Care Home: Kathryn Court

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What the care home does well People are happy with the overall service offered at Kathryn Court. One relative said, "I can`t think of anything bad about Kathryn Court. The staff are extremely caring, smart, polite and communicative. The home is kept very clean and the food very good and varied."The home is well managed, with a competent and well trained manager in place. Staff were positive and well motivated. One said, "Our service users are always a priority. We always make sure they are safe and all their personal needs are done with respect and dignity. Our aim is to make them feel at home and we are all one big happy family. We try very hard to keep them happy." Kathryn Court purpose built and provides a comfortable environment for people. The entrance area is warm and welcoming with useful information available on the home and other topics that might be of interest. People know that they will be able to welcome their visitors at any time. If people or their families have any concerns they know that they have access to a clear complaints procedure. Staff will try to assist and their concerns will be looked into and addressed. The organisation provide people with opportunities to express their views, and have good strategies in place to help them to monitor the quality of the service. What has improved since the last inspection? A requirement made at the last inspection relating to medication has been met and people can be assured that their medicines are managed well by staff. Due to a change in staff deployment, people will receive their morning medicines in good time each day. Care staff are now more involved in promoting activities. This should give people more opportunities for stimulation and occupation. A `tea room` and a sensory area have been set up to provide additional facilities and opportunities. New garden furniture has been bought to help people to enjoy the out door space. People are kept involved and informed of activities and events through a bright and cheerful newsletter. Maintenance and improvement of the premises is ongoing to ensure that people live in a well maintained home that meets their needs. Since the previous inspection a new assisted bath has been installed, blinds have been fitted in the conservatory, and work to re-decorate all corridor areas is about to commence. Staff training has been ongoing throughout the year with some staff having undertaken training in dementia care, health and safety, and fire procedures amongst other things. What the care home could do better: People should have adequate facilities in which to store their toiletries and bathing equipment in their en suite areas.In general people are cared for by a well trained workforce, and training has been ongoing. However due to staff turnover management need to continue to monitor levels of training and ensure that all staff have good levels of basic training and are kept up to date in all areas. When new staff start work their induction should be carried out to a consistent standard so that they are competent and confident in carrying out their duties. Staffing rotas need to be accurately maintained so that it is possible to know easily from viewing them who is on duty, and if staffing levels are adequate. CARE HOMES FOR OLDER PEOPLE Kathryn Court 84 Ness Road Shoeburyness Essex SS3 9DG Lead Inspector Ms Vicky Dutton Unannounced Inspection 8th July 2008 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 Kathryn Court DS0000015442.V368500.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. Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kathryn Court Address 84 Ness Road Shoeburyness Essex SS3 9DG 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) 01702 292800 01702 292383 kathryn.court@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc Mrs Susan Loftus Care Home 52 Category(ies) of Dementia - over 65 years of age (52), Old age, registration, with number not falling within any other category (52) of places Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th June 2007 Brief Description of the Service: Kathryn Court is a two-story, fully detached, purpose built property, set in compact grounds in Shoeburyness. The home is registered to accommodate fifty-two older people (over the age of 65), including those who have dementia. Accommodation is provided in forty-eight single and two shared en-suite bedrooms, on both levels of the home. Access between levels is provided by a passenger lift. Communal space available comprises of four day rooms and a conservatory. Visitor car parking is available by the main entrance of the property, where there is also a small enclosed garden for service users to use. Local shops are opposite the home and around the local area. A regular bus route passes the front of the home. Fees for the home range between £400 & £700 a week. There are additional charges for personal requirements, chiropody, hairdressing and some transport costs. CSCI inspection reports are available from the home and the CSCI internet website. Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced ‘key’ site visit. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The compliance with a requirement made at the previous inspection was assessed. The site visit took place over a period of nine hours. A partial tour of the premises was undertaken, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. The home’s Annual Quality Assurance Assessment (AQAA) was sent in to us (CSCI.) The AQAA was received by the due date, was briefly but fully completed. The AQAA outlined how the home feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives involved professionals and staff. Ten residents, two staff, one care managers and four relatives surveys were returned. The views expressed at the site visit and in survey responses have been incorporated into this report. We were assisted at the site visit by the manager, and other members of the staff team. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the service does well: People are happy with the overall service offered at Kathryn Court. One relative said, “I can’t think of anything bad about Kathryn Court. The staff are extremely caring, smart, polite and communicative. The home is kept very clean and the food very good and varied.” Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 6 The home is well managed, with a competent and well trained manager in place. Staff were positive and well motivated. One said, “Our service users are always a priority. We always make sure they are safe and all their personal needs are done with respect and dignity. Our aim is to make them feel at home and we are all one big happy family. We try very hard to keep them happy.” Kathryn Court purpose built and provides a comfortable environment for people. The entrance area is warm and welcoming with useful information available on the home and other topics that might be of interest. People know that they will be able to welcome their visitors at any time. If people or their families have any concerns they know that they have access to a clear complaints procedure. Staff will try to assist and their concerns will be looked into and addressed. The organisation provide people with opportunities to express their views, and have good strategies in place to help them to monitor the quality of the service. What has improved since the last inspection? What they could do better: People should have adequate facilities in which to store their toiletries and bathing equipment in their en suite areas. Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 7 In general people are cared for by a well trained workforce, and training has been ongoing. However due to staff turnover management need to continue to monitor levels of training and ensure that all staff have good levels of basic training and are kept up to date in all areas. When new staff start work their induction should be carried out to a consistent standard so that they are competent and confident in carrying out their duties. Staffing rotas need to be accurately maintained so that it is possible to know easily from viewing them who is on duty, and if staffing levels are adequate. 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. Kathryn Court DS0000015442.V368500.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 Kathryn Court DS0000015442.V368500.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): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wanting to move into the home are assured by the information given and assessments undertaken that their needs can be met. EVIDENCE: On surveys eight out of ten people said that they had received sufficient information about the home to help them make a decision about moving in. Previous inspections of the home had identified that the manager or staff always carried out a pre-admission assessment to be sure that the home is suitable to meet people’s individual needs. At this inspection we looked at the files of two people who had recently moved into the home. Both people had moved to the home from areas at some distance away to be near families locally. It had not therefore been practical for staff from the home to visit them to carry out an assessment. Families had visited the home and shared information with the manager about the needs of their relative. The manager also said that they had discussed one persons needs in detail over the Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 10 telephone with a social worker. On looking at the files we saw that comprehensive information was available from a hospital in one case, and a social services department in another. The assessment process had been completed on the day of admission. One person spoken with said that they had been happy with arrangements and were “settling in well.” Intermediate care is not provided at Kathryn Court. Kathryn Court DS0000015442.V368500.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, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People receive good care and healthcare support to meet their individual identified needs. EVIDENCE: People can expect to receive care suited to their individual assessed needs. Based on information and assessments completed before and following admission care plans are developed that people or their families are encouraged to be involved with. People were happy with the care and support received. A relative said, “[Relative] gets very well cared for. There is everything they need to have, and they get all the help they need.” During the day of the site visit people seemed happy and appeared well cared for. One person said, “The staff are good and help us as much as they can.” A member of staff said, “Handovers are very precise covering all needs. Detailed assessments are carried out on all new admissions. This info is reflected in care plans.” Another said that they “Promote individuality, with all care tailored to individual needs.” Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 12 To see how well staff understand people’s needs and plan for their care we viewed a number of care files, staff were spoken with and practice observed. Staff and the manager had a good awareness of people’s individual needs and were observed to give people the care and assistance they needed based on their care plans. Care plans are understood by staff, those viewed provided a good basis to ensure people receive the care they need. The level of detail was good, and would help staff understand what people’s needs were, and the best approach to meeting these. Staff felt that they had been “Helped by person centred care training.” Some areas where care plans could be improved to ensure that people’s care needs are fully identified and met by staff were highlighted to the manager. For example one care plan contained no reference to the person having Parkinson’s disease, or what the impact would be on their care needs. The manager and care team manager (CTM) thought that the information had been there previously. Another care plan contained no reference to a persons potential breathing difficulties. For most people good records are maintained in relation to ongoing daily care, but some attention to detail is needed. One person was referred to the district nurse for a sore that had developed. Daily observations and records of professional visits demonstrated a lack of recording and follow through. The care records kept for a person cared for in bed were poorly maintained. Staff had not been consistently recording when fluids or food had been given. It therefore appeared that they had gone for extended periods of time without such care. In a phone call following the site visit the manager confirmed that these issues had been dealt with. On surveys six out of ten people said that they ‘always’ received the medical support they needed. Two said that they ‘usually’ did and one that they ‘sometimes’ did. From records that we viewed, people can feel confident that staff will be sensitive to their changing health care needs, and support them to access appropriate help. The files we looked at showed that people are referred to appropriate professionals such as community psychiatric services when needed. People are also offered regular opportunities to access chiropody, optical and dental care. District nurses visit the home as needed to attend to people’s needs. People living at the home said, “If I need medical support I get it,” and, “I can always have medical help when necessary.” Relatives felt that they were kept informed about people’s needs. They said, “I have always been called when [relative] needs to go to the hospital or doctors,” and, “They always contact me by phone if needed even though I visit my [relative] twice a week.” From practice observed, and records and systems viewed, people can feel confident that their medicines will be managed safely by staff. Good records are maintained. Staff have received appropriate training in managing medicines. Since the previous inspection staff deployment has changed to ensure that there are two Care Team Managers (CTM’s) on duty each morning. This enables medicines to be administered on both floors at the same time and ensures that people receive their medicines in a timely manner. Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 13 During the day of the site visit staff treated people with care and respect. A member of staff said, “Our service users are always a priority. We always make sure they are safe and all their personal needs are done with respect and dignity.” Kathryn Court DS0000015442.V368500.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, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have opportunities to enjoy a fulfilling lifestyle, and maintain contact with friends and family. EVIDENCE: On surveys seven out of ten people said of activities that they are ‘usually’ available, one said that they ‘sometimes’ were, and one that they ‘always’ were. Currently an activity co-ordinator only works on two days each week, as opposed to the full time hours of the previous activity co-ordinator. To try and compensate for this care staff are becoming much more involved in ensuring that people have opportunities for stimulation and activity. The AQAA said that, “all staff are working towards providing activity based Care.” During the site visit, staff did undertake activities with people. Individual ‘activities assessments’ have not yet been fully completed to properly identify people’s occupational needs. Activities assessments, and records relating to activities are maintained by staff, but kept separately from people’s care plans and other records. This does not help in providing a holistic approach to care. Since the previous inspection a ‘tea room’ has been developed to provide people with a pleasant place to entertain visitors, or for themed activities. A Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 15 sensory area has also been developed to provide a relaxing place for people. Regular activities such as gardening and knitting clubs are also available to people. Local church and other groups are involved with the home, so people have opportunities to feel part of the local community. Outside entertainers and a Pets as Therapy dog also visit the home on a regular basis. One person said, “There are difficulties for trips outside, mainly lack of transport and for dealing with wheelchairs and walking frames.” From a colourful newsletter seen, and verbal information given, it seems that management and staff are trying to address this issue. The activity co-ordinator is in negotiation with dial-a-ride, and volunteers to push wheelchairs, or assist with activities are being sought. We observed, and people told us, that they had autonomy, were offered choices in their daily lives, and were free to follow their own routines. One person told us, “When I want to go to my room someone will always help me.” Information about advocacy services was available so that people know where they can go to for independent advice and support if they wish. Visiting at the home is very open. Visitors came and went as they wished throughout the day of the site visit. People said that food provided by the home was good and made comments such as “Yes the food is generally good,” and “I always enjoy the food.” A relative said, “The food is always very good and varied.” Lunch on the day of the site looked appetising, and people were individually served according to their choice. When people needed assistance, staff did this in a sensitive manner. Kathryn Court DS0000015442.V368500.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, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are protected from abuse through clear complaints procedures and good practice. EVIDENCE: There is a clear complaints process in place for people to use. This was on display for people. From surveys it was clear that people knew how to raise any concerns about the service. When we viewed records we saw that management deal well with any concerns raised. People felt confident in raising any concerns. One person said, “If ever I need to sort anything out it is dealt with straight away.” Staff understand that it is important that people feel able to raise any issues. One said, “As a key worker my service users will always let me know if they or their families have a problem, and I will always pass on any information to management. Any other service users who have any concerns which I know about, I would certainly go to management.” Since the previous inspection one person has raised concerns with CSCI. Their concerns were about the security of the building and were considered as part of this site visit. Staff training records and staff spoken with showed us that staff have undertaken training in safeguarding and have a good understanding of this important aspect of care. Management are clear about their responsibility to report any issues to safeguarding teams. Since the previous inspection four Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 17 safeguarding concerns have been raised. Three of these relate to the management of people’s financial affairs by their representatives. Investigations into these are ongoing. Management at the home raised the issue on behalf of one person, and since then social services are including a review of people’s financial arrangements as part of their annual review process. People told us that they have confidence in the home. A relative said, “I feel my [relative] is very safe in their care. They do a very good job.” Care plans showed recognition of behavioural needs. Appropriate care plans and risk assessments were in place to help staff assist people appropriately. A few staff have undertaken training relating to the management of challenging behaviours, and further training is planned. Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 18 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, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a pleasant and well maintained home, which meets their needs and expectations. EVIDENCE: Kathryn Court provides people with a spacious and well maintained environment. People have pleasant rooms, which they are able to personalise to their own tastes. All have en-suite facilities. Rooms viewed were homely with personal touches. People told us that they were happy with their accommodation. One said, “I am very comfortable here and have everything to hand.” Some people have their own telephone to help them maintain contact with friends and family. Since the previous inspection new lounge and dining room chairs have been provided, bathrooms have been made less clinical and more homely, and a redecoration programme is ongoing with further works planned. Upstairs the communal accommodation has been Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 19 reorganised from having two areas that could be used for lounges, to having a games area and one lounge area. This needs to be kept under review to ensure sufficient space is provided for people. On the day of the site visit when a number of people wished to use the single lounge area it was cramped. On a survey one person said, “In my home I feel the dining room is over crowded with wheelchairs and frames.” From observation at the site visit this probably related to the dining arrangements downstairs, which is used to capacity. The situation is monitored by staff to ensure people’s safety. We noticed that that en-suite areas do not have vanity units or storage facilities. People’s toiletries and other items were therefore noted to be stored on toilet cisterns or in baskets on the floor. Some en suites have a small shelf but sometimes these were not level causing things to fall off easily. Many taps around the home do not have hot/cold indicators on them to assist people, particularly those who have dementia. For the size of the home Kathryn Court does not have much outdoor space for people to enjoy. However the small garden areas are pleasant and well maintained. This year new garden furniture has been purchased to help people to make the most of the space. The home’s kitchen area is in need of refurbishment. The manager said that this is on the schedule of works for the home. On the day of the site visit the home appeared to be clean and most areas smelt fresh. The manager highlighted that regular floor audits are undertaken to ensure that standards are maintained. On surveys seven out of ten people said that the home was ‘always’ fresh and clean. One person however said, “Sometimes the commode and toilet are not cleaned and the room is not always clean. Beds are not moved out and skirting boards are not cleaned very often.” A relative said, “Depending who is on shift sometimes the floor in my [relatives] room needs a Hoover. As far as I know its done each day.” According to the AQAA completed there is a low level of training in infection control procedures amongst care and domestic staff. Domestic staff spoken with identified that they had undertaken a range of training but not infection control that would help to inform their practice. One person was not entirely sure if anyone currently living at the home had MRSA, or others conditions that they should be aware of. The manager said, and information on the training matrix indicated that dates for infection control training to be implemented are being discussed. The home has a suitable laundry area so that people’s clothing and laundry is managed in a hygienic manner. The laundry person said that they had undertaken relevant training and were aware of safe practices. Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 20 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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A team of experienced and trained staff ensures that people are well supported. EVIDENCE: Since the previous inspection recruitment and retention of staff has been an ongoing task at the home. For various reasons there has been quite a high turnover of staff. However the manager said that the home is now nearly fully recruited to, retention is good and that no agency staff have been used for a while. Management feel that the following staffing levels are sufficient to meet the needs of people living at Kathryn Court. In the mornings there are two care team managers (CTM’s) and six care staff on duty. During the afternoon and evening this drops to one CTM and six care staff. At night there are three care staff and one CTM on duty. The manager’s hours are supernumerary. Ancillary staff such as an administrator, cooks, and domestic staff are employed. We looked at three weeks rotas and it appeared that staffing levels are being maintained as stated. However there is some doubt as to the accuracy of the rotas. For example one member of staff was rostered on the main rotas to be working an early shift on one day and a late on the next. On the additional shifts rota they were recorded as working night shifts on the same days. Another member of staff was recorded as sick on one day and a late shift on the next day on the main rota, but on the extra shift rota they Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 21 were identified as working two night shifts. Although the home was reported to be nearly fully recruited to, rotas viewed showed a number of vacancies. To cover these some staff are working from 07.15 to 21.30 (double shifts) on a number of days each week, in addition to single shifts on other days. One CTM in charge is recorded as working an early shift and a night shift on the same day. This is either not good practice, or shows poor rota maintenance as previously identified. Staff working too many additional hours is not good practice as staff may become tired and not perform so well putting people at risk. The manager said that the hours worked by staff are monitored so this should not happen. On surveys and in discussion staff felt that there were generally sufficient staff to meet people’s needs, but one person said, “There is always enough staff to take care of service users, but sometimes if we are a career short (due to Dr’s or hospital visits) it will leave us short on the floor. Therefore we cannot meet all their needs.” On surveys of people living at the home two people out of ten said that staff were ‘always’ available to them when needed. Seven said they ‘usually’ were and one said ‘sometimes.’ On surveys only one relative said that the home needed more staff. During the day of the site visit staff cover around the communal areas was good. Staff were generally available to meet people’s needs, and interact with them. People told us that they liked the staff at the home and got on with them well. One person said that, “The staff are very efficient and thoughtful.” Another said, “All the staff are always kind to me.” On surveys all but one person felt that staff ‘always’ listened and acted upon what they said. At the site visit and on surveys we felt that staff were well motivated and positive about their role. One said, “I am very happy in my work and we have a great care team and a brilliant management team. We all work together to try and keep up the standards at Kathryn Court making it a very happy and caring home. I hope I will continue to work and enjoy every day as I do.” At the site visit it was confirmed that out of 25 care staff and CTM’s, ten have achieved a National Vocational Qualification (NVQ) in care at level 2 or above. Two further staff are working towards NVQ in care at level 2. Four staff who already have NVQ at level 2 are working towards a level three qualification. The manager confirmed that further staff will soon be ‘signed up’ to undertake NVQ’s. Although the home has not yet quite achieved the recommended 50 of staff trained to NVQ standards, they are demonstrating a commitment towards this. People are cared for by staff who have generally been recruited safely to ensure that they are suitable to look after vulnerable people. The two files we looked at showed that required checks such as Criminal Records Bureau, (CRB) identification proof and references had all been carried out. One person had commenced before the CRB check had been received, but a POVA 1st check was in place. One had not given their most recent employer as a referee. The manager is aware that these issues do not represent best practice. On surveys staff confirmed that checks had been carried out before they started work. Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 22 Staff said that when they started work at the home they had undertaken an induction to help orientate them to the home. One said, “The staff were very helpful and an induction form was completed.” The organisation uses a comprehensive induction training manual based on Skills for Care standards. This is given to staff after they have completed an initial period of employment of a few weeks. In the initial period a basic induction checklist is worked through. For one member of staff this had all been dated and signed off on the same day, but no core training such as moving and handling was identified as having been undertaken on the induction record or the training matrix. For another member of staff who started in June, the induction checklist had not been fully completed, and they had not yet received their full induction manual. This shows an inconsistent approach to ensuring that new staff receive the knowledge they need in a phased and managed way. Staff told us, and the home’s training matrix and records confirmed that there are good opportunities for training. This ensures that people are looked after by staff who have appropriate skills and understanding. The training matrix identified that training in basic areas is provided, and that all grades of staff receive training in dementia care. There are some gaps in training, for example food hygiene, and not all staff having completed all relevant training, but management are aware of this and working towards arranging further sessions. Areas where other training might assist staff in meeting people’s needs were not identified on the matrix. For example one recent admission is registered blind, but there is no indication that staff have had awareness training in sensory impairment. Overall however records and discussion showed that management is committed to ensuring people are cared for by a skilled workforce. One relative said of staff, “Some seem to have more skill and knowledge than others. Overall there is no problems at the moment.” Another said, “From what I see they are experienced in their jobs.” Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 23 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, 35, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe and well managed home. EVIDENCE: The home is well managed and has a competent manager in post who is registered with us (CSCI.) The manager has appropriate qualifications and training for the role. Staff are positive about the support and leadership offered by management. One said, “Management are always available for a chat if you have any issues. Supervisions are held a minimum of six times a year.” People can feel confident that management consider their thoughts and views to be important in the running and development of the service. There are Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 24 opportunities for people to express their view through residents and relatives meetings. A suggestion box is available. The manager has an ‘open door’ policy and also holds a weekly ‘surgery,’ providing an opportunity for relatives to discuss any issues. As seen in the staff room, regular staff meetings are held for all grades of staff. The organisation has strategies in place to monitor the quality of the service. An annual audit is undertaken which people contribute to through surveys and discussion. This process took place at Kathryn Court in May 2008. Regular monthly visits are undertaken by a senior person in the organisation to ensure that standards are being maintained. The manager completes a very comprehensive managers report each week. Information recorded on this relating to, for example falls, complaints and people’s care is monitored at head office. Local processes such as care plan audits, medication audits and monitoring the premises also take place to ensure people ongoing safe care. The AQAA completed by the manager was briefly but fully completed. People know that if they or their families ask the home to help them look after their personal monies that this will be done in a way that safeguards their interests. Good records are maintained, and the system is regularly audited by staff from the organisations finance team. People can be sure that health and safety is given priority. Systems and services such as the fire system are regularly tested and checked. Risk assessments and procedures are in place so that staff know how to manage different situations. Most staff have received training to make them aware of, and maintain good practice in core areas such as fire awareness, health and safety and moving and handling. The practice of having beds placed alongside a wall, that was observed in many bedrooms, including where a person was being cared for in bed, was discussed. This may not fully promote safe moving and handling practice to protect people and staff. Any additional risks or environmental issues associated with this should be identified in risk assessments. Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 25 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 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 26 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. Standard Regulation Requirement Timescale for action 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 OP12 Good Practice Recommendations So that people’s daily life and care is managed in a holistic way, the practice of keeping records, such as activity assessments and records, separate from people’s care plans should be reviewed to ensure that this provides the best outcome. Staff should receive training in managing challenging behaviour to help them better understand people needs and meet them in a consistent manner. En suite areas should be provided with storage space so that people have a suitable area to store their toiletries. So that people are cared for by skilled and knowledgeable staff, management should review their induction processes to ensure that these are carried out consistently and to a good standard. DS0000015442.V368500.R01.S.doc Version 5.2 Page 27 2. OP18 3. 4. OP19 OP30 Kathryn Court 5. OP38 Where beds are placed up against walls and people need assistance with moving and handling, this should be within a risk assessment framework so that people and staff are protected from injury. Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Kathryn Court DS0000015442.V368500.R01.S.doc Version 5.2 Page 29 - 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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