Care Home: Keller House

What the care home does well Keller House provides residents with a homely environment, with a large lounge and separate dining room. Residents are encouraged to bring pictures, ornaments and furniture with them and many have used their own possessions to personalise their rooms. Relatives and visitors are welcome at any time, and those involved in the inspection said the staff are very good. What has improved since the last inspection? Some of the issues identified at the last inspection have been met, risk assessments for the use of bed barriers have been introduced and all radiators are covered to protect residents.Keller HouseDS0000021145.V377461.R01.S.docVersion 5.2 What the care home could do better: A number of concerns were identified during the inspection and these were discussed with the deputy manager and staff. They have been included in the body of the report and a number of requirements have been made. The expectation is that the care offered to people living in the home is reviewed in line with their assessed needs and the staffing levels, and that appropriate support from the providers is in place following the development of an effective quality assurance and monitoring system. Key inspection report CARE HOMES FOR OLDER PEOPLE Keller House 52 Carew Road Eastbourne East Sussex BN21 2JN Lead Inspector Kathy Flynn Key Unannounced Inspection 27th August 2009 11:00 DS0000021145.V377461.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Keller House Address 52 Carew Road Eastbourne East Sussex BN21 2JN 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) 01323 722052 01323 722052 Mr Twalebuddeen Durgahee Mrs Erlinda Durgahee Mr Twalebuddeen Durgahee Mrs Erlinda Durgahee Care Home 15 Category(ies) of Dementia (0) registration, with number of places Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE) The maximum number of service users to be accommodated is 15. Date of last inspection 4th October 2007 Brief Description of the Service: Keller House is registered to provide care and accommodation for fifteen service users that meet the registration category of older people with dementia. Conditions of registration will be reviewed by the South East regional registration team as part of the ‘Modernising registration Agenda’. It is a large detached house situated approximately ¾ of a mile from Eastbourne town centre and the train station. The home comprises of eleven single bedrooms and two double bedrooms. There is a large lounge area, a separate dining room, which is situated next to a compact kitchen. On the lower floor there is a conservatory, which leads out to a garden. To the front of the house there is a patio area. There is a passenger lift and a stair lift that allows level access to all areas of the home. The service users’ guide is displayed in the entrance area, and details of the fees charged can be obtained from the home, these do not include toiletries. Additional charges are made for hairdressing, chiropody, newspapers and outside activities such as visits to the theatre. Intermediate care is not provided. Keller House DS0000021145.V377461.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 1 star. This means the people who use this service experience adequate quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Keller House will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home, and a second visit arranged with the deputy manager to enable the home to produce specific documentation. Care plans, medication charts, recruitment files, and the menus were viewed and the deputy manager, care staff and cooks were happy to discuss the support offered. The Annual Quality Assurance Assessment (AQAA) was completed by one of the providers, within the required timescale. However the forms completed were for Care Homes for Adults (18-61) although Keller House is registered as a Care Home for Older People and a different AQAA is required. Consequently it was difficult to use all the information included in the AQAA as the standards are different and therefore do not reflect the services offered at the home. What the service does well: Keller House provides residents with a homely environment, with a large lounge and separate dining room. Residents are encouraged to bring pictures, ornaments and furniture with them and many have used their own possessions to personalise their rooms. Relatives and visitors are welcome at any time, and those involved in the inspection said the staff are very good. What has improved since the last inspection? Some of the issues identified at the last inspection have been met, risk assessments for the use of bed barriers have been introduced and all radiators are covered to protect residents. Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 6 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Keller House DS0000021145.V377461.R01.S.doc Version 5.2 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 Keller House DS0000021145.V377461.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 is not applicable. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People looking to move to the home are provided with the information they need to decide if the home provides the support the want. Prospective residents have a full assessment of their needs and are offered a place in the home if their needs can be met. EVIDENCE: The service user’s guide is displayed in the entrance area, and the deputy manager confirmed that they are also kept in each of the resident’s rooms. Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 9 The home encourages relatives, and prospective residents if appropriate, to visit the home and meet the residents and staff before they decide if the home offers the care they want. Assessments are completed by the manager before people move into the home to ensure their needs can be met. Relatives involved in the inspection said they were pleased with the care provided, although one had not actually chosen the home she was happy with the support provided. Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system provides a considerable amount of information about the residents needs, however staff may not offer the support recorded for all of the residents. Training in the correct recording and administration of medication is provided for staff to protect residents, and policies and procedures are in place, although staff did not follow the homes policies. EVIDENCE: Four care plans were examined, they contained a considerable amount of information based on activities of daily living, which aims to identify the specific support needs of the residents. Three of those viewed contained preadmission assessments, risk assessments including those for mobility, pressure relief, falls, nutrition with monthly weights, as well as risk Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 11 assessments and consent forms for the use of bed barriers as required following the last inspection. However there were a number of concerns about the relevance of the information recorded and how staff can meet the residents’ needs. There was evidence that the care plans have been reviewed, however this had not been done on a monthly basis for all the residents. There was no evidence in one care plan that the resident or a representative had been involved in developing the plan; the moving and handling assessment had not been reviewed although staff said his needs had changed; the risk assessments had not been reviewed within the last month and the life profile had not been completed, so it would be difficult for staff to plan appropriate support based on his interests and choices. A number of the residents are at risk of falls and assessments are included in the care plans, however it was found that these were not reviewed and updated following falls in two of the care plans viewed. Staff were not offering specific support recorded in care plans. In particular one resident should be encouraged to talk, walk with assistance and join in the activities but was not supported to do this. This may be linked to the number of staff working in the home, refer to Standard 27. A care plan had not been completed for a resident recently admitted to the home. It contained only the pre-admission assessment, there was no record of the GP visit or if there were any changes to the support offered following this, risk assessments including the moving and handling and Waterlow assessments had not been completed. This resident was quite confused and distressed at times and had not been eating very well since admission. Staff were unable to evidence that they were providing the care and support that she needs and wants. The deputy manager advised that it is the homes policy that they do not complete the care plans for the first week following admission, but they do observe them. The expectation is that the care plans are discussed and completed, with the residents and their representatives, when they are admitted to care homes. Staff can use it to guide them to provide the support and care people need when they first move into a strange environment, as well as use the information as a base line from which they will be able to identify any changes in a residents needs. There was little evidence that the care planning system is based on Kitwoods person centred care approach as stated in the AQAA. The support offered by staff is recorded is a separate folder, which when examined was noted to be made up of short statements about the residents’ day, with very little information about how their individual needs are met. Daily records are a good source of evidence to show that care is being Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 12 provided, as detailed in the care plan, when well written they help ensure a consistent approach and good quality of care for residents. It is in the homes interests to be able to show what they have done, along with providing the evidence on which to base the monthly review, and to record that they are following the assessment of needs. Residents are registered with GP’s and records are kept of visits by District Nurses and Community Psychiatric Nurses and allied professionals, including chiropodists. Although it is difficult to assess how accurate these are, as already noted a GP visit had not been recorded, and if new residents are not assessed when they first move in referrals to allied health professionals, such as dieticians, may be delayed. The staff confirmed that the home has policies and procedures in place for the ordering, storage, administration and recording of medication, and they said they have attended relevant training. The medicine administration record (MAR) charts were viewed and some of the medication given to residents that morning was not signed for. The staff member responsible said that she had given out the medication and was in the process of signing the sheets when she was called away to assist the District Nurse. The controlled drug book was also examined, the records of two residents receiving medication was not clear and therefore unsafe. The deputy manager made appropriate changes to the book by the second day of the inspection. A requirement was made regarding controlled medication following the last inspection. The expectation is that relevant training is provided for all staff responsible for medication to ensure they are up to date with appropriate safe systems of storage, recording and administration of medicines. Staff were using a handling belt inappropriately when assisting residents to get up to use the bathroom, or move from one chair to another. The belt is designed to enable staff to safely support people who can stand or walk and just need guidance, but staff were using it to lift residents. Staff spoken with said they know that they do not use it properly but they have to move the residents, and there are a number who are unable to stand up. The deputy manager said that residents may have different needs depending on how they feel each day, therefore a system to assess their needs daily should be developed, and appropriate aids should be available to enable staff to meet these. Staff offered residents personal care when appropriate and they respected their dignity, talking to them and explaining what they were doing at the time. A visitor said the staff are very good and look after her husband very well. Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home aims to enable residents to make choices about their day to day lives, however the routines of the home are not flexible and residents have little opportunity to make decisions. EVIDENCE: The AQAA states that Keller House is a flexible home which supports the day to day wishes and needs of the residents, with opportunities for stimulation through leisure and recreational activities based on the residents preferences, and residents are encouraged to exercise choice and control over their lives. However the feedback during the inspection was that activities are not organised on a daily basis, and they are not based on the interests and preferences of residents, as recorded in some of their care plans. Although Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 14 music was played in the afternoon and a member of staff was sitting with them encouraging residents to join in, with some residents singing along. All the residents were in the lounge at this time, including those who prefer to remain in their rooms. A number of residents were asleep at the start of the inspection, the TV was on and staff were busy preparing for lunch. Staff advised that all but two of the residents are assisted to get up, washed and dressed and are sitting in the lounge before the day shift starts. It was noted that most of them spend all day in the lounge, and there were very few opportunities for staff to spend time with them. Overall there was little evidence that residents are encouraged to make choices about their day to day lives, the routines of the home were based on staff completing the work needed to provide basic support and care. There were clearly many residents with a wide range of needs relating to different stages of dementia and further appropriate stimulation and socialisation, over and above the general day to day care duties is required to promote a person centred approach. Staff spoken with said that more staff are needed, so that they can help residents to spend their time doing something they enjoy. The dining room is next to the kitchen and is used only by those residents who can walk independently, staff said residents who are not mobile remain in the lounge for meals, they are not asked where they would like to sit. A three week menu has been developed which lists choices for each of the meals, and the deputy manager advised that they are offered choices and a record is kept. The records were examined and they showed that the residents are asked what they want to eat two weeks before the actual meal is provided. The deputy manager confirmed that they do this so that they know what food to buy, and the indication is that this is a cost based exercise rather than one that enables residents to make choices. Residents were not offered a choice for lunch, although they did eat the meal, staff assisted some residents, and staff were noted to give residents what was available rather than asking them what they wanted. There is considerable opportunity to make meals a pleasant and positive time for people with dementia, and with appropriate planning, staff training and sufficient staff numbers meals can be a valuable social experience for residents. Visitors are welcome at any time and those spoken with said they are happy with the care their relatives receive, although they also felt that the staff are very busy and do not have as much time to spend with residents as they should. Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has procedures and policies in place for complaints and concerns, and staff have attended training for the protection of vulnerable adults. EVIDENCE: The deputy manager advised that there are systems in place for people living in the home, for residents, their relatives and staff to raise any concerns they have. She said these are usually dealt with when they are raised, and the complaints book shows that the concerns recorded have been have been addressed. The main concern during feedback from staff at the time of the inspection, and from the relatives meeting, was that there are insufficient numbers of staff working at the home. The deputy said that this is going to be addressed, and subsequent to the inspection the provider has stated that they have employed an additional member of staff. Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 16 Training in the protection of vulnerable adults is provided for staff and those taking part in the inspection said that they have attended this and were able to demonstrate an understanding of abuse. Keller House DS0000021145.V377461.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Keller House offers the people living there a homely environment. Staff attend training in the control of infection to protect residents. EVIDENCE: Keller House is a large, detached, converted building with gardens to the front and rear. There is a large lounge on the ground floor and a dining room adjacent to the kitchen on a lower level. Residents rooms are on each floor, they have been encouraged to bring pictures, ornaments and furniture to the home and many have personalised their rooms. Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 18 On the first day of the inspection it was noted that the carpets throughout the home were dirty, one room needed the carpet to be shampooed and the stand aid needed cleaning. The staff advised that the housekeeper was on holiday and arrangements had been made for someone from the sister home to do the cleaning. On the second visit the deputy manager advised that the hoover had broken, they had replaced it and were now able to keep the home clean. The shaft lift and stair lift enable residents to access all parts of the home, there is an assisted bath for residents to use if they wish, although staff said most of the residents prefer a shower, and there are toilets on each floor. There is a stand aid available to transfer residents and staff said that they were not using it to assist residents at the time of the inspection. There is no hoist at the home, although some residents were unable to weight bear, the deputy manager said that this would be reviewed in line with the homes assessment of the residents individual moving and handling support needs. The suitability of the low armchairs for residents who need assistance to stand was discussed, as were the bed tables and commodes that needed repair or replacement, an audit of the homes furniture would identify any concerns that need to be addressed. The expectation is that assessments are completed by someone qualified to do so, for example an Occupational Therapist. The last inspection identified that the toilet on the first floor did not have a hand wash facility, and although the manager said action would be taken this has not been addressed. The deputy manager and staff advised that residents do not use this toilet, although staff and visitors do and then use the hand wash facility in the bathroom nearby. There is a conservatory, on the basement level, at the rear of the home through which residents can access the rear garden. At the time of the inspection residents were not using this facility as there were no staff available to support them. Staff have attended infection control training and are aware of the homes policies and procedures for the use of aprons and gloves. Keller House DS0000021145.V377461.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels at the home are insufficient to meet the residents needs, and the homes recruitment procedures are not robust and do not protect residents. EVIDENCE: Feedback from residents, staff and visitors at the time of the inspection was that there are not enough staff employed in the home, this was also raised at the relatives meeting two weeks prior to the inspection. Two care staff were providing support and care for 15 residents, the majority sitting in the lounge, with two residents in their own rooms at the start of the inspection. The deputy manager was attending medication training, staff contacted her and she returned to the home to assist with the inspection. The staff who took part in the inspection discussed the needs of the residents that they felt they could meet at that time, and they identified that if there were more staff the support would be less task orientated and more based on the residents’ individual preferences and choices. They explained that the night Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 20 shift is covered by two staff, one awake throughout the night and one sleeping between 11pm and 6am. The sleeping staff use the couch in the residents lounge, which means that resident are unable to use it during these hours, although some residents get up in the early hours or before 6am. A notice near the entrance to the lounge states that there must be a member of the care team in the lounge with residents at all times. However there were times, staff were assisting residents to use the bathroom or when they were in the kitchen collecting lunch, when residents were left alone in the lounge. Although Keller House is registered as a residential home a number of residents have specific and complex needs. The staffing levels should be reviewed on a regular basis and changes made to ensure the home can meet the assessed needs of all the residents. Training opportunities for staff are good, new staff are required to complete induction training, in line with Skill for Care, and one member of staff said that she was working through this at the moment and expected to start National Vocational Qualifications (NVQ) level 2 soon. Four staff files were examined and additional information from duty rotas was viewed, the files contained two written references, application forms and all but one had the required Protection of Vulnerable Adult (POVA) and Criminal Records Bureau (CRB) checks. The deputy manager said that she understood the recruitment procedures should ensure all the required checks are completed before staff work in the home on their own, although she has no control over this as they are carried out at the sister home. However it was noted that a new staff member worked at the home on night duty before the CRB check had been completed. The lack of appropriate checks was highlighted as a concern at the last inspection and a requirement had been made. It was also noted that one of the staff had a work permit that authorised them to work for the employer specified on the certificate, this was not Keller House or DFB (Care) Ltd. Subsequent to the inspection the provider has confirmed that the person now has residence, so does not need a work permit. Keller House DS0000021145.V377461.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The aim of the staff working at the home is to provide appropriate care for residents. However the supporting systems, such as quality monitoring, are not effective and this may affect the support offered to residents. EVIDENCE: The deputy manager has been in post for six months, she is an experienced carer and is aware of the residents supports needs. She is responsible for the day to day running of Keller House, and is able to contact the registered Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 22 manager, or the manager of the sister home, for assistance if required. She was available during the inspection and provided all the information required. The quality assurance and monitoring system includes questionnaires, and relatives meetings have been set up with the first one taking place two week prior to the inspection. The feedback from the questionnaires was difficult to assess as they were not dated. Some were completed using the picture format developed for people with cognitive difficulties, introduced before the last inspection, and others were responses to particular questions. The comments on some identified staffing and the limited activities as concerns, although some also stated that the staff are very good and look after the residents well. There was no evidence that any action had been taken to address these concerns. Other issues identified during the inspection could have been addressed if an effective monitoring system was in place, in particular risk assessment reviews in the care plans, choices at meal times and the effect of staffing levels on the social support provided for residents. A requirement concerning one of the partners visiting the home and preparing a written report on the conduct of the home was made following the last inspection. There was no evidence that these have been carried out, although the deputy manager is required to complete a monthly list of any changes at the home for the registered manager. The deputy manager advised that the home is not responsible for the residents’ finances. The deputy manager advised that the maintenance of the home is an ongoing process, and that all the necessary checks are completed including the lift, electrical products and hot water. There is a training programme in place and all staff attended and certificates are kept in their files. However the moving and handling practices in the home are unsafe and although staff recognised this as a problem appropriate action has not been taken by the providers to protect residents and staff. Keller House DS0000021145.V377461.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 2 Keller House DS0000021145.V377461.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 That care plans identify the specific needs of service users, are reviewed when there are any changes in their needs and on a regular basis, with the involvement of the resident and their representative. To ensure the residents receive the care and support they need. That appropriate training is provided for staff to ensure they are aware of and follow relevant practices with regard to medication. To ensure residents are protected. That the routines of the home are flexible and varied so that they meet the service users lifestyle, preferences, interests and capacities. To ensure that the home meets the residents social needs. That residents are encouraged and supported to make choices about all aspects of their day to DS0000021145.V377461.R01.S.doc Timescale for action 28/12/09 2. OP9 13 (2) 30/11/09 3. OP12 16 (2) (m)(n) 30/11/09 4. OP14 OP15 12 (3) 16 (i) 30/10/09 Keller House Version 5.2 Page 25 day lives, including how and where they spend their time and meals. To ensure that the care and support offered is based on the residents’ preferences. That that an assessment of the home is carried out, and appropriate changes made with regard to moving and handling aids and furniture. To ensure that service users are supported safely by staff. That the staffing levels are reviewed and changed in line with the assessed needs of residents. To ensure there are sufficient staff working at the home to meet the service users’ needs. That the home develops and introduces a robust recruitment procedure, which includes CRB checks. 5. OP22 23 (2)(n) 30/11/09 6. OP27 18 30/10/09 7. OP29 19 30/10/09 8. OP33 To ensure service users are protected. 23, 24, 26 That an effective quality assurance and monitoring system is developed and introduced to assess the services offered at the home, to include visits to the home in accordance with regulation 26. To ensure the support offered to service users meets their assessed needs. That training for staff in moving and handling is reviewed and updated in line with safe practices. To ensure services users and 28/12/09 9. OP38 13 (5) 30/11/09 Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 26 staff are protected. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Keller House DS0000021145.V377461.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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