Care Home: Kensington Lodge

What the care home does well Kensington Lodge provides a homely, friendly and supportive environment for the people who live there. People have their individual needs and wishes assessed and recorded in a plan of care and the staff team are aware of the needs of the people they are supporting. There is evidence to show that the home works well with healthcare professionals and people`s medication is being well managed There is a programme of activities in place that is suitable to the needs of people with dementia, people have a choice of menu and are supported and monitored regarding their nutritional needs. People tell us that they are happy in the home and that the staff team and new manager are kind and caring and comments seen included, ` I can`t speak highly enough of this home, it is friendly and caring and the new manager is doing a very good job`. What has improved since the last inspection? All Care plans have been reviewed and updated, daily records have been improved and systems for monitoring people`s care put in place and people are receiving personal care in a way that respects their privacy and dignity Service users have had their medication reviewed with their doctors and the systems for administration and recording medication have been updated. The home has carried out research into the dietary needs of people with dementia, there is a wide choice of menu available and there are sufficient staff in place to ensure that people are receiving the support they need at meal times. The environment has been updated with some redecoration and new furniture and new bedding purchased for the whole of the home. There is clear and comprehensive information in place to guide the staff team to the needs of the people they are supporting, staffing levels have been increased and the staff team receive regular supervision and tell us that they are well supported by the new manager. Records in the home such as daily records, monitoring forms for the use of pressure relieving equipment and for the care being provided were current and in good order. What the care home could do better: No Requirements have been made as a result of this inspection visit. The home should continue to embed in practice the positive changes made made both to the quality of care being provided and those made to the physical environment. Key inspection report Care homes for older people Name: Address: Kensington Lodge 53 Broadmark Lane Rustington West Sussex BN16 2HJ     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: Annie Taggart     Date: 1 5 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 27 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 27 Information about the care home Name of care home: Address: Kensington Lodge 53 Broadmark Lane Rustington West Sussex BN16 2HJ 01903786003 01903779160 kensingtonlodge@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr G S Nijjar,Gurkirit Kalkat Name of registered manager (if applicable) Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 18 The registered person may provide the following category of service: Care home only ( PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability or dementia (MD) Dementia (DE) Date of last inspection Brief description of the care home The home is a detached property close to the town centre in East Preston, which has bus and rail links. Accommodation is provided on two floors, with passenger lift access. The home provides residential accommodation for up to 18 residents who are over the age of 65 who have suffered or suffer from mental illness or dementia. Care Homes for Older People Page 4 of 27 Over 65 0 0 18 18 0 2 0 4 2 0 0 9 Brief description of the care home The registered provider is Mr Gurkirit Kalkat and the Registered Managers post is currently post vacant. Fees are approx 450.00 to 650.00 per week. Care Homes for Older People Page 5 of 27 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: In preparation for this inspection an Annual Quality Assurance Assessment (AQAA) was sent to the manager of the home for completion and surveys were sent to service users, staff and professionals involved with the home. The AQAA was returned in the given timescales and contained comprehensive and clear information about the services currently on offer in the home. Four service user, five staff and two professionals surveys were returned and all made positive comments about the home. We looked at any information that we have received since the last inspection and this included the last report and the improvement plan completed as a result of the last inspection visit. Care Homes for Older People Page 6 of 27 The unannounced visit was carried out on Tuesday 15th September 2009 and the visit lasted for five hours. During that time we met with all service users both in communal areas and in their private bedrooms, we spoke to all of the staff on duty and to one visitor. Four service user assessments and care plans were tracked and we look at at all supporting documentation such as risk assessments and daily records and we tracked the system for administering and recording medication. We looked at evidence of activities for people, we saw menus and nutritional plans and observed lunch, the main meal of the day being prepared and served. We saw records for the running of the business and this included complaints and concerns, Regulation 26, Registered Providers visits, Regulation 37 incident and accident recording, maintenance records and fire records. Four staff records , including those for two people recently recruited were seen and these were complete and contained all of the required documentation, we also saw staff training records and evidence of staff supervision. Feedback following the visit was given to the manager and to the Registered Manager of another home owned by the Providers. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 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 9 of 27 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 27 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 clear information available about the services on offer in the home, people have their individual needs and wishes assessed and recorded and contracts of terms and conditions of residency are agreed. Evidence: There is a Statement of Purpose and Service User Guide in place that gives clear information about the services on offer in the home. From looking at records and talking to a family member we saw that people had their individual needs and wishes assessed and recorded and we saw that families and other professionals were involved in the process. In the four assessments that we tracked there was very clear information about all areas of peoples lives including a background history, medical history and social and emotional needs. During the inspection visit a family came to view the home and we saw that it was Care Homes for Older People Page 11 of 27 Evidence: explained to them that the next step would be for the manager to meet the prospective service user in their present accommodation and carry out an assessment process. Contracts of terms and conditions of residency including the fees to be paid and the room to be occupied are agreed and those that we saw had been signed by families or legal representatives. Care Homes for Older People Page 12 of 27 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. People have their individual needs and wishes recorded in a plan of care that is kept under regular review, the home works well with a variety of healthcare professionals and medication is being well managed. Evidence: For each of the people living in the home there is now a detailed plan of care in place to guide the staff team to the individual needs and wishes of the people they are supporting. We tracked the plans for four people including two who had recently been admitted and saw that the plans had been devised using the assessment process and from gaining information from families and other professionals involved in the persons care. Care plans contained a background history for people, details of personal care preferences, nutritional assessments and monitoring guidance, pressure area care and details of social and emotional needs. Risk assessments were in place for areas such a moving and handling, personal safety and mobility needs. A senior carer told us, when the new manager took over the priority was to review and update all the care plans, we then went through them with each staff member to Care Homes for Older People Page 13 of 27 Evidence: ensure that they understood peoples needs and this is then monitored at supervision and at handover times. At the last inspection visit we identified that there were concerns around the use of pressure relieving equipment in the home and with recording the support being given to people being cared for in bed. At this visit we saw that there were clear guidelines in place for the use of specialist beds and the pressure that the beds should be set at was monitored and recorded each day. There were food and fluid intake charts in use and we saw that they had been completed and signed every two hours during the day and the night with the amounts of nutrition taken also recorded. We also saw people were being turned every two hours on advice from the district nurses and this was also recorded and was current up to the time the inspection took place. From looking at care plans we saw that the home works well with other healthcare professionals such as mental healthcare teams, district nurses and local doctors and we also saw records to show that people had access to chiropody services and opticians. Feedback in surveys from healthcare professionals in two surveys was positive about the care being provided in the home. Care plans are reviewed and updated monthly by key workers and there is also a weekly update completed on each person being cared for in the home, the staff on duty told us that any changes are discussed at handover meetings each shift and also at team meetings. Daily records were current and were written in clear and respectful language and were signed and dated. We also saw that care plans had been signed by a family member or service users representative. We looked at the system for managing medication in the home and saw that this had been reviewed and updated, there is a list of medication handlers on file, staff training was up to date and there were no gaps in signing in the Medication Recording Sheets (MAR). The manager told us, since I have been in post, all service users have received a medication review, many people have been able to reduce their medication and as a result of this are more animated and stimulated. Care Homes for Older People Page 14 of 27 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 a range of activities that offer interest and stimulation for people and nutritional needs are assessed and monitored. People are offered a wide choice of menu and receive the level of support they need at mealtimes. Evidence: From looking at records and observation on the day of the visit we saw that there is now a programme of activities in place that has been devised from assessing peoples interests and hobbies and is suitable to the needs of people with dementia. Each day there are two activities arranged and these are both in house and from external entertainers, examples of these are, film club, music groups, gentle exercise, floor games, ball games and art and craft. During the day we saw a staff member playing a ball game with individual service user and in the afternoon there was a theatre group visiting. People are also involved in simple household tasks such as folding laundry, indoor gardening such as planting tubs of bulbs for the Spring and making sandwiches and sweets. One persons care plan said, likes to have the Daily Mail each day and attempt the crossword and we saw that the person had the newspaper with them. There were sufficient staff on duty to spend one to one time with people and most people were animated and interacting with each other. Care Homes for Older People Page 15 of 27 Evidence: At the last visit a Requirement was made regarding nutritional assessments for people and highlighted improvements needed to the support they were receiving at mealtimes. At this visit we saw that the chef was very knowledgeable about the nutritional needs of people with dementia. Advice had been gained from a nutritional expert and there was a wide choice of menu on offer. We saw that the menu of the day was displayed on the board in the home and that there was a record of what each individual person had chosen for each meal. The chef told us that people are asked in the morning what they would like for lunch, otherwise they might forget and we saw that this could be changed even after the meal was served if the person changed their mind. The chef has a list of peoples likes and dislikes and where people are at risk of malnutrition because of their healthcare needs, risk assessments and daily monitoring records are in place and their weights are recorded weekly. Some of the people in the home need regular supplements as their appetites are very poor, the chef showed us research he had carried out regarding cooking attractive meals using supplements as part of the ingredients and this had worked out very well. We saw lunch, the main meal of the day being prepared and served and it looked attractive and fresh and five people had chosen an alternative meal. A family member told us, I just cant tell you how pleased my family are with the care my husband is being given, he is a very fussy eater but they make him the things that he likes and his health has improved. At the last visit there were concerns about the amount of support people were receiving at mealtimes and the quality of the support being offered by the staff on duty. At this visit we saw that the meal time was unhurried and calm, people received one to one support where needed and the staff on duty sat at the same level as people and encouraged them to eat. Care Homes for Older People Page 16 of 27 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 clear process in place for dealing with complaints and concerns and staff training and working practices are designed and implemented to protect people from risk of abuse or harm. Evidence: The home has a complaints procedure, a copy of which is included in the Statement of Purpose and also displayed in the home. We looked at the complaints books and saw that no complaints have been received since the last key inspection. We asked a family member visiting the home about how they felt about making a complaint and were told, I would go straight to the manager, he is very kind and very good at listening to anything you have to say and I am sure he would act straight away. There is also a suggestions and comments book in the entrance hall of the home and we saw that all of the comments made were very positive. From looking at training records we saw that all of the staff team have attended training in protecting people from risk of abuse or harm. We spoke to four of the staff on duty and all were aware of their responsibilities and said that they would report any suspected abuse straight away. At the last inspection visit the report detailed concerns regarding compatibility and the behaviour of some service users towards others. At this visit we found that action had been taken to address these issues by the involvement of mental healthcare Care Homes for Older People Page 17 of 27 Evidence: professionals and by making some changes to the environment, for example extending the sitting areas in the lounge. The atmosphere throughout the visit was calm and unhurried and service users were animated and chatting to each other and to the staff on duty. Care Homes for Older People Page 18 of 27 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. Recent improvements made to the home have ensured that people are living in an attractive, comfortable, homely and safe environment. Evidence: A number of improvement have been made in order to improve the environment in the home and we saw that this means that Kensington Lodge is providing a homely attractive and comfortable home for the people who live there. New bedding has been purchased throughout the home and we saw a number of beds being re-made with fresh and attractive bed linen. There is a programme of updating and redecorating the home underway and we saw that three bedrooms had been redecorated, in some rooms floor coverings had been replaced, two, new, flat screen televisions have been purchased for the lounge and two air conditioning units added in the sun lounge, which can become very warm. There is a new specialist bath fitted in the downstairs bathroom and redecoration to this room is underway. Two new windows have been replaced to the first floor. Peoples private bedrooms are bright, airy and well decorated and have been personalised with peoples own belongings and furniture and people told us they were happy living in the home. Care Homes for Older People Page 19 of 27 Evidence: During the day there was a housekeeper cleaning and checking rooms and the home was clean, fresh smelling and well maintained throughout. Records showed us that there are weekly key worker checks made and recorded for each room where the physical environment is monitored with any hazards identified and passed to the maintenance person for action. Care Homes for Older People Page 20 of 27 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 people living in the home are being supported by a competent and caring staff team and they are being protected by there being a robust staff recruitment, induction and training process in place. Evidence: From looking at staffing rotas and from talking to the manager and staff on duty, we saw that since the last inspection visit staffing levels have been improved in order to better meet the individual needs of service users. During the visit there were four staff on the early shift, three on the late shift and two were awake at night. The managers hours are addition to the rota. All of the staff on duty were experienced, two were senior carers and held the NVQ level three award. One other carer had just completed the award and one was working towards level three. The staff on duty that we spoke to where very positive about the changes in the home and one senior carer told us, the changes made have been for the better and we have very clear direction and good support, there is a lot more training and we are kept informed about what needs to be done. We tracked the recruitment records for four members of staff including two who had recently been employed and all had the required documentation including two references and a current Criminal Bureau Check. New staff undergo an induction in Care Homes for Older People Page 21 of 27 Evidence: line with the Common Induction Standards during which time they undertake mandatory training such as first aid and moving and handling. Records show us that there is a programme of training and development for staff and courses include dementia awareness, palliative care, care planning, protection of people from risk of abuse and person centred mental health awareness. During the visit we saw that the staff on duty were kind and attentive to the people they are supporting, an example of this was that when a service user became anxious and verbally aggressive at lunch time, the staff member gently diffused the situation in a very short time. In the comments book a family member had written, this is a lovely home, I really can hardly fault it here now and could not have found anywhere better. My relative is cared for by brilliant staff. Care Homes for Older People Page 22 of 27 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 home has a new manager who has the experience and background to manage a home for people with dementia. Records in the home were current and in good order, health and safety issues were being identified and addressed and the home was being well managed. Evidence: There is a new manager in post who has a number of years experience having worked as a deputy manager in another home owned by the Providers. The manager told us that they were trained in Physiotherapy, also as a moving and handling adviser and currently undertaking the NVQ Managers Qualification award. We have been told by the providers and by the manager that an application to register has been submitted to the Commission. The staff on duty and a family member were very complimentary about the open and supportive approach of the new manager and in a staff surveys we are told, the home has improved a lot with the new manager, he does well by improving the quality Care Homes for Older People Page 23 of 27 Evidence: of care we provide and with the new systems and documentation in place the home runs more effectively and efficiently. At the last inspection visit we recorded that the home has carried out a recent Quality Assurance process and that service users finances are managed by their families or legal representatives so these key areas were not assessed at this visit. Regulation 26 Providers visits are carried out on a monthly basis and detailed reports with agreed action plans are on file in the home. From looking at records we saw that accidents and incidents are recorded and action is taken to identify and minimise any health and safety issues in the home. Fire training for the staff team was up to date, we saw protective clothing such as gloves and aprons in use and there were antiseptic hand gels around the home. Following the last inspection visit, in order to address the Requirements and issues of concern, an improvement plan was required to be completed by the home. At this visit we saw that these had all been addressed and met and no further Requirements have been made. Care Homes for Older People Page 24 of 27 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 25 of 27 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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