Care Home: Kensington

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What the care home does well The home has a skilled and competent manager who has a good knowledge of the people living in the home including their care needs and as individuals . The staff working in the home also know the residents well and use the knowledge to good effect when providing care to them. The home has a very pleasant atmosphere and visitors are made welcome when visiting their friends or relatives. A number of relatives spoken to during the visit were complementary about the staff and the care they receive. The relatives were positive about the staff and an example being the "staff always nice and kind". The residents living in the home receive good personal and health care and the staff work hard to make sure that they are comfortable and feel safe. The staff were observed being kind and friendly when assisting residents and were willing to spend time with them as part of their daily lives. There are good social activities being offered to the people living in the home and this is offered in a way that takes into account their needs, choices and previous lifestyle. The people living in the home use the facilities in the attached home such as the "bar" and a "tea room". This is a good way of offering the residents a stimulating environment to have social event, spend time and enjoy each others company. The manager and staff have a good relationship with visiting professionals and they make sure that they seeks advice and support from them so that any actions taken on behalf of a resident are made in their best interest. The home provides a good standard of food which is well prepared and offers choice and variety. The food served during the visit was well received by the residents. Those of them who were asked all said that they enjoyed it and that the food was "there is always something to choose". They felt that they always had lots to eat and that they could have alternatives if the choices on the menu was not to their taste. The manager is continuing to work at making the improvements identified as a result of the quality assurance process and is looking at "best practice" advice to improve the specialist nature of the service they provide. What has improved since the last inspection? No requirements were identified at the last key inspection. One recommendation was made at that inspection, this was to improve the recording of social activities and this has been achieved. Records now show more effectively the resident`s enjoyment of the opportunities they are give to live active and fulfilled lives. What the care home could do better: No requirements were made as a result of this inspection. Three recommendations were made at this inspection they were:- that the manager continues with her plan to improve the care plans by making themmore detailed and person centered. - that the manager investigates the reason for the extreme heat in the treatment room. - that the home carry out the planned improvements to the dining rooms and the corridors so that the home continues to be a pleasant place for people to live. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kensington Ayton Street Byker Newcastle Upon Tyne Tyne & Wear NE6 2DB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Suzanne McKean     Date: 1 5 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Kensington Ayton Street Byker Newcastle Upon Tyne Tyne & Wear NE6 2DB 01912652888 01912762888 kensington@ladhar.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Baldev Singh Ladhar Name of registered manager (if applicable) Cynthia Alaere Agbo Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The five basement rooms are only to be used for service users requiring personal care Date of last inspection Brief description of the care home Kensington is a home providing nursing and residential care. It is situated in a residential area of Byker, on the outskirts of Newcastle upon Tyne. The home is purpose built and was first registered in August 2000. Accommodation is provided over three floors. The lower ground floor has five beds registered for personal care only. A passenger lift is available, if required. The bedrooms are all en-suite and of a good size. Double bedrooms are available if required. There are lounges available on each floor and a designated smoking area. There are two homes on this site and they share kitchen and laundry facilities. They are otherwise independently staffed and function separately. Care Homes for Older People Page 4 of 28 care home 49 Over 65 47 0 0 2 Brief description of the care home The home charges fees of £436 per week and as the home provides nursing care the free nursing care element of the funding is provided in addition to the costs charged to the resident. The home provides information about the service through the service user guide. A copy of the last inspection report from The Commission for Social Care Inspection is available in the entrance to the home. Care Homes for Older People Page 5 of 28 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: 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 Summary: This is an overview of what the inspector found during the inspection. How the inspection we carried out:- Before the visit we looked at, the information we have received since the last visit on 12th July 2007. How the service dealt with any Care Homes for Older People Page 6 of 28 complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of people who use the service and their relatives, staff and other professionals. The visit: An unannounced visit was made on 9th July 2009 and a further visit on 15th July the total time spent on the visits was seven and a half hours. The visit was undertaken by the link inspector for the home. During the visit we: Talked with people who use the service, relatives, staff, the manager and visitors. Looked at information about the people who use the service and how well their needs are met. Looked at the records which must be kept. Checked the staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building and parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since the last visit. We told the Manager what we found. What the care home does well: What has improved since the last inspection? What they could do better: No requirements were made as a result of this inspection. Three recommendations were made at this inspection they were:- that the manager continues with her plan to improve the care plans by making them Care Homes for Older People Page 8 of 28 more detailed and person centered. - that the manager investigates the reason for the extreme heat in the treatment room. - that the home carry out the planned improvements to the dining rooms and the corridors so that the home continues to be a pleasant place for people to live. 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 set out 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 9 of 28 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 10 of 28 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. There is a good assessment carried out by the staff prior to admission, this makes sure that the potential resident can be confident that the home is able to meet thier needs and that the home can offer a place. The home does not offer intermediate care. Evidence: The care plans contain detailed pre-admission assessments, which are completed by the Manager or the senior staff. The pre-admission assessment is then used to develop the care plan. The care plans also have a care management assessment, which is completed by their social worker as part of the assessment process. This is given to the home on or before admission and from these documents an individual care plan is produced. All of the care plans looked at had these in place. Care Homes for Older People Page 11 of 28 Evidence: The home is not registered for, and therefore does not provide, intermediate care. Care Homes for Older People Page 12 of 28 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 residents have their social and healthcare needs met by good care planning, and residents are treated with respect and their privacy protected so far as possible both when receiving care and throughout their daily life. Evidence: Each resident has an individual plan of care, which is based on the admission assessment and is then added to during the placement. The care plans contain an assessment for nutrition, wound care, moving and assisting, and continence promotion as well as a dependency score. These are up to date and detailed. Ongoing improvements have been made to the documentation and this has had a positive effect. Resident or relatives are consulted when writing the care plans and this is confirmed by the completion of a form, which is signed by them. One of the relatives who responded to the survey said that the home healed her bed sores, and improved her health. Care Homes for Older People Page 13 of 28 Evidence: Residents have access to NHS services and facilities. There is a good range of pressure relieving mattresses for the prevention of pressure sores. Nursing action taken for wound care was well recorded the home currently has three residents with a pressure wound. These are all improving and are being managed appropriately. The home seeks expert advice from external professionals if necessary. A visiting primary health care nurse was positive about the way they are assisted by the staff and how open they are to taking advice. The staff could describe the way they maintain residents privacy and were seen doing so when delivering care. The residents were complimentary about the care they received and said that the staff treat them in a friendly and pleasant way way. An example of the comments made was that the staff were lovely and they are always there to help me. Staff address the residents by their preferred name and there was a good relationship seen between the residents and the staff. The systems for managing medicines in the home are in line with safe working practice guidelines. Staff record the medicines being ordered, the prescriptions are then checked on receipt from the General Practitioners and are then sent to the Chemist for dispensing. The medicines are then again checked against the records when received into the home so that any errors can be picked up. No residents are currently managing their own medication. The manager is currently developing their strategy for caring for those residents who have reached the end of their lives. This is a system, which is being introduced in a number of areas of care in both NHS, and community based care. Its use in care homes is relatively uncommon at this time. The manager was positive about a recent experience in which it was used. The documentation for this is detailed and was a good example of good end of life care. A number of the staff have completed additional training in the care of the dying. Care Homes for Older People Page 14 of 28 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. Residents are satisfied with the flexibility of their routines and social activities, which meet their cultural, social, religious and recreational interests and needs. There are good arrangements for residents to maintain contact with their family and friends and the local community. Evidence: Residents said that they are encouraged to take control of their daily routines in simple but important ways including the time they get up, and what and when they eat. They also said they make choices about how they spend their day and that they were happy with the activities available. Organised activities are available and staff confirmed that residents choose to take part or not. The home has an activities co-ordinator, who is contracted to work 30 hours per week. She was not in the home during the visits but a number of the residents described the work that she did and they knew the things she offered. There are some home-based social opportunities for residents to participate in. The residents also have the opportunity to go to Balmoral (the home that is attached) to use the facilities available there. These include the room that has been set out as a pub and the one which has Care Homes for Older People Page 15 of 28 Evidence: been made into a cafe. There is a good newsletter published on a monthly basis which is available throughout the home and given to al of the residents. The residents described trips out that they had had, one was to Whitley Bay and one said that they had had a really good laugh and another best laugh for ages another trip had been to Saltburn. The individual recording of the resident participation is good and describes their participation or if they declined to participate. Also one to one time is given for those who do not wish to, or are unable to take part in, group activities due to their physical limitations. A relative said that the home was a a nice place for me to visit and that her relative was happy and settled. The residents bedrooms are personalised reflecting individual choices and preferences and residents asked said they were happy with the decoration. Residents receive visitors when they wish and use their own rooms, the small lounges or the larger, busier lounges to receive them. Relatives confirmed that they are made welcome. Information about visiting is given in the residents guide. The food being served at lunchtime on the day of the second visit offered choice and appeared to be well presented and well received by the residents. Residents spoken to said that the food was nice and that we get enough choice and there is always plenty to eat. Staff spoken to were aware of the need for some residents to have their food intake monitored and knew about which foods were important for these residents. Care Homes for Older People Page 16 of 28 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 is a good system for managing and dealing with complaints, which makes it possible for them to be investigated and action taken to address any issues identified. The residents are protected from abuse through the effective process for recruitment and selection of staff and through staff induction and training programmes. Evidence: The complaints procedure is available in the service users guide and a copy is available at the front entrance as well as being displayed in other places in the home. The Manager records complaints in line with the company policy, she also records expressions of concern so that she can address them both as part of the complaints procedure and for quality assurance purposes. Residents understood how to make a complaint, and could identify the way this would be dealt with. Relatives who were visiting the home were aware of the complaints procedure but felt that their concerns were being dealt with before the need for formal complaint. One of the returned surveys from a resident said that they felt that the staff are always friendly and ready to listen to concerns and try to held and correct whenever possible. All of the staff have received protection of vulnerable adults training. Staff could describe the principles of protection of vulnerable adults and were knowledgeable Care Homes for Older People Page 17 of 28 Evidence: about how to alert senior staff of any concerns they have. The manager and senior managers in the service have worked well with the Care Quality Commission and the safeguarding team to make sure that the residents are protected when issues arise that need to be looked at through the safeguarding adults procedures. Care Homes for Older People Page 18 of 28 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 environment is good, it is clean and odour free, and there is a programme in place to make sure it remains in good repair and pleasant. Good control of infection practices are in place and the staff were aware of their responsibilities. Evidence: The home was purpose built for the client group and as a result has good-sized corridors and is designed to allow service users to use the entire home with ease and in safety. The decoration is in keeping with the style of the home and the furnishings are suitable for the residents living in the home. The Manager has an ongoing redecoration plan and has identified equipment and furnishings she feels are needed to maintain the standards. These include the dining rooms which now need to be redecorated and the corridors which need to be re-carpeted. The residents spoken to were happy with the decoration and maintenance standards. The home is clean and was odour free. The residents bedrooms were personalised reflecting individual choices and preferences and three residents asked about their bedrooms said they were happy with the decoration and that they were kept clean by the staff. The laundry was clean, organised and well equipped. The sluices were tidy, clean and odour free and the disinfectors operational. Staff followed infection control policies throughout the day. The light and emergency call cords were all clean and all Care Homes for Older People Page 19 of 28 Evidence: emergency cords reached skirting level. Care Homes for Older People Page 20 of 28 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 are recruited and selected using a good system, which ensures that they do not present a risk to the residents and there is a good training programme to make sure that they have the skills and experience to care for the people living in the home. Evidence: Staff records for recruitment and selection are completed in line with the company policies and procedures. This includes two references and a completed application form. The requirement to have a CRB and POVA check in place is applied to all of the staff in the home. The is a system in place for doing an analysis will to identify skills gaps for the staff so that additional training can be given as necessary. The supervision and appraisal process gives staff the opportunity to be involved in thier own developement and in any decisions made in the home. The training records allow the Manager to plan training; it was very clearly maintained and offered an efficient and easily examined system. Statutory and clinical training is given in line with the company policy and includes moving and handling, fire and health and safety. All staff have had the training at necessary intervals. Care Homes for Older People Page 21 of 28 Evidence: More than 50 of the care staff have achieved the National Vocational Qualification to level 2. Care Homes for Older People Page 22 of 28 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. There are good systems in place to make sure that the home is managed effectively taking into account the needs and wishes of the residents and that safe working practices and quality assurance protect the people living in the home. Evidence: The manager Mrs Agbo has worked in the home since August 2007 and is registered with the Care Quality Commission. She has been a registered nurse for 28 years and has experience in a broad spectrum of nursing areas including occupational health and care of older people. She had worked as a deputy manager for more that two years before being appointed as manager of Kensington. She is currently working toward her Registered Managers Award. There are two deputy managers employed and both were on duty on the second day of the inspection. They were working well together and there is clear identification of the role each has. They meet regularly with the manager to make sure that they have a Care Homes for Older People Page 23 of 28 Evidence: clear picture of what needs to be done. The records to support the Managers confirmation that she ensures safe working practices in relation to first aid, food hygiene and moving and handling are in place and are satisfactory. There is a good training programme in place to meet the requirements for this to be achieved. Formal supervision for care staff is up to date. Senior staff also work with carers to carry out informal supervision of their practice when delivering care and the qualified nurses are knowledgeable about the skills of the care staff. The manager takes the necessary action to ensure the health and safety of the service users. This is supported by the policies and procedures and by discussion with the Manager. She regularly tours the home to ensure that the staff are complying with safe working practices. Audits are carried out for a a number of areas including, infection control, bedrooms, care plans, and accidents. The Manager facilitates relative and resident meeting, from which notes are available. This gives them the opportunity for them to communicate with the home and have input into the things going on, and for the manager to tell them what is happening. During the visits the relatives visiting were chatting in a very positive way with the staff and all of them were spoken to by the Manager if she was around. This gives them the opportunity to approach her informally if necessary. The home uses a number of internal mechanisms as part of the quality assurance process. These include monthly reporting to the senior staff in the company and an extensive audit programme. There is a programme of meetings including full staff, nurses and nutritional meetings which includes relevant staff and a relative and heads of department meetings. The manager is also involved in the companies managers meetings. There have been some concerns regarding the way that the staff communicate between the shifts/teams and the manager is looking that as as part of the improvment programme. The personnel records kept in the home of residents who are receiving assistance to manage their finances are detailed, logical and appropriate. Receipts were in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place. The personal allowance records examined allowed the audit of individual residents moneys to ensure that it is being managed effectively. The home have taken steps to limit the amount of money held by them in the home and have sought alternative ways of achieving this depending upon the individual residents financial situations. A number of the residents have personal back accounts. Care Homes for Older People Page 24 of 28 Care Homes for Older People Page 25 of 28 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 26 of 28 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 It is recommended that the manager continues with her plan to improve the care plans by making them more detailed and person centered. It is recommended that the manager investigates the reason for the extreme heat in the treatment room. It is recommended that the home carry out the planned improvements to the dining rooms and the corridors to make sure that the home continues to be a pleasant place for people to live. 2 3 9 19 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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