Care Home: Kenilworth Manor

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What the care home does well Both the people who use the service and visitors to the home were complimentary of the care and services provided. One person said "staff are absolutely amazing" "all have been smashing to me since I came in" another stated "some are excellent some are really really friendly and helpful". Another said "you may be interested to know that at night they come round and check you are alright in bed they don`t just open the door". A professional visitor said "residents really are cared for" and referred to the home as "one of the best in the country". Each person at the home has a detailed care plan stating their care needs and the staff actions required to meet these needs to ensure they receive the care and services they require consistently. The meals and food provided is of an exceptional standard with plenty of choice available. This is served in an attractive dining area with a high standard of crockery and tableware. Relatives and visitors are welcome to join residents for meals. One person asked about the food said it was "excellent very good". The home has achieved the `Gold Star Safe Food` rating following an inspection from Environmental Health. Staff were observed to be friendly and supportive to the residents and welcomed visitors to the home. Staff were seen to treat people with respect and courtesy when dealing with any requests made of them. The home produce a monthly newsletter to keep people informed about what is happening in the home. This includes information on events, birthdays, staff on holiday, new residents, social activities and any other matters of interest. The manager has been the lead in achieving accreditation in the `Gold Standard Framework` for the home in caring for those people with life limiting illnesses. The Gold Standards Framework is a common-sense approach to formalising best practice so that good care becomes the standard for all people all of the time. This includes how staff approach care for those with life limiting illnesses. Kenilworth Manor is a period building which has been well maintained with furniture and fixtures of a high standard. What has improved since the last inspection? Some new electric beds and air mattresses have been purchased to benefit the nursing needs of people at the home. The Service User Guide has been updated to ensure this includes all of the required information to help prospective residents make a choice on whether to stay at the home. Continued improvements have been made to the environment including the recent addition of two ensuite wet rooms, new furniture in three bedrooms, complete refurbishment of two rooms and recarpeting of the areas outside rooms 1,2 and 3. Duty rotas have been reviewed so that now they include all staff working in the home and in what capacity so it is clear whether there are sufficient staff being allocated to support the needs of people living in the home. An at-a-glance training schedule has been developed for all staff showing all training accessed over the year. This helps management identify which staff have training outstanding that they need to attend. What the care home could do better: A review of medication management is required to ensure this is managed effectively consistently for all people at the home. Comments provided by people at the home and their relatives suggest the provision of social activities needs to be further reviewed to ensure the social care needs of residents are being met. Staff training records need to demonstrate that all staff have completed statutory training as required. Suitable actions need to be taken where it may be identified that training is not up-to-date to ensure staff can work with people in the home safely. The number of carers with a National Vocational Qualification should be increased to ensure the 50% standard is met. This training helps staff to provide more effective care to the people who use the service. The new proposed induction programme for the home which incorporates the "Skills for Care" common induction standards needs to be implemented. This is to demonstrate staff are receiving sufficient training to care for residents safely. Newly appointed staff must not commence employment with the home until a suitable Protection of Vulnerable Adult (POVA) check is obtained or a Criminal Records Bureau (CRB) check. This is to ensure staff are deemed safe to work with people in the home. Duty rotas need to give a clear indication of staff covering night duty when there are absences such as annual leave or sickness so it is clear there are sufficient staff on duty to care for people. Action needs to be taken to ensure the hoists are serviced within their recommended timescales and the Fire Risk Assessment for the home is updated. This is to ensure the health and safety of the people using the service is not compromised. Key inspection report Care homes for older people Name: Address: Kenilworth Manor Thickthorn Orchards Kenilworth Warwickshire CV8 2AF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 1 5 0 6 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 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. 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 Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Kenilworth Manor Thickthorn Orchards Kenilworth Warwickshire CV8 2AF 01926858030 01926851443 kenilworthmanor@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Kenilworth Manor Limited care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 34 Date of last inspection Brief description of the care home Kenilworth Manor is a converted manor house and is a listed building due to its architectural and historical interest. The home is located in a quiet residential area and is close to the town and its amenities. The home is registered to provide accommodation and care to people over the age of 65 who may require nursing care. There is one large lounge and an attractively decorated dining room. Within the lounge there is a flat screen television and music system and there are high winged backed chairs to ensure people can sit comfortably. A hearing loop is available in the lounge and dining room to assist those people with hearing aids to hear more easily and there is also a portable hearing loop that can be used by individual service users when they Care Homes for Older People Page 4 of 38 Over 65 34 0 Brief description of the care home receive visitors. There are 26 single bedrooms and four double rooms, although at the time of inspection, the double rooms had single occupancy. Almost all of the rooms have an ensuite facility and some of these also have showers. Two have newly fitted wet rooms. In addition there are also three communal bathrooms, two of these have a parker assisted bath to enable people with mobility problems to use it and there is one shower room with a chair. The accommodation is provided on a number of floors with access to these via a passenger lift or stairs. There is also stair walker available which mechanically transfers wheelchairs and people up and down stairs in an emergency. The homes decor, furniture and furnishings are homely and of a high standard. There is a large and attractive landscaped garden which can be approached from steps or a ramp from the main building. The garden can be viewed from many bedrooms as well as communal areas. The fees are in homes brochure and are from £920.00 to £1300 for single occupancy in a double room. These are subject to change. Extra charges are made for hairdressing, aromatherapy, private opticians, dentists and chiropody. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last key inspection took place on 2 July 2007. This inspection took place between 8.10am to 6.35pm. Two people who were staying at the home were case tracked. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment was received from the service prior to the inspection detailing information about the care and services provided. Care Homes for Older People Page 6 of 38 Questionnaires were also sent out to people living in the home as well as their relatives and staff who work in the home to ascertain their views of the service. Information contained within the AQAA and outcomes of surveys have been included within this report as appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records, quality monitoring records and medication records. People who use the service were observed in the lounge/dining areas to ascertain what daily life in the home is like. A brief tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? Some new electric beds and air mattresses have been purchased to benefit the nursing needs of people at the home. The Service User Guide has been updated to ensure this includes all of the required information to help prospective residents make a choice on whether to stay at the home. Continued improvements have been made to the environment including the recent addition of two ensuite wet rooms, new furniture in three bedrooms, complete Care Homes for Older People Page 8 of 38 refurbishment of two rooms and recarpeting of the areas outside rooms 1,2 and 3. Duty rotas have been reviewed so that now they include all staff working in the home and in what capacity so it is clear whether there are sufficient staff being allocated to support the needs of people living in the home. An at-a-glance training schedule has been developed for all staff showing all training accessed over the year. This helps management identify which staff have training outstanding that they need to attend. 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. Care Homes for Older People Page 9 of 38 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are provided with sufficient information to make a decision to stay in the home and are assessed prior to their admission to ensure the home can meet their needs. Evidence: There is a detailed Statement of Purpose and Service User Guide available in the home. This is kept in the lobby area near the front desk. Prospective residents are able to visit the home and sample menus, observe any social activities that take place and view the environment. They also have the opportunity to attend an informal question and answer meeting with management staff and can collect a brochure of the home detailing services offered, fees and information about staff that work at the home. Terms and conditions by way of a contract is given to each new resident and there is a trial period of four weeks to ensure both parties are happy with the placement. Care Homes for Older People Page 12 of 38 Evidence: Comment cards received from nine people living at the home showed that seven felt they had received enough information about the home to help them make a decision to move in and had received the Terms and Conditions for the home. One person said they did not know if this happened and one person said they had moved into the home in a hurry but knew the reputation was good. Each resident is assessed prior to them staying at the home to ensure their needs can be met. Assessment documentation was viewed on the care files for two people using the service. One of these had spent a period of time in the home on respite so their care assessment had been carried out during this time. Details of their needs had been transferred to their care plans to ensure these were met by staff. The manager states in the Annual Quality Assurance Assessment document forwarded to us that where the prospective resident is in hospital, appropriate hospital discharge summaries and written reports of their needs are also obtained. Care Homes for Older People Page 13 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 needs of people who use the service are set out in detailed care plans and a good standard of care is being provided. Policies and procedures for medication management are not being followed consistently to demonstrate people are receiving their medication as prescribed. Evidence: The Annual Quality Assurance Assessment (AQAA) states that the health, personal, social, emotional and spiritual needs are identified and planned and that reviews of these needs are done on a regular basis. This was confirmed during the review of care records for the two people case tracked. Risk assessments had also been completed in regard to poor mobility, falls, skin integrity, pressure sore risk and risks of poor nutrition as also stated in the AQAA to ensure people using the service can be cared for safely. One person was noted to have Parkinsons Disease. A clear care plan was in place to manage this stipulating the importance of ensuring the resident received their Care Homes for Older People Page 14 of 38 Evidence: medication promptly at the times stated. A risk assessment had also been devised in regards to moving and handling identifying that the person needed two carers to support them due to their Parkinsons Disease diagnosis and also because they were anxious. Staff spoken to were aware of this persons needs and the support they required. Daily records gave a clear record of the persons mental health due to them being anxious and depressed and it was evident that the specialist support they required had been accessed. Another person using the service was noted to have poor sight and showed a reluctance to receive regular support from staff in regards to personal hygiene. This had been clearly recorded in the care plan and staff had recorded in the daily records actions taken to ensure this is addressed regularly. A risk assessment had been devised for this persons poor sight and staff were aware they needed to be regularly checked to ensure they were mobilsing around the home safely. The deputy manager confirmed that this person has not requested talking books or a large button telephone but these can be organised if required. It was noted these had been provided for another person living in the home with poor sight. People spoken to were complimentary about the staff support they receive. One stated staff are absolutely amazing all have been smashing to me since I came in another stated some are excellent some are really really friendly and helpful. Another said you may be interested to know that at night they come round and check you are alright in bed they dont just open the door. Comment cards received from nine people living at the home showed that four felt they always received the care and support they need, three felt they usually did and two people said they sometimes did. One person commented first class assistance, a relative commented excellent and very happy place. The AQAA states that the manager has been the lead person in achieving accreditation in the Gold Standard Framework for the home for caring for those with palliative care needs. This is a system which supports staff in developing good quality care for those people in their last year of life. The Deputy Manager confirmed that since the last inspection they have purchased new electric beds and specialist air mattresses to support the nursing needs of people in the home and help to make them more comfortable. Since the last inspection, the manager has introduced more frequent audits and spot checks of medications to help ensure medications are managed appropriately. Staff Care Homes for Older People Page 15 of 38 Evidence: have also attended safe handling of medicine courses to ensure they are suitably competent to manage medications. The review of medications confirmed that whilst most of those checked were correct, there were some discrepancies and areas still requiring further improvement. Co-codamol for one person showed that the number carried forward from the last medication period was incorrect. There were four tablets unaccounted for. The manager was able to establish that this was because the number of tablets carried forward should have been 91 and not 95 as stated on the medication record. If the medication record is not accurate at the start of the medication period this can impact on the effective management of medication. For one person it was established from their care records and discussing their care with staff that creams were to be applied to their skin each day. The creams were not written up on the medication record to show when they should be applied and there was no evidence they had been used. Warfarin medication that had been prescribed for two people was checked. This was found to be incorrectly managed for both people. This was also found to be incorrectly managed during the last inspection to the home. This concern was discussed with the Deputy Manager who agreed to investigate the errors and take appropriate action to ensure this was managed correctly from now on. It was noted that on one record a medication that was to be given once a week had not been given for two weeks. This had been identified by the manager and followed up with the staff involved. Letters to the staff were seen on their files and although this error was highlighted to them, it was not clear that actions had been taken to ensure these staff continued to manage medication safely. The Deputy Manager said that the medication records had been checked following medication rounds for these staff. The Deputy Manager agreed to ensure that any actions taken following medication errors identified in the future are backed up with an appropriate action plan to ensure the members of staff concerned are deemed safe to continue managing medication. Those people whose medications were reviewed were not identified to be taking any homely remedies. The AQAA received from the service states that since the last inspection any homely remedies are now clearly indicated on records and are appropriately stored for people to use when needed. No concerns were identified regarding the privacy and dignity of the people who use the service. All those seen and spoken to looked well cared for. Their hair and nails were clean and they looked well presented with clothing suitable for this time of year. Care Homes for Older People Page 16 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 who live at the home find their lifestyle mostly matches their expectations and enjoy regular contact with family and friends. The food provided by the home is of a good standard and is both appetising and nutritional to ensure they receive a balanced diet. Evidence: There is usually a social activity provided each day and schedules of planned activities are provided in the form of a newsletter to people in the home on a monthly basis. Planned activities are also detailed on a notice placed on the piano in the reception area. Duty rotas confirmed the Activity Organiser was available for two days per week during June 09 due to flexible working arrangements. Staff confirmed that she usually works two and a half days per week and sometimes part of the weekends for special occasions. Social activities on other days are reliant on other staff or outside providers. The newsletter for May and June 2009 were viewed and activities listed included Scrabble, Bingo, Pastoral care visit, quiz, skittles, keep fit and videos or DVDs. Birthdays of residents are also celebrated and these were also detailed. Staff confirmed these are celebrated with a lunch party consisting of a buffet and Care Homes for Older People Page 17 of 38 Evidence: champagne as well as a birthday cake. A recent event held included a bar-b-que which residents said they had enjoyed. There were several thank you letters viewed commenting on how much this was enjoyed by both people living at the home and their relatives. The newsletter for May 2009 states that a shopping trip is being organised and if anyone wants to attend to let the Activity Organiser know so that transport can be arranged. On the day of inspection most people did not come into the lounge until late morning due to having breakfast in their rooms. The Activity Organiser who has a cheery personality was available in the lounge and was preparing the scrabble ready for those who wanted to play. She had a chat to each person as they came in. It was evident she knew the people living in the home very well and was able to talk to them about their family and recent social events at the home. After lunch the lounge was full with people playing bingo which they clearly enjoyed. One person spoken to said I always go to bingo and keep fit but dont care for board games. When asked if they felt there were enough social activities they said not really no and said it would be nice if transport could be organised to go out. Another person spoken to said I cant see to play bingo and scrabble they are all connected with eye sight so have to sit on the outside looking in. Another stated there are activities provided on some days, Tuesday and Thursday but no complaints. A social activities folder is kept which details any activities that each person has participated in. This included exercise, visitors, quizzes, board games, outings, parties or communion. It was clear most were engaging in some type of activity each week although not necessarily each day. Some of the less able people in the home said they got bored sometimes sitting in their rooms all day. A comment card received by us from a member of staff states that people living in the home have commented that staff have no time to chat to them or have a cup of tea with them and they would like to go out on more outside visits. Questionnaires completed by people at the home showed they wanted more outings, more walks, more theatre, cinema and shopping trips. One also commented they wanted more visits from outside entertainers. It was not evident that there has been many planned outside visits but the Deputy Manager advised that many residents do go out with their family and residents are Care Homes for Older People Page 18 of 38 Evidence: supported where possible to make outside visits. It was also explained that in the past offers of outings have not been taken up although this was partly due to some residents wanting one-to-one visits as opposed to group outside visits. It is evident however from comments made that this is an area that should be reviewed to ensure all people who use the service feel their social care needs are being met. The Annual Quality Assurance Assessment document completed by the manager of the home and forwarded to us states that spiritual needs are addressed by regular services provided by Church of England and Roman Catholic visiting clergy for people unable to attend church. Also, day and evening hymn and prayer groups meet on a regular basis and the Activities Co-ordinator holds remembrance services intermittently for residents who have passed away. This information was confirmed during the inspection through viewing activity records and talking to people who use the service although one person said that they would prefer private one-to-one services as opposed to group services. The catering service at Kenilworth Manor is provided to very high standards and there is a team of people dedicated purely to ensuring this service is maintained at these high standards. This includes two chefs, kitchen assistants and drinks hostesses. We observed that during the morning a member of catering staff asked each person what they would like for their main meal and for supper later that day. Choices on the day of inspection included braising steak or plaice with parsley sauce, new potatoes, mash, swede and leeks. For desert profiteroles, steamed jammed sponge with custard or fruit was offered. The supper menu consisted of ham or chicken sandwiches, carrot soup or poached chicken. People spoken to confirmed they are given a choice each day and one person said this is usually meat or fish. One person said they didnt want carrot soup and requested asparagus instead, they also didnt want the other options offered and asked for a mushroom omelette which staff agreed to provide. The chef plans menus each week and each day menus are printed so that people know what meals and choices they can have. In the kitchen there is a white board with every persons name on it, it details any allergies, likes, dislikes and any special diets required. Nursing staff advise the catering staff of new residents and what their dietary requirements are. Breakfast is provided for each person on a breakfast tray which is taken to their rooms. Trays are presented with white china, small cafetieres, sugar and milk jugs on white paper tray doilies. These trays are also provided to visitors to the home. Care Homes for Older People Page 19 of 38 Evidence: The dining room is carpeted and is furnished to a high standard. All tables have glasses, condiments, table clothes, napkins, cutlery etc. Prior to lunchtime each person was offered a sherry which some had in the lounge.The lunchtime is organised so that there are two sittings. The first sitting is usually attended by all those people who require assistance to eat are served and staff sit at the table with them. The Deputy Manager confirmed that other people living in the home can also attend at this earlier time if they choose. Similarly if some of those people needing assistance wish to eat at the second sitting they can. Those people attending the first sitting were observed to be assisted sensitively and slowly, none were observed to be rushed. Some people were observed to have plate guards and alternative cutlery to make eating and drinking easier for them. Some people spoken to during the inspection were complimentary of the food. One person said excellent very good another explained how they had recently attended a buffet for a birthday which they really enjoyed. They also commented on how good the chef was at preparing canapes. One person said the food was not too bad but explained they were limited in choices due to a medical condition they had. Comment cards received from nine people living in the home show that two felt they always like the meals, two people usually do and four sometimes do, one person has not responded. The kitchen was viewed and was found to be clean and organised. Good stocks of food were available in the fridges/freezers and storage areas. Care Homes for Older People Page 20 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to allow for any complaints or concerns to be dealt effectively and people who use the service are aware of who to speak to if they have any concerns so these can be followed up. Evidence: A complaints procedure is in place and this is detailed in the Service User Guide for the home. People spoken to said they knew who to raise any concerns with if they needed to but all those spoken to said they did not wish to raise any. It was noted that the procedure did not contain details of the Local Authority contacts should any person wish to refer their complaint on to them. The Deputy Manager agreed to review this. A complaints book is available in the home to record any complaints and there is also a record for staff to complete any concerns that may have been reported to them. The Annual Quality Assurance Assessment (AQAA) received by us from the home states one complaint has been received since the last inspection and that this was resolved within 28 days as stated in the homes complaints procedure. This has been subsequently discussed with the manager who confirmed this was in relation to manual handling. She advised this matter had been fully investigated and responded to. No complaints have been received by us since the last inspection. A copy of the vulnerable adults procedure is available in the home which details types Care Homes for Older People Page 21 of 38 Evidence: of abuse and actions required when reporting any incidents. There have been no incidents of this nature reported to us for this home. It was evident from records that training on the protection of vulnerable adults had been completed by most of the staff, we were informed there are still ten staff who need to complete training. All new staff that start at the home are required to read the policies and procedures on abuse and are given a booklet detailing the contact numbers they would need to report this. Staff spoken to during the inspection were able to state actions they would take should they observe abuse or this be reported to them. Staff were less clear on where this should be recorded other than in the care plan documentation. It was evident from reviewing staff files that a Criminal Records Bureau check had not been obtained before a person had started. This can place people living in the home at risk and therefore impacts on the protection of people in the home. Care Homes for Older People Page 22 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 is maintained to a high standard and is clean pleasant and hygienic to ensure people live in a safe, comfortable and homely environment. Evidence: Kenilworth Manor is an impressive building which is listed due to its architectural and historical interest. The home has a very attractive large landscaped garden which can be approached from steps or a ramp from the main building. People living at the home confirmed that they frequently use the gardens in finer weather. The home is decorated and furnished to a high standard and was clean and tidy on the day of inspection with no unpleasant odours. There is a large entrance hall with period furniture and a piano, doorways lead off to the left and right to the lounge and dining areas. There is one large lounge with coordinated furniture and furnishings and comfortable chairs with winged tops to support people living in the home. Down the centre of the lounge are glass top tables with lots of magazines of interest underneath such as Coast, Waterlife, Warwickshire Life. Windows and doors are large and bright with heavy quality curtains. The lounge also has small tables for people to use to rest their drinks and it was observed that seating is moved around as appropriate to encourage social interaction. A hearing loop is available in the lounge and dining room to assist those people with hearing aids to Care Homes for Older People Page 23 of 38 Evidence: hear clearer and more easily and there is also a portable hearing loop that can be used by people when they receive visitors. Due to there only being one lounge this limits people from being able to go to a quiet room if entertainments are taking place or from meeting with visitors in private unless they use their own private room. Similarly due to limited office space there are no dedicated areas where staff can do training or meet with visiting professionals. There are 26 single bedrooms and four double rooms although at the time of inspection the double rooms were being used as single rooms. Almost all of the rooms have ensuite toilet facilities and many also have showers or baths. Since the last inspection two of the rooms have been fitted with wet rooms. These were viewed and had been completed to high standards. Bedrooms seen were variable in size but all contained personal possessions to make them homely. Two rooms had recently been refurbished with new furniture and new carpets had been fitted outside rooms 1,2 and 3. The Deputy Manager said others would be done as they are vacated. There are three communal bathrooms, two of these have a parker assisted baths to enable people with mobility problems to use them and there is one shower room with a chair. There is a sluice room available in the home to manage any soiled or infected linen and there is also a laundry in the basement. This has two washing machines and two driers to manage the laundry needs of the home. No concerns were raised in regards to the management of the laundry. This is managed via a colour coded system so that staff know which floor laundry has come from and can ensure this is returned to the right floor. Staff wear uniforms and tabards to carry out various tasks and staff have access to disposable gloves. Blue plastic aprons are available for care staff to use for food related activities and white plastic aprons for areas of care. A dedicated hand wash sink is available in the kitchen as well as the laundry for staff to wash their hands to help in maintaining good infection control practices. Systems are in place for staff to transfer dirty washing to the laundry in suitable bags and sufficient baskets were available in the laundry to manage dirty and clean washing. Care Homes for Older People Page 24 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 needs of people are met by caring and supportive staff who are trained to do their jobs but some actions are required to fully demonstrate training standards are being met and that recruitment systems are being followed to safeguard residents. Evidence: On the day of inspection there were sufficient staff to support the needs of the people who live in the home. The Manager was not on duty so the inspection was conducted with the Deputy Manager. Since the last inspection action has been taken to ensure duty rotas now show staff designations as well as identify all staff who work at the home. The Deputy Manager advised that they aim to have at least two nurses (RGNs) on duty for the early shift (7.30 to 5pm) with eight carers or nurses to support people in the home. From 4.30pm to 10.30pm they aim to have one nurse and five carers. There are slight variations in the shift times in that some staff start at 7.30am and others at 9am and some finish at 1.30pm or 5pm. At night they aim to have one nurse and two carers on duty. Duty rotas viewed confirmed that these numbers are being achieved with the exception of the night duty shifts. Duty rotas showed that some staff had taken annual leave or were off sick when rostered to work night duty leaving two staff instead of three staff to work the shift. It was not clear from duty rotas seen that additional staff had been identified to cover these shifts and we therefore cannot be Care Homes for Older People Page 25 of 38 Evidence: sure sufficient numbers of staff were available to meet the needs of people who use the service. It was however evident that there was at least one nurse on duty each night. Duty rotas showed that there are domestic staff on each day except Sunday to clean the home and laundry staff on duty from Monday to Friday. The kitchen rota showed there is one head chef, a deputy head chef and three chefs plus an assistant cook to manage the catering needs of the home. In addition there are kitchen assistants and coffee hostesses available to support the kitchen and ensure people who use the service receive a high quality service. The manager confirmed in the Annual Quality Assurance Assessment document sent to us that sometimes they do need to use agency staff to cover absences in the home but they do try to use the same staff from the agency to provide some consistency for people living in the home. People spoken to were very complimentary of the staff. One stated staff are perfect from the youngest to eldest they are wonderful another stated there are several carers who are excellent and really help and realise when you are down and couldnt ask for better but there arent many of them, another said they are all very good here. One person when asked if their call bell was answered promptly said yes, yesterday I accidently set it off instead of putting the light on and staff came straight away. A visitor to the home said the staff always look after me so well when I visit. Comment cards received from nine people living at the home show that four people feel staff are always available when they need them, four stated they usually are and one person has stated they sometimes are. Two people have commented that there could be a better response to the call bell. A relative has commented that the home has very caring and welcoming staff, another states we would like to congratulate the management of Kenilworth Manor in the way all their staff are trained, they are always cheeful and friendly and create a warm family atmosphere. Staff spoken to said that they felt there were enough staff on duty to support people in the home. One stated if some floors are behind we give help, we all work together. A nurse said we are absolutely never short of nurses. Staff said there was nothing they would change about the home and confirmed they have access to any training they might need. One member of staff stated there is a notice board on first floor with training and Melanie (manager) is always highlighting courses that are available. They stated they are encouraged to attend. Care Homes for Older People Page 26 of 38 Evidence: A training schedule viewed showed all training provided including statutory training and staff attendance which was indicated by a tick. It was evident that some staff had not attended all of the required training such as moving and handling, food hygiene and fire training. It was not clear if dates had been organised for these staff to attend although it was evident that ongoing training is being accessed by the home. Fire training had been arranged for the day of inspection and some of the staff were therefore attending this training. Training records must clearly indicate that all staff have attended statutory training within the required timescales so that it is clear they can work with people safely. Induction training is provided by the home and induction booklets are given to new staff showing the areas where they need to complete training. Staff are required to sign areas in the booklets to confirm their understanding of what they have been shown. It was not evident that the induction training provided is based on the Skills for Care common induction standards which require specific training in a number of areas over a period of weeks. Comment cards received by us from staff working at the home show that they feel the induction process should be longer and that increased supervision through this process should be provided before they work as part of the shift. The Deputy Manager was able to provide documentation confirming that this induction training has been now been set up and new staff would be attending training based on the core units contained within the common induction standards. The home continues to mentor student nurses and they work in the home as extra staff to those permanent staff on the duty rota. At the last inspection the manager explained that training is undertaken with staff in the home all of the time so that new processes and techniques can be shared to ensure consistency in staff approaches to care. This training has included flushing peg tubes (used for people who are unable to eat), correct use of the call bell system, recognition of TIAs (mini strokes) and transferring people from the bed to a chair safely. The manager confirmed there are 24 carers employed by the home and of these there are eight with a National Vocational Qualification (NVQ) II, one with NVQ III and one with NVQ IV. This is less that the 50 standard required, this means that people cannot be confident that there needs will always be met by suitably qualified and competent staff. The Deputy Manager did however say there were over in numbers of trained nurses eg they have 15 RGNs which means there are always experienced and qualified staff on duty. A commitment was given to increase the number of carers with Care Homes for Older People Page 27 of 38 Evidence: an NVQ qualification. A review of staff files was undertaken and it was found that there were some areas in need of improvement. The Annual Quality Assurance Assessment completed by the manager states staff files confirm good recruitment practices, CRB check, two written references, application form and employment history. Application forms had been completed but some of the information regarding employment dates was not clear so it was not possible to be sure there were no gaps in employment histories. References had been obtained but in one case one of the references had been taken verbally and had been recorded by management staff and as the second written reference only contained one sentence, this had been followed up by the home and further information received verbally recorded. Criminal Record Bureau (CRB) checks had been requested and received for both employees but one of them was not received until after they commenced employment with the home. No staff should work at the home until a Protection of Vulnerable Adult (POVA) check or CRB check has been received This is to ensure all staff have been deemed safe to work with people at the home and do not present any risks to them. Care Homes for Older People Page 28 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A suitably experienced and qualified manager is in place who aims to ensure the best interests of the residents are maintained. Systems are in place to ensure the health and safety of the home although some check are due to maintain the safety and protectection of residents. Evidence: The Manager of the home is a trained nurse (RGN). She has attained the Registered Managers Award in Care, a NEBOSH qualification in Health and Safety (this includes controlling workplace hazards and management of health and safety in the home) and has been the lead in achieving accreditation in the Gold Standard Framework in caring for those people with palliative care needs. She has many years experience of working in a care setting and is therefore both suitably qualified and experienced to manage the home. Staff were observed to work effectively with management and appeared confident and at ease to raise any concerns or issues with the management as required. Care Homes for Older People Page 29 of 38 Evidence: A visiting training officer responsible for the placement of the nurse students was very complimentary of the home. She said residents really are cared for and she always recommends students to come to the home because it was one of the best in the country. She also advised that nurse students get a thorough grounding in regards to the delivery and assessment of care. Although we found there were some good outcomes for people who use the service, we also found that there are areas where improvements need to be made. For example medication has not been well managed and shortfalls identified at the last inspection in July 2007 have not been fully addressed. This means that people cannot be confident their medication will be administered as prescribed and this could impact on their health and welfare. Staff recruitment practices have not been managed consistently to safeguard people living in the home. The number of care staff with a National Vocational Qualification (NVQ) II or equivalent is less than we would expect. Not all staff have received statutory health and safety training such as moving and handling and food hygiene. Therefore people cannot be confident their needs will be met by suitably trained and qualified staff. There are a number of staff who have not attended training in how to recognise and prevent abuse as well as understand the whilstleblowing procedure and the process for reporting any possible abuse without the risk of victimisation. This could place people at risk and result in concerns not being reported as required to ensure they are acted upon. It was evident through discussions and records viewed that staff consult people living in the home about their personal circumstances and day-to-day things in the home. They are consulted on daily activities, entertainment and menus and their requests are granted where possible. Family and friends are entertained and catered for and a visitor to the home confirmed how well staff looked after them. Questionnaires are sent to people at the home and their family on an annual basis to assess their views on the care and services provide. If people are in the home on a short stay, they are asked to complete a questionnaire at the time of their discharge. An outcome report had been completed following the receipt of 16 questionnaires from people who use the service. The outcome report showed that they had been asked Care Homes for Older People Page 30 of 38 Evidence: about the catering service, receiving post, church services, nursing care, cleaning and laundry and entertainment. In all cases the majority of responses were either excellent or good. Areas which indicated there may be some action required were in regards to responses given for preferred waking times and bed times. A person spoken to during the inspection stated that they felt they were woken too early and would like to stay in bed for longer. Staff however stated that if people want to stay in bed for longer they can but if everyone wants to get up at the same time, they have to work the timings out so they can get some up slightly earlier or later. Several comments were made within questionnaires about social activities with people stating that they want more walks, more summer activities in the garden, more theatre, garden centre, cinema and shopping trips. It was not evident that a report had been compiled of actions taken to address some of the issues raised within the quality questionnaires. The manager has subsequently confirmed that the results of the questionnaires were shared with staff and residents. A report should be completed and made available to people living in the home and their relatives so that they know the issues that have been raised and what has been done about them. The Deputy Manager agreed to ensure this was addressed. There were several compliments made within questionnaire responses such as overall lovely care, youre all fabulous, all staff have a pleasant attitude are helpful and will try to resolve any query/concern. All members of our family are pleased with excellent services provided by Kenilworth Manor. Appropriate systems are in place for the management of residents money. The manager advised that most people choose to keep their own money and secure facilities are available for storage in their rooms. It was evident that records of all money received and expenditure made are kept to ensure appropriate management of any money kept by the home on behalf of residents. Accident records were viewed and it was evident appropriate actions had been taken to address these. However there were some accidents where medical intervention had been sought that not been reported to us. Medication errors also had not been reported to us. This is important so we know actions have been taken to manage risks and help prevent them happening again. The Deputy Manager advised this would be addressed from now on. Care Homes for Older People Page 31 of 38 Evidence: A review of the health and safety records in the home was undertaken to confirm health and safety checks are being undertaken and equipment in the home is safe. It was evident that recent checks had been undertaken on the water, portable electrical appliances, gas and electrical wiring. Hoist checks were noted to be due in May 09. The provider stated that a new fire risk assessment was in the process of being organised and was due to be discussed at the fire training organised for the evening on the day of inspection. Care Homes for Older People Page 32 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 33 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be given as 13/07/2009 prescribed consistently. (This issue was raised at the last inspection). This is so that the health needs of residents are managed effectively. 2 9 13 Suitable actions must be carried out and documented when medication errors are made to ensure staff are deemed competent to continue managing medications. This is ensure staff manage medications safely to maintain the health of people using the service. 13/07/2009 3 29 19 All new staff must have a Protection of Vulnerable Adult (POVA) check or Criminal Records Bureau check in place before they are employed at the home. 31/07/2009 Care Homes for Older People Page 34 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is to ensure staff have been deemed safe to work with the residents. 4 30 13 Staff must complete all 31/08/2009 statutory training within the required timescales and records need to demonstrate this. This is so that people who use the service can be confident the staff have the knowledge and skills to care for them safely. 5 37 37 Accidents and incidents in 31/07/2009 the home which could impact on the welfare of the people living in the home must be reported to us. This includes those where medical intervention is sought and medication errors. This is so we can be clear appropriate actions have been taken to safeguard people. 6 38 23 The Fire Risk Assessment for 31/07/2009 the home must be kept upto-date. This is to ensure any fire risks to the home are managed effectively to keep residents safe. Care Homes for Older People Page 35 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 38 13 Action must be taken to ensure the hoists are serviced regularly consistently. This is to ensure equipment remains safe for people living in the home to use. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Medication records must accurately record the amount of medication available at the beginning of each medication period. (This issue was raised at the last inspection). This is to ensure medication can be effectively audited to make sure people have been given their medication as prescribed. In view of the comments made by people who use the service in regards to wanting more social events, outside visits and entertainment. It is advised this area is reviewed to ensure the social care needs of people (including those less able) are met. It is advised that the Local Authority details are included as part of the complaints procedure to allow any person living in the home or their representative to refer their complaint onto this service should they wish. It is recommended that all staff attend training on the protection of adults to ensure they continue to be up-todate with procedures to safeguard people living in the home. It is recommended that the provision of a quiet area in the home is identified so that residents, visitors and staff can use this and do not have to impose on people sitting in the communal lounge or staff working in offices in the home. Duty rotas need to demonstrate that where changes are Page 36 of 38 2 12 3 16 4 18 5 19 6 27 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations made following sickness or annual leave, other staff have been identified to cover the shifts. This in particular applies to night duty. 7 28 Action should be taken to ensure further care staff achieve the National Vocational Qualification II qualification. This is to ensure the home meet the stipulated standard of 50 and also to help care staff provide more effective care to people living in the home. Action should be taken to implement induction training booklets for new staff based on the Skills for Care Common Induction Standards. This is to ensure staff develop suitable levels of competency to care for people appropriately. It is advised that following the receipt of any quality questionnaires a report is compiled of areas which have been identified for improvement and clear actions are identified and taken to address these. 8 30 9 33 Care Homes for Older People Page 37 of 38 Helpline: 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). 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