Care Home: Kenmore Home - Leonard Cheshire Disability

What the care home does well People told us they are involved in regular meetings with managers and staff of the home. Topics discussed focus on day to day life in the service. Menus are also planned and activities people want to participate are discussed. This type of consultation will help to ensure that people have a say in all aspects of daily life in the service. Health care professionals said: "Staff cope well with people`s complex needs and there is a caring attitude amongst all staff ". Staff have a very good knowledge of people`s health, social and emotional needs. We were impressed with the empathic way in which staff communicated with people. The ex by ex received the following feedback from people he spoke with "the staff are very good". The ex by ex also made the following comments: "The craft/activity room is staffed by a mixture of paid staff and volunteers. The residents were all noticeably happy, stimulated and busy doing what they wanted to do. The atmosphere in the craft/activity room was pleasant and homely. It felt like we were a group of friends hanging out together in the kitchen of somebody`s own home". All people were positive about the current staff group. What has improved since the last inspection? Serious issues of concern were raised during our key inspection in June 2009. Our concerns related to the poor personal and healthcare support people were receiving, people`s lack of choices and lifestyle in the home, the lack of transparent complaints procedures, poor staffing arrangements and the general poor management of Kenmore. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 The management of the Leonard Cheshire organisation and staff of the home took these issues seriously, took swift action and in the main all these concerns have now been addressed. Since our last key inspection the registered manager has left. A temporary manager was appointed. She worked at the home for 5 months and instigated significant improvements at Kenmore. A new manager and care manager have recently been appointed and the general consensus is that the improvements have continued. Staff and people living in the home all told us that things are better organised, the atmosphere in the home is calmer and happier, the cleanliness has improved and that staff are receiving direction and guidance. People also said that the current manager is interested in the people living in the home and is very approachable. Improvement in people`s care records has continued. This will mean staff know the physical and social support people need and so people will receive a higher standard of consistent care. The meal time experiences for people was better organised and people were served in a timely fashion. We found significant improvements in the standard of personal care people had received. People supported these findings. Improvements in medication systems have been made. This will help protect people. People living in the home told us the home is always clean and the cleanliness of the home has improved over recent months. Staff said they felt working practices have improved "We can provide a better level of consistent care to people". People said "Staff seem much happier"; "They are around when we need them, its nice now". Staff added "I really love working here now, staff moral is great". Improvements have been made in recruitment procedures to ensure that all the required checks are done before new staff start work. This means people are better protected. What the care home could do better: Some medication practices and storage procedures need to improve so that people`s health and welfare are protected.Kenmore Home - Leonard Cheshire DisabilityDS0000001087.V378497.R01.S.doc Version 5.3 People`s records must be securely stored at all times so that their confidences` are kept. Care plans need to be set out in a way that makes it easy for staff to find specific information about people`s needs quickly. This will make sure staff can refer to a care plan to see exactly what support anyone living in the home needs. The person`s daily notes should reflect the information actually recorded in their care plan. Staff should continue to develop and implement individual activities plans with people so that they are supported to achieve their individual goals. Additional staffing or activity coordinator input should be considered which may benefit people who are less able or willing to join in with group activities. The work on improving the environment should continue and be completed as soon as possible. This will help to ensure the home is comfortable and suitably equipped to meet people`s needs. Key inspection report CARE HOME ADULTS 18-65 Kenmore Home - Leonard Cheshire Disability 100 Whitcliffe Road Cleckheaton West Yorkshire BD19 3DR Lead Inspector Michael O`Neil Key Unannounced Inspection 30th November 2009 09:30 Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Kenmore Home - Leonard Cheshire Disability Address 100 Whitcliffe Road Cleckheaton West Yorkshire BD19 3DR 01274 872904 01274 851996 john.hrynczyszyn@LCDisability.org www.LCDisability.org Leonard Cheshire Disability 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) Vacant Care Home 29 Category(ies) of Physical disability (29) registration, with number of places Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. Day care - 5 Date of last inspection 10th June 2009 Brief Description of the Service: Kenmore offers nursing care for up to twenty nine people, aged 18 to 65 years, with physical disabilities. The home is a detached Victorian house set in its own grounds and has been extended to provide single room accommodation on the ground and first floor. The first floor is accessed by a passenger lift. It is situated in a residential area of Cleckheaton close to local amenities and easy access to the motorways. Kenmore is one of nineteen services run by Leonard Cheshire Services, a charity that provides services for people with a disability. Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. Fees range from 560.40 to 1246.65 pounds per week. Hairdressing, toiletries, transport and newspapers are not included in the weekly fee and are charged separately. This information was provided by the manager on 30 November 2009. Copies of inspection reports are available from the home on request. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection carried out in one day over a period of seven hours by one inspector. An expert by experience (ex by ex) also assisted with the visit. An expert by experience is a person who, because of their experiences of using services, visits a service with us. This helps us get a picture of what it is like to live in or use the service. The ex by exs main focus was talking to people about how they felt their privacy and dignity was respected and what their daily routines and meals were like. They also observed how staff spoke with people and cared for them. The purpose of this visit was to look at how the needs of people living in the home are being met and to follow up on the requirements made at the last inspections. During the visit we spoke to people living in the home, staff and management. We looked at various records including care records and looked at some parts of the home. Before the visit we sent surveys to the home to distribute to people using the service, visiting health care professionals and staff. Eleven surveys were returned to us and their views are included in this report. We asked the home to complete an Annual Quality Assurance Assessment (AQAA); this is a self-assessment which focuses on how the home is meeting the needs of the people using the service. This was completed and gave us the information we asked for. Our pharmacy inspector visited the home to look at medication practices on 11th August 2009 and we also carried out a random inspection at the home on 3rd September 2009. The reason for these additional visits was to follow up the requirements from the last key inspection carried out on 6th June 2009, when we rated the overall service as poor. We asked the home to provide improvement plans following our visits. Regular updates to the improvement plans and progress reports have been provided by the service. This report is based on information from our site visit, the random and pharmacy inspection, the feedback from surveys, the feedback from the ex by Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 6 ex, the homes self assessment, the homes improvement plans and information we have received about the home since our last visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: What has improved since the last inspection? Serious issues of concern were raised during our key inspection in June 2009. Our concerns related to the poor personal and healthcare support people were receiving, peoples lack of choices and lifestyle in the home, the lack of transparent complaints procedures, poor staffing arrangements and the general poor management of Kenmore. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 7 The management of the Leonard Cheshire organisation and staff of the home took these issues seriously, took swift action and in the main all these concerns have now been addressed. Since our last key inspection the registered manager has left. A temporary manager was appointed. She worked at the home for 5 months and instigated significant improvements at Kenmore. A new manager and care manager have recently been appointed and the general consensus is that the improvements have continued. Staff and people living in the home all told us that things are better organised, the atmosphere in the home is calmer and happier, the cleanliness has improved and that staff are receiving direction and guidance. People also said that the current manager is interested in the people living in the home and is very approachable. Improvement in peoples care records has continued. This will mean staff know the physical and social support people need and so people will receive a higher standard of consistent care. The meal time experiences for people was better organised and people were served in a timely fashion. We found significant improvements in the standard of personal care people had received. People supported these findings. Improvements in medication systems have been made. This will help protect people. People living in the home told us the home is always clean and the cleanliness of the home has improved over recent months. Staff said they felt working practices have improved We can provide a better level of consistent care to people. People said Staff seem much happier; They are around when we need them, its nice now. Staff added I really love working here now, staff moral is great. Improvements have been made in recruitment procedures to ensure that all the required checks are done before new staff start work. This means people are better protected. What they could do better: Some medication practices and storage procedures need to improve so that peoples health and welfare are protected. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 8 Peoples records must be securely stored at all times so that their confidences are kept. Care plans need to be set out in a way that makes it easy for staff to find specific information about peoples needs quickly. This will make sure staff can refer to a care plan to see exactly what support anyone living in the home needs. The persons daily notes should reflect the information actually recorded in their care plan. Staff should continue to develop and implement individual activities plans with people so that they are supported to achieve their individual goals. Additional staffing or activity coordinator input should be considered which may benefit people who are less able or willing to join in with group activities. The work on improving the environment should continue and be completed as soon as possible. This will help to ensure the home is comfortable and suitably equipped to meet peoples needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported in making an informed decision about whether the home is right for them. They can be confident that the home will be able to meet their needs because a full assessment is done before they move in. EVIDENCE: Seven people living in the home completed surveys for us. They said they had been given enough information before moving in to help them decide if it was the right place for them. People told us they had visited the home before making a decision about moving in. We saw records of pre-admission assessments in the care plans we looked at. Staff liaised with professionals, the person and their families to find out about peoples needs. This assessment will help to ensure that people have the information needed to make choices about where they live. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, 9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are involved in planning and making decisions about their care and this is recorded in their care plan. Peoples records are not always securely stored which means their confidentiality may be breached. EVIDENCE: We looked at three peoples care records during this visit and three at our visit in September 2009. Improvement in peoples care records has continued. The care records we looked at had detailed assessments of peoples needs. This information is used to draw up care plans showing how peoples personal, health and social care needs will be addressed. The care plans are person centred and have information about peoples abilities and preferences. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 12 People or their representatives are involved in drawing up care plans and making decisions about how care and support will be given. The persons care plans had been regularly reviewed. The care plans do contain vast amounts of information some of which is repeated. It was difficult to find information about peoples needs. Care plans need to be set out in a way that makes it easy for staff to find specific information about peoples needs quickly. This will make sure staff can refer to a care plan to see exactly what support anyone living in the home needs. Staff, when writing peoples daily notes, were not being reflective of the information actually recorded in the persons care plan. Staff in some plans were recording information every half hour to say that they had checked that the person was comfortable or a piece of equipment was satisfactory. Recording checked and O.K. could be recorded elsewhere .An overall evaluation of the persons care that is linked to the actual care plan should be recorded. This could be recorded less frequently than half hourly. Peoples care records which contain sensitive and confidential information are stored in peoples rooms. This is a positive initiative in that it gives people access to their own records at all times .The rooms however are not locked and at the times when the rooms are unoccupied it means that the records are not secure. Peoples records must be securely stored at all times so that their confidences are kept. People told us they are able to make decisions about what they do and how they spend their time. They told us they are supported in maintaining their independence and the records showed that where this involves taking risks there are assessments in place to show how these risks will be managed. People told the ex by ex I like living here, I have control over what I do. Whenever possible people are supported in managing their own money and this is recorded in the care records. We saw individual records kept of all transactions. People told us they are involved in regular meetings with managers and staff of the home. Topics discussed focus on day to day life in the service. Menus are also planned and activities people want to participate are discussed. This type of consultation will help to ensure that people have a say in all aspects of daily life in the service. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service promotes and encourages the development of social and practical skills for most people. This ensures that the majority of people have the opportunity to participate in leisure activities and live as part of the community. People are given the opportunity to exercise their right of choice regarding their daily lives. EVIDENCE: People using the service who completed our surveys and who we spoke with said they are able to make decisions about what they do and how they spend their time. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 14 Daily routines are flexible. People said they can have their meals at any reasonable time and we saw people eating their breakfast and lunch and varying times during the morning and early afternoon. Improvements have been made since our last key inspection in June 2009 so that peoples care plans are now in place that clearly show what peoples social care needs are and how these needs are to be met. We found people have been consulted about their interests and what activities and trips they would like to take part in. There is also information about how people like to spend their day. We also found that during the week various activities are arranged on a daily basis and during the next month there are various trips out and parties being organised. Community groups and entertainers are planning to visit the home in the lead up to Christmas. There are some people living at the home that enjoy a range of activities and are involved in going out on trips, to day centres and church. The home also organise trips out shopping and visits to places of interest. For other people their opportunities for personal development seem to be very limited. We did see some people sat in the lounges who received little staff interaction or stimulation other than sitting in front of the TV. The activities coordinator has developed plans for these people but the time she can spend with them on a one to one basis is limited. Additional staffing or activity coordinator input may benefit people who are less able or willing to join in with group activities. The ex by ex made the following comments: The craft/activity room is staffed by a mixture of paid staff and volunteers. The residents were all noticeably happy, stimulated and busy doing what they wanted to do. The atmosphere in the craft/activity room was pleasant and homely. It felt like we were a group of friends hanging out together in the kitchen of somebodys own home. Following the observations and discussions with various people who live at Kenwood the ex by ex made the following overall comments: There are still limited options for residents to get out of the home. The activity/craft room is clearly popular and appears to be in heavy demand; the demand is such that it needs a larger venue. It seemed as if the craft/activity room belonged to the residents who use it, where as the lounges on the floor above just looked like the lounges of a residential home. I believe that it is vital that the management of Kenmore Home work with the staff to try and bring the outside world in and to enable the residents who can to get out of the home more. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 15 At the previous inspection in June 2009 we asked staff to make sure that mealtimes are properly organised and that staff are available to support and assist people with their food intake. People living in the home have been consulted about the meals and mealtimes, through meetings with the general manager and meetings with the catering staff. The meetings with the catering staff are now continuing on a regular basis so that people can continue to give direct feedback. We saw from the minutes of these meetings that people living in the home have brought up various issues directly with the cook, who has listened and acted on what had been said. During this visit and the random inspection in September 2009 we saw that there were plenty of staff around and people who needed assistance got support when their meal arrived. The meal time experiences for people was better organised and people were served promptly. People told us they enjoy the food and are offered a choice of meals. Staff are trying to accommodate peoples personal tastes in relation to the food served. People told the ex by ex The meals are lovely, The food is good, Wonderful food – excellent improvement. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health is monitored and arrangements for dealing with health issues are met with support from health professionals. People are treated with respect and said they are very happy with the care they receive. Some medication practices still provide some risk to peoples health and welfare. EVIDENCE: Care plans show that peoples health is monitored and people have access to health care facilities and any relevant specialists that are necessary. Records show that people are assisted and supported by staff to make decisions and choices about all daily living needs. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 17 Information of peoples personal care needs is recorded, this also includes peoples wishes and preferences and when staff provide personal support in daily routines. Health care professionals said: Staff cope well with peoples complex needs and there is a caring attitude amongst all staff . During this and the inspection in September 2009 we found significant improvements in the standard of personal care people had received. People supported these findings. We saw people looked well cared for, men had been shaved, people’s hair had been combed/brushed and people’s clothing was clean. People and their relatives are now very positive about the level of care and support provided at Kenmore and made comments to the ex by ex such as: The staff are very good. Staff have a very good knowledge of peoples health, social and emotional needs. We were impressed with the empathic way in which staff communicated with people. Our pharmacy inspector visited Kenmore to look at medication practices at the service on 11th August 2009.Several requirements and recommendations were made following this visit. We checked progress made to meet these requirements during this visit. Improvements in medication systems have been made since August 2009.All requirements made then have now been met. Two recommendations remain outstanding. Regular auditing of medication records and storage is also being carried out by the care supervisor of Kenmore to check with continuing compliance. All medications administered were signed for on peoples medication charts. However people were not fully protected because not all Medicine Administration Records (MAR) were adequate. Where topical creams had been applied these had been signed for on charts in peoples rooms. We would recommend that when nurses delegate the task of applying creams to care workers, then the whole of the task should be delegated. Arrangements should be made for the care worker responsible to sign the record of administration, not a copy, in line with current professional best practice guidance. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 18 Some handwritten MAR sheets checked did not contain General Practitioners or two members of staffs signatures alongside any directions regarding the dosage of the medication or the time the medication was to be given. Medication was securely stored in locked cupboards in a locked room. The Controlled Drugs Register was checked and this had been completed correctly with two signatures and a diminishing total. Qualified nursing staff dispense all medication. Guidance from the Nursing and Midwifery Council on the administration of medication is available to staff at the home.These systems and procedures will help to protect people. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate systems in place to make sure that peoples concerns/complaints are taken seriously and acted on and to make sure that people are protected from abuse. EVIDENCE: At the previous key inspection in June 2009 we asked staff to make sure that all complaints were documented and responded to in line with the home’s procedure and that adult protection issues are properly reported and any necessary action is taken. These issues have been addressed. Information about the complaints procedure is available in the home. People told us they know how to make a complaint if they need to and know who to speak to if they are unhappy. We looked at a complaints file held by the home. This had details of 6 complaints or concerns that had been made to the service. We saw that these complaints and concerns were correctly recorded to show the source of each complaint, how it was acknowledged, the action taken to investigate it, the outcome and the final response to the complainant. This means that complaints are being dealt with properly. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 20 We spoke to the manager who told us that staff had been reminded about the correct reporting procedures to follow and the action to take in relation to adult protection issues. We saw minutes of a General Staff meeting held at Kenmore on 16 July 2009, which confirmed this. Staff said they are aware of protection polices and procedures and said they had received training on safeguarding issues. Records were seen of recent adult safeguarding training staff had undertaken. This ensures people who use the service are safe and protected. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,26 & 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and comfortable but is in need of refurbishment and redecoration to bring the accommodation up to date. EVIDENCE: People living in the home told us the home is always clean and the cleanliness of the home has improved over recent months. The home was clean when we visited. Refurbishment of the home is required as an ongoing project. Some parts of the home look tired and in need of brightening up. Some paintwork around the home is chipped and some walls damaged. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 22 Some work is taking place to improve the environment. New furniture has been purchased and some areas have been redecorated. This refurbishment should continue so that people can live in pleasant surroundings. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, & 35 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff to meet peoples needs and people are protected because all the required checks are done before new staff start work. Staff are supported in developing the skills and knowledge they need to meet peoples needs. EVIDENCE: At the previous key inspection in June 2009 we asked the service to make sure that there were enough suitably qualified staff on duty, including ancillary staff, to make sure that people’s needs are met consistently. During this visit and our random inspection in September 2009 we found the following improvements: Staffing arrangements have been reviewed and staff have been organised into 3 smaller teams with specific responsibilities for certain parts of the home and the people who live in these areas. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 24 Additional senior staff are being recruited. Where necessary the level of staff support required, to meet the individual and changing needs of people living at Kenmore, is being re-assessed. Staff training has been arranged to ensure that staff are better skilled to meet any specific individual and changing needs of people living at Kenmore. In the surveys staff said that there were sufficient numbers of staff employed to meet all the needs of people at the home. The staff we spoke to said there were enough staff on duty to meet peoples needs. We saw that staff were available to attend to peoples needs when needed. Staff said they felt working practices have improved and added We can provide a better level of consistent care to people. People said Staff seem much happier; They are around when we need them, its nice now. At the previous key inspection in June 2009 we asked the service to make sure that staff are fully checked before they are allowed to work without supervision. The manager told us that all the required checks are done before new staff start work. Three staff files were checked at this visit and three at the random inspection in September 2009.The files contained a range of information including two references and a declaration of health and identification. The staff had undertaken a criminal record bureau check (CRB), at the enhanced level. The area manager in the improvement plan which was forwarded to us in November 2009 confirmed that all staff files have now been audited. We received confirmation that all staff working at the home have had all the required checks carried out. This confirmed thorough recruitment practices were in place, which was sufficient to safeguard people. Staff told us they received induction training when they started work and this covered what they needed to know. Staff said they get the training they need to keep them up to date and to help them meet peoples needs. They said they have regular supervision and feel very well supported by the management team. Comments from staff were very positive about the service. They said I really love working here now, staff moral is great. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the management of the home has improved. In the main the policies and procedures in place protect and safeguard people who use the service. EVIDENCE: Prior to the visit the service had submitted an Annual Quality Assurance Assessment (AQAA). The AQAA was received on time. This shows that the service works in a cooperative manner with us. The service had also submitted improvement plans when we requested them. This kept us informed of the progress the service was making following our Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 26 inspections at the service in June, August and September 2009. Since the last key inspection of Kenmore the post of registered manager at the home has become vacant. Over the last 5 months a temporary manager was in post. She had been temporarily appointed in role as manager by the registered providers to bring about improvements at Kenmore and provide management support until vacant posts were filled. This had the desired affect and significant improvements have occurred at the home. People have also noted the improvements. They were all in agreement that Things are now so much better at the home . The management of the service need to be able to demonstrate that these improvements can be sustained. A new permanent manager has been appointed and has been in post for four weeks. The manager is a qualified nurse and has many years experience within the nursing and caring profession. She has completed her Registered Managers Award. We would ask that the registered providers write to us to inform us of these changes to the management of the home and apply for the new manager to be registered with us. The management team of Kenmore have ways in which to check out the quality of the service that they are providing. Regular staff meetings are arranged. Minutes of these meetings were seen. People and their representatives said they saw and spoke with the manager of the home on a regular basis. Her door is always open one person said. A home newsletter has been produced. This provides information to people about what is happening in the home. The representative of the registered provider visits the home on a regular basis, a report is written following the visits and any identified actions taken. There is evidence of internal auditing of the homes environment, services and records. There is evidence that the ethos of the home is much more open and transparent. Generally the views of both people who use the service and staff are being listened to, and valued. The manager and care manager said they have attended training on the Mental Capacity Act and the Deprivation of Liberty legislation. Other staff however had little knowledge of the legislation and needed training. Information leaflets are available in the home although staff said they had not read them. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 27 The manager said that no one in the home was being deprived of their liberty when we visited. The lack of staff training relating to deprivation of peoples liberty may mean that peoples rights are not fully protected and promoted. However, the manager did state that Training is accessed via Social Services; it is ongoing and will be a focus for 2010.Staff advocate strongly on behalf of the residents to ensure their rights are protected and promoted. The self-assessment form completed by the home indicated that the required maintenance and servicing of equipment is up to date, a sample of records we looked at confirmed this. Staff said they had received recent fire safety and other health and safety training. These measures will promote the safety and welfare of the people. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000001087.V378497.R01.S.doc 2 3 X 3 2 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 2 X 3 X Version 5.3 Page 29 Kenmore Home - Leonard Cheshire Disability No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA10 Regulation 17 Requirement Peoples records must be securely stored at all times so that their confidences are kept. Timescale for action 01/03/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA6 Good Practice Recommendations The persons daily notes should reflect the information actually recorded in their care plan. Care plans need to be set out in a way that makes it easy for staff to find specific information about people’s needs quickly. This will make sure staff can refer to a care plan to see exactly what support anyone living in the home needs. Staff should continue to develop and implement individual activities plans with people so that they are supported to achieve their individual goals. Additional staffing or activity coordinator input should be considered which may benefit people who are less able or willing to join in with group activities. The activity/craft room is clearly popular and appears to be in heavy demand; the demand is such that a larger venue should be considered. DS0000001087.V378497.R01.S.doc Version 5.3 Page 30 3. 4. 5. YA12 YA12 YA12 Kenmore Home - Leonard Cheshire Disability 6. YA12 7. YA20 8. YA20 9. 10. 11. YA24 YA26 YA37 11. YA40 Ways at meeting some of the observations made by the ex by ex in relation to improving peoples lifestyle at the home should be considered and where possible implemented. When nurses delegate the task of applying creams to care workers, then the whole of the task should be delegated. Arrangements should be made for the care worker responsible to sign the record of administration in line with current professional best practice guidance. To protect people the Medication Administration Records (MAR) should contain General Practitioners, or two members of staffs signatures, alongside any directions regarding the dosage of the medication or the time the medication is to be dispensed. The programme of renewal of the fabric and decoration to improve the environment should continue. The refurbishment of bedrooms should be included in the homes redecoration and refurbishment plan. This will make sure that the accommodation is updated. The registered providers should write to us to inform us of the changes to the management arrangements at the home and apply for the new manager to be registered with us. To protect peoples rights and choices staff should receive training on the mental capacity act and deprivation of liberty. Kenmore Home - Leonard Cheshire Disability DS0000001087.V378497.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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