives described staff as, “lovely”, “brilliant” and “excellent”. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 17 The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 18 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, 35, 36 and 38 Residents, staff and relatives views are sought about the quality of the service. Clear records are kept of resident’s financial transactions. Staff are supported by regular, formal supervision. EVIDENCE: KCHT and the registered manager operate a quality assurance and monitoring system. Quality is monitored via divisional area meetings, health and safety meetings, and through the residential forum. The KCHT operations manager visits the home unannounced and conducts a quality audit using a specific format, which is forwarded to CSCI. An annual quality survey is conducted with residents, relatives and staff and the results published. The results are published for the whole of KCHT residential care homes in the southeast area and so it is not reflective of the outcomes for residents at The New Close. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 19 Although resident’s individual monies were not inspected, there was evidence that where the home holds monies on behalf of residents, clear records and receipts are kept of all financial transactions. A formal system of supervision has been re-established in the home, whereby the deputy manager supervises team leaders and team leaders in turn, supervise care staff. Staff said that they receive regular supervision and records confirmed this. Each staff member has a long-term plan and objectives to work towards. Care plans were cross-referenced to the accident book and indicated that in the main, accidents were recorded in accident book. Throughout the inspection staff were observed undertaking good moving and handling techniques with residents. The first aid boxes have been fully restocked since the last inspection. The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 20 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 3 3 x 3 The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? 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 (1) Requirement The registered person must ensure that individual plans of care contain the action to be taken by staff or others to meet residents assessed needs The registered person must ensure that the dental care needs of two residents are addressed The registered person must regularly review the action plan for intervention of residents at risk of falling, to assess whether it is effective in reducing the number of falls for residents The registered person must ensure that: - All hand written entries on the medication administration sheets are signed and countersigned - There is sufficient stock of all medicines The registered person must ensure that the medication procedure includes protocols for the covert administration of medication The registered person must ensure that the premises are DS0000023607.V278747.R01.S.doc Timescale for action 17/03/06 2 OP8 12 (1) a b 24/01/06 3 OP8 12(1)a, 18(1)b 17/02/06 4 OP9 13 (2) 24/01/06 5 OP9 13 (2) 17/03/06 4 OP22 23 28/02/06 The New Close Version 5.1 Page 22 assessed by a suitably qualified person affirming evidence of suitable adaptations and equipment (timescale of 01/04/05 not met) 5 OP27 18 (1) The registered person must write 17/03/06 to the CSCI informing them of the assessment tool and criteria used for assessing residents’ dependency levels, in establishing the current staffing levels at the home 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 3 4 Refer to Standard OP1 OP7 OP8 OP30 OP12 Good Practice Recommendations The registered person should give consideration to presenting the service user guide in a format that has meaning for the residents for whom it is intended The registered person should ensure that daily notes contain details of the personal care given to residents The registered person should ensure that staff training in visual impairment is extended to include additional staff The registered person should ensure that all residents have opportunities to engage in stimulating activities. In order to achieve this, consideration should be given to reestablishing the sensory room The registered person should ensure that all staff receive refresher training in adult protection, annually The registered person should ensure that the results of the quality survey are published individually for The New Close to ensure that appropriate action can be taken to address any issues raised 5 6 OP18 OP33 The New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 New Close DS0000023607.V278747.R01.S.doc Version 5.1 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!