Care Home: Kenilworth Grange

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What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Kenilworth Grange Spring Lane Kenilworth Warwickshire CV8 2HB Lead Inspector Yvette Delaney Key Unannounced Inspection 28th January 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 Kenilworth Grange DS0000004328.V361836.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. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kenilworth Grange Address Spring Lane Kenilworth Warwickshire CV8 2HB 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) 01926 863320 01926 863310 february-power@hotmail.com www.southerncrosshealthcare.co.uk Trinity Care Limited Ms Margaret McAtamney Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th February 2007 Brief Description of the Service: Kenilworth Grange is a purpose built care home, which is registered to provide care for up to sixty elderly people. The home provides accommodation on three floors. The first floor provides twenty beds for those who require residential care. The ground and lower ground floors accommodate up to 40 people in three units who require nursing care. All bedrooms have en suite facilities and are for single occupancy. Shared lounges and dining rooms are available on each floor and there are communal bathrooms and toilets for residents’ use. There is a passenger lift to each floor as well as the main staircase. There are large gardens to the rear of the home, which are accessible to all residents, and there is ample car parking to the front of the building. Kenilworth town centre is close by with all the usual amenities. At the time of the inspection, the fees charged range from £690.00 - £860.00 per week. The fees do not include newspapers, toiletries, private transport and the services of a chiropodist, dentist, optician or hairdresser. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this home is 2 stars; this means that the home overall provides good outcomes for the people who use the service. This was the first Key Unannounced inspection of this year, which examines all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents. The unannounced inspection took place over two days between the hours of 09:30 and 16:30 hours. This key inspection visit showed improvement in a number of key areas. It was evident that the manager and other staff had made good progress in ensuring that Kenilworth Grange Care Home is meeting the Care Home Regulations and National Minimum Standards of practice. This report uses information and evidence gathered during the key inspection process, which includes a visit to the home. Information examined and seen includes a Statement of Purpose and Service User Guide written by the home, inspection activity details, a number of case files, records and files maintained in the home and information from other agencies and the general public. Questionnaires were also sent out by us to find out the views of residents, their relatives, carers and advocates on services provided by Kenilworth Grange. Responses in questionnaires highlight some issues that if not reviewed could have a long-term impact on outcomes for people who use the service. In some cases, these issues could be related to poor communication. The Manager from the home has started to look at ways of communicating with residents and their relatives. One system of communication being looked at is the use of residents/relatives forums chaired by a resident or relative. Some of the issues expressed in the questionnaires have been discussed within the body of this report. Twenty questionnaires were sent out to residents five were returned (25 ) one was not completed. Twenty questionnaires were sent to the relatives, carers or advocates of the twenty randomly selected residents, eight (40 ) were completed and returned to us. A pharmacist inspector undertook a full review of medication management within the home. The findings are included in this report. Three people who were staying at home were ‘case tracked’. This involves establishing an individuals experience of living in the home, meeting or observing them, discussing their care with staff and relatives (where possible), Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 6 looking at their care files and focusing on the outcomes for the resident. Tracking peoples care helps us to understand the day-to-day life of people who use the service. What the service does well: Comments received from residents and relatives on what they felt that the home does well include: • Welcoming and caring and always ready to listen. • There is a good entertainment person, who does a lot of shopping and oneto-one with residents. She also runs various activities. Activities within the home are well addressed and residents are encouraged to join in. • The home manager is always around and willing to talk about any problems or queries. • Everything to make my husband comfortable. • Provide reasonable accommodation and regular meals with people on hand to help when necessary. • Communication between carers and relatives is good. The medicine management within the home is excellent. The home has installed good auditing systems to ensure that all the medicines are administered as prescribed at all times. What has improved since the last inspection? The manager has addressed all the requirements made at the last key inspection visit of February 2007. • The contents of residents care files and care plans have improved to identify the specific care needs of individual people living in the home. Action plans provides details for care staff and nurses on how these care needs should be met. This will ensure that residents receive care appropriate to their needs. Although there are still concerns from some residents about the meals served in the home the manager has implemented ongoing quality reviews of food served. The reviews involve monitoring the views of residents and residents are involved in planning menus. This practice should help to improve the quality of day-to-day life for residents in the home. • Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 7 • The number of nurses and care staff that have attended training has increased. Topics covered include fire, manual handling and health and safety as well as other areas related to the specific needs of people living in the home. For example, dementia awareness and pressure area care. This will ensure that staff are knowledgeable about the care they are asked to give to people living in the home and help to protect residents from harm. The management and administration of resident’s monies has improved. This will support protecting residents from abuse. • What they could do better: Comments received from residents and relatives on what the home could improve on include: • “Food!” • “A lack of social interaction between staff and residents and a failure to register matters that need attention before relatives actually notice them.” • • “The quality of the food appears to be poor and I feel the menu is not at times suitable for elderly people.” “Visits for residents, organised by the home, could be made available depending on resident’s mobility.” Although no formal requirements have made following this inspection visit a number of recommendations have been made. These should help to improve the services for people using the home. The recommendations take into account the responses and comments made in questionnaires sent out by us to residents and their relatives, carers and advocates who use the services provided by Kenilworth Grange. Some of the recommendation made include: • Service users should be given timely information and notification about any changes to written contracts/terms and conditions for living in the home. This should include information related to changes in fees payable. This would help to protect residents from the risk of abuse. The home should consider if forming a relatives/residents forum would be in the best interests of people living in the home. The forum would provide feedback on positive comments or concerns to the management team The use of independent systems for determining the views of resident’s on the quality of food served in the home should be considered. This would help to promote and maintain the quality of life and wellbeing of residents. • • Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 8 • Staffing levels should be reviewed to ensure that sufficient numbers are on duty at all times. Attention should be given to peak times of activity in the home, which includes lunchtimes and where two members of staff are required to transfer a resident using appropriate and safe moving and handling techniques. This will ensure that residents care needs can be met safely at all times. Family members or their representative should be informed in a timely manner of any incident or event in the home, which affects their relatives’ wellbeing. This will support involving family members or their representative in the ongoing care of residents. • 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. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 9 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 Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 (Standard 6 does not apply to this home as people are not admitted for immediate care Quality in this outcome area is good. Comprehensive information about Kenilworth Grange is available. People visit the home before making the decision to about where to live, this gives them sufficient and current information about the home. People receive a comprehensive assessment of their care needs to ensure they can be met before admission to the home. This will support people to make an informed decision about whether to stay at the home and agree to the terms and conditions set by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide were seen and read at the time of the inspection. Copies of both documents are available in the reception area and the three residents followed through the case tracking process have Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 11 their own copy in their bedrooms. Minor amendments are needed to ensure documents are up to date. The manager said that she was aware of these and would be making the changes required. Two relatives of residents spoken with said that they were well informed when making the choice for moving into Kenilworth Grange. Relatives asked if they received ongoing information about the home state that: “The care home manager is very helpful.” “Regular lists and information is made available in the care home plus sometimes, information is posted to the family.” Two residents expressed concerns in their questionnaire responses sent to us about the level of fees in the home and failure of the home to provide information on the reasons for the increase, which are considered way above inflation rates. Comments made include: “… Unless we have, information relating to the figures involved it is impossible for us to judge whether what is being provided is provided at reasonable cost and whether the increase in the residents’ fees of over twice the rate of inflation is justifiable. … We are simply told what will happen and there is a total lack of proper consultation, which is no longer acceptable in todays world.” Terms and Conditions for living in the home does express that fees are subject to change. The concerns made however, relate to the lack of timely notification and consultation on the changes made. The manager confirmed that letters regarding any changes in fees are sent out to residents or the person acting as their advocate. Further information received from the Operations Manager for the home said that contractual terms are notified to service users or their representative in January each year. The documents reflect fee changes which will occur in February. The Operations manager goes on to say that notification of contractual changes is always accompanied by two new contracts, one to be retained by the service user and the other to be signed and returned to Southern Cross. Relatives are also given the opportunity to discuss the changes before they are agreed and implemented. The care files of three residents admitted to the home since our last inspection visit of February 2007 were reviewed through the case tracking process. The pre-admission information for all of these residents was examined. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 12 Assessments read provided details of the health and personal care needs of all the three people. Information available includes mobility, history of falls and their medical history. The availability of this information ensures that the specific care needs of each person are identified and used to complete a plan of care. All three residents confirmed that they or a member of their family had been able to visit the home before making the decision to use the home. Both sets of relatives spoken too were aware of the procedures of the Home and had seen and read the Home’s Service User Guide. Residents and relatives confirmed that the Manager had visited them to make an assessment before being offered a place in the home. One resident had been visited in their home and the other in hospital. Information in the AQAA stated that a pre-admission draft care plan was available on file with a summary of the assessment carried out. These were seen in the files examined. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. Care plans show improvement and provide staff with guidance on all aspects of resident’s needs and this should result in appropriate care being given to residents. The medicine management within the home is excellent. Staff practices when managing medicines in the home are excellent, this supports the safety of people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection, there were 51 elderly male and female people living in the home. We examined the care plans for three of the residents admitted to the home since the last inspection. These residents required either personal care only or nursing care. Since the last inspection, the manager has taken steps to improve the care planning process within the home. As evidenced in the last inspection report, care files for residents Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 14 accommodated on the first floor of the home were not specific in demonstrating all their care needs. Two of the care files examined were for residents who needed support in meeting their personal care needs. These residents are accommodated on the first floor of the home. Care files examined for these residents showed that care planning documentation had improved. Talking to the residents, care staff and examination of care files demonstrates that individual needs had been assessed and updated to identify current care needs. The care plans examined had been written to support nursing and care staff in meeting the residents care needs. Risk assessment had been reviewed and completed in all care plans examined. These include risks related to pressure areas, falls, mobility and nutrition. This gives staff information they need to provide and meet the specific and current care needs of people living in the home. Information available in care plans identified that one of the residents had been assessed as being at risk from falling out of bed. The outcome of the risk assessment showed that the person needed bedrails to maintain their safety. Instructions for staff include: ‘Check that bedrails are well fitted and secured, daily.’ ‘Bumpers to be used over bedrails.’ A further resident had been identified as being at risk of losing weight. A care plan was in place to instruct staff on the nutritional needs of the resident, food likes and dislikes and referral had been made to the GP and dietician for advice and support in managing this person’s care. Records showed that regular weight checks had been made and recorded. Instructions for staff in care plans include: ‘Allow… (Resident) to choose… (resident) own menu for the day.’ ‘Ensure that meals are well presented, attractive and in good proportion.’ ‘Weigh monthly and more often if need arises…’ ‘Liaise with GP/dietician if any concerns.’ The above information promotes the residents’ independence and choice, stimulating their appetite. The information also gives staff instructions on monitoring the resident’s weight and making an appropriate referral to a professional person if needed. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 15 Baseline observations of residents of blood pressure, pulse, temperature and weight had been recorded on or as soon as possible following admission. This is good practice and would support staff when monitoring any deterioration or improvement in a persons well being. Written daily reports in care files provided information on people’s day-to-day life in the home and provides details on their health and well being. Entries had been signed, dated and timed by the member of staff making the entries. Comments from family members on whether the home is able to meet the needs of their relatives showed a mix of responses these include: “The room smelt badly of urine until I complained. Since then, the situation has been rectified. I do not expect to have to complain about such a matter. I think that such issues should be noticed, noted and something done about it. … (resident) is after all been cared for by qualified carers.” “Care needs are addressed well…” Entries in the resident health records and comments by people living in the home confirmed that they are supported in getting access to relevant health care professionals when needed. This includes access to GP, Chiropodist, Community Psychiatric Nurse and Optician. The pharmacist inspection took place on a different date to the main inspection. It lasted just under two hours and three of the four medication rooms were assessed. The standard throughout the home was very high. Staff had a good understanding of the systems in place to maintain this. Both the nursing staff and the residential team leader spoken with during the inspection had a good knowledge of the medicines they handled enabling them to fully support the residents in the home. One new nurse had recently been employed and further training was required for her to reach the same standard of the other staff in the home. Audits indicated that the medicines are administered as the doctor prescribed. The managerial staff regularly checks that staff handle medication correctly and this has maintained the good level of medicine management. Residents are actively encouraged to self-adminsiter their own medication and risk assessed to ensure they are able to do so safely. They are supported to handle their own medicines in part if they cannot correctly take all. The home has a homely remedy policy endorsed by the doctor, which further meets the needs of the residents enabling staff to administer medicines for minor conditions, such as headache, without consultation with the doctor. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 16 All the controlled drug balances were correct and these were reflected accurately in both the CD register and medicine chart. People living in the home are well groomed and are supported by staff to ensure that their dignity and privacy are maintained. Residents were appropriately dressed on the day of the inspection. However, a comment received from a family member expressed concerns that they had on occasion found their relative inappropriately dressed when visiting. The person says that no effort had been made by staff to contact them to discuss the clothing available for their relative. The Hairdresser visits weekly and was present on the day of inspection. Most residents use this service and some of the women spoken with used the time as a social occasion. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 17 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 an 15 Quality in this outcome area is adequate. Open visiting arrangements encourage regular contact with relatives and friends. Varied social and recreational activities meet the needs of all residents. Continuing expressions of concern do not confirm that residents receive wholesome appealing meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care files examined showed that information regarding peoples preferences for their daily routine had been documented, such as their likes and dislikes of different foods, the time they like to go to bed and details of their interests and hobbies. Residents living on the first floor of the home were seen to make the choice of going to their bedroom to rest after lunch. An activities coordinator is employed in the home five days per week. This is good practice. The coordinator also supports residents living on the ground floor of the home at mealtimes. These residents are more dependent and need the support to help them eat their meals. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 18 Observations on the second day of the inspection show that good interaction was observed between staff and residents. Residents knew individual staff by name and there were good levels of rapport between residents, relatives and staff. The activities coordinator has developed a planned programme with residents. Activities on the programme include a Roman Catholic Mass, one to one time with residents, arts and crafts and a video afternoon. Residents are asked what they would like to do. One resident was identified as enjoying listening to the radio this person was partially sighted. Instructions were available for staff to assist the resident with turning the radio on and choosing the radio station that the resident wanted to listen. Comments received from residents during the inspection include: “We do have an opportunity to suggest activities”. “Residents are encouraged to join in activities but are not made to.” An open visiting policy is practised in the home. This helps to support residents to maintain links with their families and friends. Relatives and friends were seen to visit during the day of inspection. People visiting the home were willing to speak to the inspector. Conversations with families confirmed that relatives are aware they are able to visit at any reasonable time. People living in the home and their relatives had expressed a number of concerns at the last inspection about the quality of the food provided in the home. The Manager has worked hard to try to improve this by introducing a number of quality monitoring procedures. Residents order lunch on the day and menus were on display in the dining room, two courses are available. There is a choice of two main courses and two puddings. A choice of two meals was offered on the day of inspection these were for lunch: chicken casserole, beef stroganoff, vegetable was broccoli and a dessert of cake and custard or jelly and ice cream. Time was taken by staff to support residents when eating. Staff collected one meal at a time based on the resident’s choice from the heated trolley in the kitchen. The resident was then fed before a further meal was plated for another resident. This system is good practise and could give staff the opportunity to spend time with people living in the home and also be aware of what the residents have eaten. However, concerns were expressed with the manager about what systems are in place to prevent residents feeling hurried if they required a lot of time and support to eat their meal, or if staff were needed to attend to Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 19 residents other needs. The support of the activity coordinator is available at meal times as previously discussed. Manager agreed that this would need to be looked at and audited to see how well it is working. The cook is involved with the manager in reviewing the meals served. Talking to residents, asking them their likes, dislikes, and answering resident’s queries about the meals served is part of this process. Both the cook and the manager taste the food that is being served. Whether this helps or not could be argued, as it is not an objective assessment, however, staff tasting the food is only part of the quality review process. The ongoing review of resident’s meals is also supported by a daily questionnaire issued randomly to a number of residents. The ‘food audit’ form allows people to comment on meals served at lunch and suppertime each day. Some of the audit forms were seen and read. Comments made include: ‘nice,’ ‘good,’ ‘alright,’ and ‘did not like.’ All the forms were completed in the same handwriting, which did not demonstrate that individual residents had completed them. We cannot be sure that these comments are totally based on residents’ views. Overall, comments in questionnaires received by us from residents and relatives continue to express concern about the quality of food served in the home. Comments received include: “I feel the quality of the food needs to be greatly improved.” “Food could be improved here. Fruit is now available every day. This is very good.” “Despite complaints about the food during the past year, it has not improved. This is particularly disappointing because the recent fee increase was twice the rate of inflation.” One person indicated that they would like to speak to an inspector about the meals commenting: “Only if it might help to bring about an improvement in the food.” Unfortunately, this person did not identify himself or herself. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. People have access to the information they need to complain and know who to talk to if they have any concerns. The adult protection procedure and staff awareness of the procedures reduces the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the reception area of the home. Copies are also available in the Service User Guide. Residents and relatives spoken with said that they were aware of how to complain and whom to complain to. Comments made include: “Carers/Nurses in the home are very approachable and will listen and act upon, when necessary, any complaints or worries the relatives may have.” “When we have a query about … care, it is dealt with immediately.” “Whilst the concerns have been dealt with I would not have expected to have had to raise them but would have expected them to have been raised with me at an early stage.” Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 21 “If there is any problem with my… (Resident), both carers and management staff respond well and are eager to involve doctors/opticians etc. for… (Resident) well being.” The manager and records examined confirmed that 10 complaints both verbal and formal have been received by the home since the last inspection. Six of these were related to meals, one related to fees and others relate to care received in the home. One of the complaints related to care was also forwarded to us. The home investigated this complaint using their complaint procedures for the organisation, ‘Southern Cross’. Records show that the complaint was thoroughly investigated, appropriate action taken with the staff member involved and a satisfactory response given to the complainant. The systems in place to record any complaint received was seen these showed that the concerns received by the home had been appropriately investigated. The policy and procedure detailing the action to be taken by staff to ensure the protection of vulnerable adults were examined. The information guides staff on the procedures to follow if they saw or suspected evidence of abuse. Staff were able to confirm that they had attended training related to the protection of vulnerable adults. Two members of staff were able to explain the action they would take if they saw abuse. Both answered appropriately. Training records examined indicates that protection of vulnerable adults training had been received by staff during the home’s internal 2007/08 training programme. Training records showed the topics covered and the date and year the training was attended. There has been one incident referred to the adult protection team for further investigation. The local authority, responsible for adult protection, made the decision for the home to carry out an investigation. The home sent us details about the incident. There was no evidence of abuse, verbal or otherwise seen on the day of inspection. Care and consideration by members of staff towards residents was evident at all times. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 22 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 and 26 Quality in this outcome area is adequate. The standard of the environment presents a homely and attractive place for elderly people to live. However documentation to evidence the ongoing cleanliness and maintenance carried out in the home were not appropriately completed, which did not confirm that the work had been carried out and people living in the home were protected from harm at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Kenilworth Grange is a purpose built care home offering accommodation on two floors for elderly people. The home offers a service for both men and women. The first floor accommodates resident who require nursing care and the first floor provides a service for people who need support in meeting their personal needs. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 23 Some of the accommodation and facilities in the home were seen while visiting and talking to residents and their families and staff. The home is well presented and maintained. The home was clean and there were no unpleasant odours on the day of the inspection. A response received by us in a questionnaire said that they felt the home was poorly cleaned. Residents and relatives spoken with said that the home was attractive. Residents said that being able to bring in small items of furniture and other furnishings such as pictures, cushions helped to make their bedrooms homely and comfortable. Maintenance records examined showed that the maintenance person did not always give a date to show when maintenance or checking of equipment had been carried out. The information available would not provide an accurate audit trail if concerns about a piece of equipment or maintenance work carried out needs to be reviewed or followed up. There is well-equipped kitchen and on the day of the inspection the Cook was well organised and the kitchen was clean and tidy. There is a good wellorganised food store and two freezers and one fridge. Plated food was covered and opened food containers were sealed and date marked. Food stores had been received on the second day of the inspection and some items were being stored on the floor in the food storage room. Wooden storage boxes had been used to store items off the floor, the manager said that further boxes could be obtained. Records examined related to daily, weekly and monthly cleaning in the kitchen was not always appropriately dated. The cleaning records on the day of inspection had been completed and signed for the whole day. Signing these, records indicate that all cleaning had been completed; it was obvious that this was not the case as lunch had just been completed and the kitchen assistant was busy washing up and cleaning. The manager addressed this issue on the day of inspection. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. The number of staff on duty is not sufficient to meet the needs of people living in the home at all times of the day. The majority of staff are qualified and have attended mandatory and other training related to the needs of residents in their care. This will ensure that competent staff care for people living in the home. Staff recruitment procedures are robust to ensure residents are protected from the risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection the manager, two nurses, nine carers, a cook, kitchen assistant and housekeeper were working in the home. There were 51 residents present in the home each with varying levels of dependency. The manager was asked whether staffing levels were sufficient, as previously mentioned in the ‘Daily Life and Social Activities’ section of this report, to support the system for helping residents with eating their meals at mealtimes. Mealtimes are a time of peak activity and in one area of the home; there were three staff to support eleven residents with eating their meals. Duty rotas examined showed that over a period of one month staffing levels had been maintained. Comments were received from residents and relatives staffing levels these include: Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 25 “There are occasions when there is not enough carers to assist residents. For example when there are, two carers needed to move or lift a resident.” The home could be improved “With extra staff.” A training matrix showed that staff had received recent mandatory training. Staff spoken with said that they had attended fire training, moving and handling, cross infection. The majority of care staff working in the home (70 ) have completed a National Vocational Qualification (NVQ) level 2 or above in care. Six further carers have started the course. Maintaining a high number of qualified staff in the home will support residents receiving care appropriate to their needs and promote their wellbeing. Information available about the induction process for the home shows that it is linked to the common induction standards developed by the Skills for Care Council. A review of four staff files confirmed that recruitment practices for the home are good. Staff files contained evidence of Protection of Vulnerable Adults (PoVA) checks and Criminal Records (CRB) checks. These were completed before staff commenced working in the home. References obtained were appropriate. In one staff file examined, a character reference had been obtained due to limited previous work history this was supported by a professional reference given by the previous employer. Records of interviews are maintained to support equal opportunity practices within the home. Robust recruitment practices will support the safety of people living in the home. Training records were available for examination. These showed that staff had completed a series of training in 2007/08. Training records showed the date and topics covered in the training. Following some training sessions, staff complete a formal test, this involves answering questions on to the training they have received. This is good practice as it involves checking the knowledge and level of understanding of staff on the training related to the care of people living in the home. Comments made by relatives and residents about staffing include: “The staff appear to have the necessary skills and experience.” “The care staff are qualified and seemingly are encouraged to go on courses. They are sympathetic to the residents needs.” “A wide range of nationalities are employed at the home to care for the residents. Most speak excellent English but not all. It is difficult for elderly people … to understand some of the carers who have foreign intonations to their English…” Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 26 “One major concern I have is that on the resident’s side they are operating with minimum levels of staffing. The major result of this is that the residents do not get enough stimulation from conversation with the staff as well as other residents.” “The carers and nurses are very patient and kind and friendly”. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 27 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, 33, 35, 36, 37 and 38 Quality in this outcome area is good. A person with the required experience manages the home. The welfare and well being of people are protected and safeguarded decreasing the risk from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was present on both days of the inspection. The manager is knowledgeable about people in the home this includes residents and their families and staff. She has the necessary experience to run the home. The manager has confirmed that she is currently undertaking the Registered Manager Award, which she has nearly completed. The manager is Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 28 responsible for the care practices in the home and the overall day-to-day management of the care home. The manager is keen to make improvements and since the last inspection had taken actions to address all of the issues identified in the last report. Resident’s and relatives commented in conversation about the management of the home to say that: “The manager is always approachable”. The home has internal audit processes in place to monitor the views of people using the service, meals served, care practices for example medication management and the writing and accuracy of care plans. The outcomes of audit reports were seen. The manager had followed up the outcome of audits carried out where specific action had been identified as needed to improve practices. These audits will help to ensure that the home is run in resident’s best interests. A quality assurance manual is available in the home. Auditors from within the organisation but who do not work in the home carry out ongoing audits for example checking practices related to managing resident’s monies. The Operations manager does monthly unannounced visits to the home to look at the service provided and obtain residents, relatives and staff views on the running of the home. The outcomes of these visits are formally shared with us by sending monthly reports to our office. The reports received have been informative providing information on how well the service is doing as well as action to be taken to improve practice and the environment. Surveys are carried out by the home to determine the views of professionals visiting the home, residents living in the home and the views of staff on the services provided. The minutes of a recent resident’s/relative’s minutes were read. The minutes did not demonstrate that discussions had taken place or what involvement residents or relatives had had in expressing their opinions on the service provided. The manager is in the process of appointing an independent chairperson for the “Residents/Relative’s Forum” group which has been set up in the home. This is good practise and will help to give residents and relatives the opportunity to provide input on the running of the service provided by the home. This could be useful to feedback concerns or positive comments to the management team. Individual computerised records are maintained for people where the home holds personal monies. Receipts were available to confirm expenditure and detailed information was available on individual accounts. The records of the Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 29 three residents followed through the case tracking process where examined. Cross-referencing receipts with the records maintained on monies received and spent on behalf or by the resident showed the balances to be correct. At the last inspection, concerns were discussed about the lack of individual receipts to show what residents monies had been spent on. This had improved, although some concern remains about the reluctance of the chiropodist to issue individual receipts and the level of detail on receipts produced by the hairdresser. Both parties are providing a service for individual people living in the home. There was a clear audit trail; two people undertake a monthly internal audit. A member of staff from the organisation who does not work in the home undertakes a further audit. This should ensure that peoples money is held safely. Staff supervision takes place in the home. Records available show that areas covered include: observation of care practices, nursing procedures, personal care and training. The home informs us of any incident or event that affects the well being of people living in the home. Responses received in questionnaires confirmed that relatives are informed of important issues affecting residents. Some comments however, indicate that there are mixed views as to when family members are advised about incidents affecting their relative’ wellbeing. Comments include: “I have not been told when the situation actually occurs but I am advised when visiting in the evening.” “Any incident that arises with my… (resident) health or mobility, we are contacted immediately to inform us of any action that may be needed.” “They (the home) have kept me informed of any illness or fall my… (Resident) has had. Sometimes that has not happened until after diagnosis e.g. … (resident) had been seen several times with an ear infection…. I would like to have been informed earlier that the infection was not clearing up and notified when the doctor was coming to see … (resident) so that I could have taken part in any discussion as to treatment etc.” Health and safety and maintenance checks had been carried out to ensure equipment in use is safe and in full working order. Electrical equipment used in the home had been tested to ensure us it was safe to use and appropriately wired. The ‘5’ year electrical certificate was available and current. The various hoists used in the home were being tested on the day of inspection. Water temperatures checks had been recorded monthly and this assists in the prevention of people accidentally scolding themselves. Maintenance checks were completed on fire systems and equipment. Records related to maintenance and services related to the environment were organised. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 30 Previous concerns identified at the inspection in February 2007 related to practices carried out by the housekeeper when using chemicals and failing to protect themselves when cleaning had been addressed. Housekeeping staff had attended an update in training in handling hazardous substances and health and safety. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 31 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 2 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 32 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 OP2 Good Practice Recommendations Service users should be given timely information and notification about any changes to written contracts/terms and conditions for living in the home. This should include information related to changes in fees payable. This would help to protect residents from the risk of abuse. Staff should ensure that residents are suitably dressed at all times. This will support residents to maintain their dignity. The use of independent systems for determining the views of resident’s on the quality of food served in the home should be considered. This would help to promote and maintain the quality of life and wellbeing of residents. Dated records should be maintained of any ongoing maintenance checks carried out in the home. This will provide an accurate audit trail. Records evidencing cleaning carried out in the kitchen should be signed and dated after the task has been carried DS0000004328.V361836.R01.S.doc Version 5.2 Page 33 2 3 OP10 OP15 4 5 OP19 OP26 Kenilworth Grange 6 OP27 7 OP38 out. This will ensure that accurate and up to date records are maintained and support the control of cross infection. Staffing levels should be reviewed to ensure that sufficient numbers are on duty at all times. Attention should be given to peak times of activity in the home, which includes lunchtimes and where two members of staff are required to transfer a resident using appropriate and safe moving and handling techniques. This will ensure that residents care needs can be met safely at all times. Family members or their representative should be informed in a timely manner of any incident or event in the home, which affects their relatives’ wellbeing. This will support involving family members or their representative in the ongoing care of residents. Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Kenilworth Grange DS0000004328.V361836.R01.S.doc Version 5.2 Page 35 - 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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