Care Home: Kenmure Lodge

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What the care home does well The people who live and work at Kenmure Lodge were positive in their comments, these included: `Good food, on the whole you could not wish for better staff, the staff keep this place going.` `Very good food and happy staff.` `They take good care of me.` `The staff are excellent, I am very satisfied and have no complaints. The staff give me a hug when I feel down. All the staff understand older people and can communicate well, even the younger staff.` `I think the residents are well looked after. The staff are trained well. The home is clean and tidy.` `I have worked for this company for many years and have always been able to talk to the management with any kind of query and always get full feedback, they are always helpful with problems.` `Kenmure Lodge is a very friendly and welcoming care home. All the individual needs of the client are met in a respectful and professional way.` The care and health needs of people who come to live at the home are understood and are met by the staff team. There are some activities which are available and occasional trips out. People living at the home are encouraged to make suggestions and have regular opportunities to give their views. Staff have regular opportunities to add to and update their skills. There is a low staff turnover and good relationships between staff and the people living at the home. The manager is experienced and considered to be approachable and involved in the day to day running of the home. What has improved since the last inspection? The staff have continued to undertake training and achieve qualification in social care. There has been additional training provided in health matters. Staff can attend courses and can also complete distance learning courses and use training DVDs at the home, to up date their skills. What the care home could do better: The plan of care should include guidance on any identified risk or individual behaviour which may be difficult to manage. A clear system of tracking appointments should be agreed. The decor and furnishings of the home are in need of modernisation and updating. Equipment and liquids should be stored safely at the home. Key inspection report Care homes for older people Name: Address: Kenmure Lodge Kenmure Lodge Kenmure Place Off Garstang Road Preston Lancashire PR1 6DD     The quality rating for this care home is:   two star good 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: Felicity Lacey     Date: 1 0 0 9 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 24 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 24 Information about the care home Name of care home: Address: Kenmure Lodge Kenmure Lodge Kenmure Place Off Garstang Road Preston Lancashire PR1 6DD 01772250513 01772563861 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Rowedast Developments Limited care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC 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 - Code OP The maximum number of service users who can be accommodated is: 24 Date of last inspection Brief description of the care home Kenmure Lodge provides residential care for up to 24 older people, who may be under or over the age of 65. The home is situated in a residential area, near to the city centre and is close to a range of local amenities. Accommodation is arranged over two floors with a lift providing access to the first floor. The grounds are small, with limited provision for sitting outside but a ramp is provided for easy access. Strong links have been forged with the local community; relatives and visitors call into the home at all times and people living at the home are able to take advantage of the many amenities Care Homes for Older People Page 4 of 24 Over 65 24 0 Brief description of the care home available in the local area. Care Homes for Older People Page 5 of 24 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: two star good 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: This inspection included an unannounced visit to Kenmure Lodge. Prior to the visit information was provided by the manager of the home in an Annual Quality Assurance Assessment (AQAA), this is a record of how the service provided at Kenmure Lodge meets the standards set out in law and good practice guidance. Surveys were sent out to people living and working at the home to gather their views and 15 completed surveys were returned. During the visit people who live at Kenmure Lodge, a relative, staff and the manager were spoken with. The last full inspection of the care home was on 28 September 2007, there was an Annual Service Review completed on 26 September 2008. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: The plan of care should include guidance on any identified risk or individual behaviour which may be difficult to manage. A clear system of tracking appointments should be agreed. The decor and furnishings of the home are in need of modernisation and updating. Equipment and liquids should be stored safely at the home. Care Homes for Older People Page 7 of 24 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. Care Homes for Older People Page 8 of 24 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 9 of 24 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. A full assessment of a persons support needs is completed before admission to the home, this ensures that staff are able to meet the persons needs. Evidence: The responses given in surveys indicated that enough information is provided by Kenmure Lodge to enable an informed decision to be made before moving to the home, people spoken with who live at Kenmure Lodge confirmed this. Some people were familiar with the home through living in the local area. Before a person is admitted to the home a member of staff visits them to gather details of their personal care needs and the support required. This information also includes consideration of personal preferences, interests and individual needs. The manager also ensures that a copy of any health or social services assessment is obtained and these were seen on peoples files. The staff spoken with were familiar with the care needs of people at the home. They Care Homes for Older People Page 10 of 24 Evidence: confirmed that they have enough information prior to a person coming to the home to understand the type and level of support the person requires. Care Homes for Older People Page 11 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people are understood by the staff and this promotes the welfare of people living at the home. Evidence: All people living at Kenmure Lodge have a written care plan which has been agreed with them, and which is reviewed on a monthly basis. The care plans seen contained relevant information and had been signed by the person living at the home or their representative, this ensures that care needs are agreed and understood by staff of the home. The care plans seen showed that changes in health and personal care needs were documented and responded to. There were risk assessments for moving and handling and other activities, with brief guidance to ensure people were being supported in a consistent way in line with their own abilities. The care plan should fully address all support needs, for instance there is a person who has some behaviours which can be difficult to manage, and these should be documented and the way in which staff should respond should be agreed upon and recorded. In this way staff act in a consistent way and can find the best way in which Care Homes for Older People Page 12 of 24 Evidence: to manage this persons behaviours. The manager was advised to ensure that any care need which presents a risk or which requires a consistent approach should be included on the care plan together with guidance about how the need is to be met and managed. People spoken with felt that the staff were very good at meeting their health needs. They confirmed that the doctor was called, without delay, whenever needed. The district nurse is involved regularly at the home. A number of comment cards were seen which had been completed by health professionals and which confirmed that staff were always available to assist, and understood the health care needs of the people at the home. There was evidence in daily notes and on care files of regular involvement of community health services, such as the optician, dentist and podiatrist. In the main it was possible to track the health care needs of people at the home and when appointments had been attended. On one care file a letter indicated that a follow up appointment would be sent, however it was not clear if this had arrived or if it needed to be chased up by staff. The manager is to look into this and explained that there are a number of ways in which appointments are recorded and tracked. Staff confirmed that they use the care notes, a communication book and diary to know what appointments have been made. There is also a regular staff handover during which information is passed on. The medication at the home is stored and administered in a safe way. Staff have received training and are also now using health awareness training modules, provided by Boots, which address specific conditions and the medications used to treat these conditions. The record seen were up to date. There is a system of returns for medication. The people spoken with during the visit spoke highly of the staff. They thought that staff were respectful of privacy. Staff were seen to be assisting people in ways which promoted their dignity. There are some shared rooms at the home and the people using these have agreed to do so. It is important that this agreement is documented, especially as some of the shared rooms are designated as rooms in which the person can smoke. Care Homes for Older People Page 13 of 24 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. There are opportunities for people to take part in social activities and to continue to be part of the local community, in this way they can continue to enjoy their preferred interests and lifestyle. Evidence: Some people spoken with felt that there were activities they could take part in including exercises games, Karaoke and DVD games. Students from the local college have visited the home to provide Beauty Treatments and it is hoped that this will become a regular occurrence. Some people liked to spend time on their own and others were happy following their own interests, at the time of the visit some people were enjoying knitting and artwork. Some people felt that there could be more variety of activities, for example maybe a discussion group or speakers. This was discussed with the manager who put it on the agenda for the Residents Meeting. There are occasional trips out. A few people are able to go out independently. The home is located near to local shops and amenities. Friends and family are welcome at all reasonable times. The home maintain links with local churches and community groups. Care Homes for Older People Page 14 of 24 Evidence: People living at the home manage their own finances or have a representative to do this for them. Small amounts of personal monies are kept at the home and these are accounted for by staff and checked on a regular basis by the company secretary and a senior member of staff. The people spoken with thought the food was very good. Everyone spoken with thought there was enough choice. The menu contains traditional favourites and people said that the staff would get their favourite food on request. The dining tables were set out with table clothes, condiments and sauces and a choice of hot or cold drinks. Special diets are catered for and when required advice from the dietitian is followed. Care Homes for Older People Page 15 of 24 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. There are complaint and safeguarding policies at Kenmure Lodge, which are understood by staff and this promotes the safety and welfare of people who live at the home. Evidence: There have been two recorded complaints received by the home since the last Key Inspection, both complaints have been satisfactorily resolved and related to minor issues. The people living at the home who were spoken with during the visit felt that their opinions were regularly sought and listened to. If there were any concerns these would be raised with staff and people were confident they would try and sort things out. Staff spoken with were able to explain how they would deal with complaints in both an informal and formal way. The complaints procedure of the home is on display and included in the information given to people living at the home. Some staff have completed safeguarding training as part of National Vocational Qualification studies. The manager is familiar with local safeguarding procedures and these are available for staff to read. Staff, including the manager, spoken with understood the need to report any allegations or suspicions and that this must be done in line with social services protocols and guidance. Care Homes for Older People Page 16 of 24 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 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 warm but some furnishings, fixtures and decor requires updating and modernisation. Evidence: The home was originally a school and consequently has many architectural features, such as high ceilings and variation in room sizes which contribute to the ambiance of the home. Efforts have been made to minimise the effect of these features and to provide a more homely environment. There are two communal rooms, a small outdoor area with seating and some bedrooms which are spacious and other which are very compact. There is a need to update the decor, furnishings and fixtures which are outdated and worn in many parts of the home. The building is very large and requires constant maintenance. The personal equipment of people living at the home should be safely stored in their rooms, however if equipment is not in use this should be kept in a safe storage area. At the time of the visit a hoist was being stored in a bedroom but was not being used by the occupant. During the tour of the home, shampoos and toiletries were seen to be left in the bathroom, these should be stored safely in a cabinet. The home was clean and hygienic. The home had been visited recently by environmental health who had made some recommendations which the manager is Care Homes for Older People Page 17 of 24 Evidence: implementing. The people who lived at the home thought it was kept clean and free from odours. There are infection control procedures in place and staff have completed in house training about the importance of following these procedures. Care Homes for Older People Page 18 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff at Kenmure Lodge regularly update their skills and are qualified, this means they are able to meet the needs of the people living at the home. Evidence: The people who completed surveys and who gave their views during the inspection visit felt that there was always enough staff on duty. There are now 11 staff who have completed a National Vocational Qualification in Care which is the recommended qualification for people in the social care sector. Staff have regular opportunities to up date their skills by attending training courses and completing distance learning modules. The staff spoken with felt that they were supported in their job roles and were encouraged to add to their skills. There is a low turn over of staff at the home and this benefits the people living there who have formed strong relationships with many staff members. The staff files show that the home is following safe recruitment procedures. Staff complete a period of induction during the first months of employment and this introduces them to all aspects of providing support for older people. The people living at the home held the staff in high regard. They felt the staff were approachable and friendly. Care Homes for Older People Page 19 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager creates an open and inclusive atmosphere in which people living at the home and staff feel valued and that their opinions matter. Evidence: The manager has many years experience in providing social care. He has completed the recommended qualifications for a registered manager. The people spoken with and staff find him to be approachable and able to sort out matters that arise. He is committed to involving people who live at the home in their own care, and involves people through regular meetings to discuss the working of the home and on a one to one basis. The people who live at the home, visitors and professionals are asked to complete satisfaction surveys. The home holds an Investors in People Award which is an external quality assurance award. The owner of the home is a regular visitor and provides monthly reports on the conduct of the home. Care Homes for Older People Page 20 of 24 Evidence: Records are maintained of financial transactions. When money is spent on behalf of a person living at Kenmure Lodge, this is receipted and countersigned. Safe working practices are promoted at the home through regular health and safety training and updates. The manager ensures that health and safety training is kept up to date, including infection control, Food Hygiene and First Aid. Equipment is maintained and serviced regularly. The information provided by the manager indicates that routine health and safety checks have been completed. Accident records are stored on the individuals personal file and this enables monitoring of the frequency and cause of personal accidents. Care Homes for Older People Page 21 of 24 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 22 of 24 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 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 7 The care plan should set out in detail the action which needs to be taken by care staff to ensure that the individual care needs of people are managed in a consistent way. There should be a programme of renewal of the fabric and decoration of the building to modernise its fixtures and fittings. Equipment and liquids should be stored safely to reduce the risk of an accident. 2 19 3 19 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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