Care Home: Kenwyn

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What the care home does well The home is a purpose built property that is well maintained. It provides a spacious environment that is warm, clean and well furbished. Residents spoken with were happy in the home and had their own possessions around them. The grounds are extensive and very well maintained. The home has won several awards for its gardens; last year they won the Barchester in bloom award. Residents have a gardening club and can participate in growing flowers and vegetables. A competent nurse assesses new residents prior to them moving into the home. This is to ensure the home can meet their needs. The assessment involves the resident, their relatives and health professionals as necessary and records are kept. A person centred plan of care is compiled from the initial assessment and it directs staff in the care to be provided. A number of risk assessments are undertaken, for example to prevent pressure sores, to ensure adequate nutrition and to prevent falls. The nurses maintain individual daily records, and they are informative. Residents say their healthcare needs aremet, they are treated with respect and their privacy is upheld; this was also seen to be so during the inspection. There are good systems in place for the receipt, storage, administration and disposal of medicines. Storage is safe and secure on each unit. A qualified nurse administers the medicines at all times. There are three people responsible for the organisation of activities, entertainment and trips out. Residents said they enjoy what`s on offer especially going out. Residents are given a programme of events and records are kept. Activities include bingo, art, quizzes, reminiscence, cookery, knitting and gardening. Residents said they could receive visitors when they wish and their individuality and personal preferences are respected. The home tries to ensure that mealtimes are a pleasurable experience. Nutritional needs are assessed to identify any specific dietary requirements. The menu is very varied with fresh fruit and vegetables on offer every day. There is a variety of finger food, omelettes and a sweet trolley. The dining room has a servery and a hot trolley is used to take meals to people who eat in their rooms. Recruitment procedures are robust and there is plenty of training on offer to staff. The management strive to improve services and the care provided by a range of audits and surveys. Regular meetings take place with staff and residents. There is a comments book in reception and residents said they could talk freely to the staff and management if they needed to. What has improved since the last inspection? A bar has been provided for residents where wine, beer and soft drinks are served. A mobile facility is available for those unable to go to the bar. An evening pub quiz is well attended. The office on Trellisick unit has been moved and is better for confidentiality. The staff offices on each unit have been fitted with cupboards and shelves to improve storage. New soft furnishings and flooring has been provided in the dining room upstairs. The training room is now in use upstairs. Training for staff has improved with a member of staff responsible for co-ordinating courses and attendance. She compiles a newsletter regularly for staff. There are more apprenticeships and NVQ training. The Company has it`s own NVQ academy and an NVQ trainer based in Cornwall. Care plans are being written in a person centred manner and the mental capacity act is incorporated. More detail is included and they direct staff well. The food continues to improve and is delivered in a hot trolley to those eating in their rooms. There are very few complaints about the food. The home achieved the Investors In People (IIP) award in December 2007. The gardens have improved with a path put in from the patio to the circular path around the home. This enables wheelchair users to access the path without going via the car park. A sensory garden has been created off Tresco unit by the activity co-ordinators and residents. Other residents have been busy with raised beds and the greenhouse; they have also created a small memorial garden. Kenwyn were the regional winners of the Barchester in bloom competition. Activities have improved, there are now two full time and one part time coordinators. They are striving to improve links with the local community; some of the trips include socials at a local church, a pantomime and bingo in Camborne. There are no staff vacancies at the moment and the registered manager said there is a better balance of overseas staff; most have been working at the home for over three years. Personnel files have improved with dividers included for each section. All staff, employed over six months, had an appraisal last year and the supervision system has improved. A resident`s committee has been set up and meetings are chaired by one of the residents. They write their own minutes and give feedback to the registered manager after the meeting. Accident auditing has improved and monthly monitoring is in place. What the care home could do better: An inventory should be produced for the contents of the safe so that the people responsible know what is supposed to be in it. Staffing was reported by residents and staff to be insufficient at times, particularly in the mornings. This issue has also been recorded in several meeting minutes. The registered manager agreed to undertake a review of the care staffing throughout the home and to report to the Commission. CARE HOMES FOR OLDER PEOPLE Kenwyn, Truro Newmills Lane Kenwyn Hill Truro Cornwall TR1 3EB Lead Inspector Diana Penrose Unannounced Inspection 29th January 2008 09:30 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kenwyn, Truro Address Newmills Lane Kenwyn Hill Truro Cornwall TR1 3EB 01872 223399 01872 223884 kenwyn@barchester.com www.barchester.com/kenwyn Barchester Healthcare Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Amanda Jane Trotter Care Home 108 Category(ies) of Dementia - over 65 years of age (34), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (34), Old age, not falling within any other category (60), Physical disability (14) Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Pencarrow & Trelissick - Service users to include 60 adults of old age (OP). Tresco Unit - Service users to include up to 34 adults aged over 65 with a mental illness (MD(E)). Tresco Unit - Service users to include up to 34 adults aged over 65 with dementia (DE(E)). Glendurgan Unit - Service users to include up to 14 adults aged 18 to 65 years on admission with a physical disability (PD). To include one named service user under the age of 65 years in Tresco Unit. Total number of service users not to exceed a maximum of 108. To include two named service users under the age of 65 years in Pencarrow and Trelissick Wing. 25th July 2006 Date of last inspection Brief Description of the Service: Barchester Healthcare owns Kenwyn Nursing Home and a large number of homes throughout the country. Kenwyn is situated on the outskirts of the City of Truro. It is a very large home that offers both residential and nursing care for up to 108 people. The service provides care and accommodation for residents whose needs these include elder care, nursing, dementia, mental disorder, physical disability and palliative care. Accommodation is on two floors and divided into four separate units. There are two lifts accessible to residents. There are four double bedrooms the rest are single, all have en suite facilities and all rooms have accessible call bells. Meals are prepared in a well-equipped kitchen on the ground floor. There is a secondary kitchen on the first floor. Meals are served in the dining rooms on each unit or individual bedroom if preferred. The large dining room upstairs is equipped with a servery so residents can choose their meal and it is served hot. The extensive grounds are attractive and well maintained. There are patios with seating and tables. Car parking space is provided. A Senior Nursing Sister supported by a team of qualified nurses and care staff manages each unit. The Hotel Services Manager is responsible for the catering and domestic staff. Three Recreational Therapists are employed to organise activities and trips out. There are good opportunities for socialising and visitors Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 5 are actively encouraged. Information about the home is available in the form of a residents’ guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from £ 372.96 to £1533.47 per week; this information was supplied to the Commission by the registered manager. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Two Inspectors visited Kenwyn Nursing Home on the 29th and 30th January 2008, they spent ten hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that residents’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that residents’ placements in the home result in good outcomes for them. All of the key standards were inspected. On the days of inspection 108 residents were living in the home, two of these were receiving respite care. The methods used to undertake the inspection were to meet with a number of residents, relatives, staff and the management to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspectors toured the building. The registered manager has completed an Annual Quality Assurance Assessment (AQAA) and the information provided has also been used to inform this inspection. This report summarises the findings of this inspection Residents expressed satisfaction with the care and services provided at the home and said they are always treated with kindness and respect. What the service does well: The home is a purpose built property that is well maintained. It provides a spacious environment that is warm, clean and well furbished. Residents spoken with were happy in the home and had their own possessions around them. The grounds are extensive and very well maintained. The home has won several awards for its gardens; last year they won the Barchester in bloom award. Residents have a gardening club and can participate in growing flowers and vegetables. A competent nurse assesses new residents prior to them moving into the home. This is to ensure the home can meet their needs. The assessment involves the resident, their relatives and health professionals as necessary and records are kept. A person centred plan of care is compiled from the initial assessment and it directs staff in the care to be provided. A number of risk assessments are undertaken, for example to prevent pressure sores, to ensure adequate nutrition and to prevent falls. The nurses maintain individual daily records, and they are informative. Residents say their healthcare needs are Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 7 met, they are treated with respect and their privacy is upheld; this was also seen to be so during the inspection. There are good systems in place for the receipt, storage, administration and disposal of medicines. Storage is safe and secure on each unit. A qualified nurse administers the medicines at all times. There are three people responsible for the organisation of activities, entertainment and trips out. Residents said they enjoy what’s on offer especially going out. Residents are given a programme of events and records are kept. Activities include bingo, art, quizzes, reminiscence, cookery, knitting and gardening. Residents said they could receive visitors when they wish and their individuality and personal preferences are respected. The home tries to ensure that mealtimes are a pleasurable experience. Nutritional needs are assessed to identify any specific dietary requirements. The menu is very varied with fresh fruit and vegetables on offer every day. There is a variety of finger food, omelettes and a sweet trolley. The dining room has a servery and a hot trolley is used to take meals to people who eat in their rooms. Recruitment procedures are robust and there is plenty of training on offer to staff. The management strive to improve services and the care provided by a range of audits and surveys. Regular meetings take place with staff and residents. There is a comments book in reception and residents said they could talk freely to the staff and management if they needed to. What has improved since the last inspection? A bar has been provided for residents where wine, beer and soft drinks are served. A mobile facility is available for those unable to go to the bar. An evening pub quiz is well attended. The office on Trellisick unit has been moved and is better for confidentiality. The staff offices on each unit have been fitted with cupboards and shelves to improve storage. New soft furnishings and flooring has been provided in the dining room upstairs. The training room is now in use upstairs. Training for staff has improved with a member of staff responsible for co-ordinating courses and attendance. She compiles a newsletter regularly for staff. There are more apprenticeships and NVQ training. The Company has it’s own NVQ academy and an NVQ trainer based in Cornwall. Care plans are being written in a person centred manner and the mental capacity act is incorporated. More detail is included and they direct staff well. The food continues to improve and is delivered in a hot trolley to those eating in their rooms. There are very few complaints about the food. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 8 The home achieved the Investors In People (IIP) award in December 2007. The gardens have improved with a path put in from the patio to the circular path around the home. This enables wheelchair users to access the path without going via the car park. A sensory garden has been created off Tresco unit by the activity co-ordinators and residents. Other residents have been busy with raised beds and the greenhouse; they have also created a small memorial garden. Kenwyn were the regional winners of the Barchester in bloom competition. Activities have improved, there are now two full time and one part time coordinators. They are striving to improve links with the local community; some of the trips include socials at a local church, a pantomime and bingo in Camborne. There are no staff vacancies at the moment and the registered manager said there is a better balance of overseas staff; most have been working at the home for over three years. Personnel files have improved with dividers included for each section. All staff, employed over six months, had an appraisal last year and the supervision system has improved. A resident’s committee has been set up and meetings are chaired by one of the residents. They write their own minutes and give feedback to the registered manager after the meeting. Accident auditing has improved and monthly monitoring is in place. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 9 be made available in other formats on request. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are only admitted to the home following a thorough assessment of their needs to ensure the home can provide appropriate care. EVIDENCE: Completed assessment documents were inspected and found to be comprehensive. They were completed appropriately, dated and signed. There is evidence that residents are involved in the assessment process and they sign the document. Residents said they were visited prior to admission and they were given information about the home. One said he came to the home to see his room before he moved in. The Annual Quality Assurance Assessment completed by the registered manager states that the assessment tool used has been improved to ensure the home can manage a person before they are admitted. They are also considering developing senior care staff more in the role of assessment. The home does not provide intermediate care. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents said their healthcare needs are met and they have care plans to ensure that staff know how to care for them. There is a suitable medicines system in place. EVIDENCE: Seven resident’s files were inspected; each contained an individual care plan, various relevant risk assessments, pre-admission assessment details and other relevant care information. Risk assessments include the use of bedrails and they are reviewed monthly. Care plans have improved and they direct and inform staff in the care to be provided. The registered manager said she is trying to move away from a problem based plan to a person centred plan and this was evident in the documents inspected. Some residents were unaware of their care plan but others had seen their plan and signed it. The plans are reviewed each month and records are kept. The daily records are more informative than the night records and this was fed back to the registered manager. The Annual Quality Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 13 Assurance Assessment states that fluid and dietary intake are more closely monitored. Doctors and other healthcare professionals visit the home when required and records are kept. Residents spoke of going to the hospital for appointments and of visits by their doctor. The management said that the home has sufficient suitable equipment for moving and handling and pressure relief. Staff spoken with said there were no problems in this area. Some nurses act as links for specialist subjects, for example continence, tissue viability and the Liverpool Care Pathway. The home has suitable medicines policies in place; the local policy was updated in September 2007. There are good systems in place for the receipt, storage, administration and disposal of medicines. Storage is safe and secure on each unit. A monitored dose system is used. Medicines received into the home are recorded and signed for on the medicine administration chart. Medicines are disposed of appropriately with records maintained. Controlled medicines are handled appropriately with records kept according to legislation. Staff said they receive training from the pharmacist. The management team undertake regular monthly medicine audits. A nurse checks the emergency equipment on each unit daily and records are maintained. There are suitable arrangements for ensuring that resident’s privacy and dignity are respected. Residents have their own telephone line to their room. Resident’s said their privacy is respected and this was observed during the inspection. Staff were seen to knock on doors prior to entering. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Outings and activities are on offer every day throughout the home, visitors are welcomed and residents are encouraged to live a life of their preference. The food served is to a high standard and ensures that residents are offered a balanced diet. EVIDENCE: The home has two full-time and one part-time activity co-ordinators who organise activities and outings for the residents. There is an activities area next to the upstairs lounge. The registered manager said that this area has improved and links with the local community are much better. Some residents talked about a trip to a pantomime and socials at a local church. Residents said they are told what is going on and can choose whether or not to join in. Activities include bingo, art, quizzes, reminiscence, cookery, knitting and gardening. Some residents participate in the gardening club and have grown flowers and vegetables. They have won competitions for their efforts across the Barchester Group. The home holds an annual summer fete and residents said they get very involved with this. There is one to one social interaction and staff said this has increased with the new activities team. Records of activities Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 15 are held individually for each resident in a file separate to the care records. Photograph albums were seen depicting the development of the resident’s gardens and flower displays done by the residents at a local church. A bar has been created on Trelissick unit and several residents said this has improved their social life. Wine, beer and soft drinks are on offer. Four residents, from across the units, were having a drink and a chat by the bar before lunch. The activities team provides a mobile service for those unable to get to the bar. Advice is sought from the nursing staff prior to alcoholic beverages being served. Most residents said they choose when they get up and go to bed. Some residents said they do not have a choice as to when they get up or when they have a bath, it has to suit the staff and the availability of the hoist. They choose what clothes to wear and how they spend their day. They said they receive visitors when they wish and can receive them in private, the visitor’s book showed that several people visit the home each day. Staff said that residents are encouraged to live their lives as they wish but this has to be in line with individual risk assessments. Residents have their own possessions and furniture around them. There are several choices on the menu and the daily routines are flexible. One resident said, “It is like a hotel here, I do as I wish and I wouldn’t wish to be anywhere else”. There is a varied menu that includes finger food, salads and omelettes. There is a sweet trolley with fresh fruit available each day. A majority of residents said the food is very good and it was certainly observed to be very good, with a great deal of choice available. Meals are served in the dining areas or individual bedrooms and they are very well presented. Assistance looked appropriate however one resident said she eats slowly and staff do not have time for this so she feels rushed. This comment was fed back to the registered manager. The servery upstairs allows meals to be staggered, as food is kept hot; it also enables residents to choose their meal at the table. Food is delivered to other units in hot trolleys and served by catering staff. Special events such as Burn’s Night, Valentines Day, Mothers Day and so on are celebrated in the home. Residents said they have a cake made for them on their birthday and their family can join them for a meal in the home when they wish. Comments include “The meals are excellent with choices on the menu”, “portions can be too big”, and “The food is very good”. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are suitable policies in place for complaints and adult protection; all staff get appropriate training to make sure that residents are safeguarded. EVIDENCE: There is a suitable complaints policy in the home and a method for recording complaints, the action taken and the outcome. There have been two notable complaints to the home since the last inspection and both were dealt with promptly. The department of adult social care is still considering the response for one of these. The same two complaints were notified to the Commission since the last inspection, both were dealt with appropriately by the registered provider and partially upheld. Anonymous concerns have been raised by another person but not upheld. There is an adult protection policy that includes the local inter agency procedures. Information received at training events is also held in the file. All staff receive adult protection training, some in house and some external. Mental capacity act training is also provided for staff. Residents said there are no barriers to raising concerns with the management. There is a secure facility for the storage of money in the home. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean with every effort made to eliminate unpleasant odours. The building and grounds are very well maintained providing a safe environment for residents, staff and visitors. EVIDENCE: The home was purpose built and has wide corridors and plenty of space. It is clean and well maintained, refurbishment and redecoration is ongoing. Some residents have chosen the décor for their rooms. Comfortable furniture is provided in the lounges and there are facilities for residents to entertain visitors. Residents said they are happy with their rooms and the facilities provided. The staff offices on each unit have been fitted with cupboards and shelves to improve storage. The office on Trelissick unit has been moved and provides a more confidential facility. New soft furnishings and flooring have been provided Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 18 in the dining room upstairs. The grounds continue to be well maintained and Kenwyn were the regional Barchester in bloom winners. A grant has enabled a path to be created from the patio at the rear of the home to the existing path around the garden. This means that residents in wheelchairs no longer access the path via the car park. Bathing facilities have been improved with Parker baths and wet room shower facilities provided. There were a few unpleasant odours in the home but housekeeping staff were trying their best to eliminate them. They said the odour neutralizer could only be applied to carpets when residents are not in the room. All parts of the home appeared to be clean. There are adequate sluices with washer disinfectors. Hand-washing facilities are appropriate and staff were wearing disposable gloves and aprons appropriately. All laundry is undertaken in the home and there are infection control policies in place. Some issues were raised regarding the laundry service, for example items not returning or getting another persons clothes. This was discussed with the registered manager who said that she had increased the laundry hours as issues have been raised to her. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are robust and the training provision is very good. Residents feel that staff are kind and caring but said there are insufficient numbers at times and they are very busy. EVIDENCE: Each unit has a Nursing Sister in charge, there is a qualified nurse on duty at all times with a team of care assistants. The registered manager said there is one staff vacancy however a person has been identified to fill the post subject to relevant checks. There are few agency staff employed but the nurse bank has expanded. The rota showed a consistent number of staff for each unit however residents said that staff are very busy especially in the mornings. Some residents said they do not get up until late, not always through choice, but because staff are too busy to attend to them earlier. Residents were getting up late on some units during the inspection and it was not always possible to determine whether it was personal choice. Relatives and staff echoed their concerns in respect of insufficient staffing levels especially in the mornings. Staff did appear busy in the morning. Minutes of staff and resident’s meetings show that staffing levels are a concern in the home. It is recommended that the registered manager undertakes a review of the care staffing throughout the home and sends a report to the Commission. She said she would do this and address any problems. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 20 Residents said that staff are very patient and caring and they do their best. Staff were observed to interact very well with residents and in a kind manner. Comments from residents include “The staff are very kind, more than you could imagine”, It’s a good place and the staff are very caring” and “The staff are very busy and not very friendly”. Comments from staff include “The home has a good team of carers and nurses”, “The whole home works well, better than it used to” and “I am very happy working here we are a good team”. 56 of care staff are qualified to at least NVQ level 2 in care. Some have level three and others are enrolled on NVQ courses. The home has an equal opportunities policy. Overseas staff said they are treated fairly and the same as everyone else. Six personnel files were inspected and contained the records required by legislation. The filing system has improved with dividers for each section. All relevant recruitment checks have been undertaken however the managers have recently been told by Company Directors to destroy all CRB documents. Discussion took place in respect of this and the CSCI policy. Interview records are maintained and employees receive terms and conditions of employment. There is an induction programme in place that includes the Skills for Care criteria. Induction records inspected had been dated and signed apart from one, which was blank, and this was discussed with the registered manager. There is a training and development programme for the home. Training needs are identified during the annual appraisal system and supervision sessions, with records kept. Individual training records are maintained for staff and a matrix is held electronically. Staff receive training specific to the needs of the individual units as well as all statutory training. There are posters around the home advertising training sessions and a training newsletter is circulated monthly. The registered manager said that training has improved since a new person has been made responsible for training. Modern apprenticeships are undertaken and the Company has it’s own NVQ academy with a co-ordinator based in Launceston. Staff said they are satisfied in their roles and the training provision is excellent. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team are competent and run the home well. Quality assurance and health and safety systems are in place for continual improvement of the service and the safety of residents, staff and visitors. EVIDENCE: The registered manager is competent and experienced to run the home. She is a qualified mental nurse and has achieved the Registered Managers’ Award. She keeps herself up to date on current issues by reading relevant magazines and using the internet. Staff said she is a good leader and also works as part of the team. One member of staff said the home has been managed much better since this manager and her deputy have been doing the job. Residents said the registered manager is approachable and that she or her deputy come around every day to see the residents. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 22 There is an annual quality assurance survey undertaken with residents and relatives and the results have been positive. The registered manager said that meetings take place with various groups of staff every three months; not all of the minutes were in the file. There is s resident’s committee, chaired by one of the residents, they also meet every three months and minutes are kept. Heads of departments meet on a weekly basis. The minutes show that concerns can be raised and that action is taken. One nurse said the meetings she attends are constructive. There is a comments book in the reception and thank you letters are kept. There is an excellent audit programme that includes health and safety, the kitchen, food, professional practice, medicines, pressure sores and record keeping. Action plans are developed for any shortfalls. The Regional Manager visits the home each month to inspect the home, she writes a report in accordance with regulation 26 of the care homes regulations 2001. The home have also achieved the Investors in People Award since the last inspection. Some residents handle their own money and have lockable facilities in their rooms. No money is held on behalf of residents, they are invoiced each month for anything that has been bought for them. Receipts are kept for hairdressing, chiropody and all other purchases. If anyone requires cash this is provided from petty cash and invoiced to the resident. The registered manager or her deputy are on call and said they would come into the home if money were required out of office hours. There is a system enabling the home to cash cheques for residents. It is recommended that an inventory be produced for the contents of the safe. The management endeavour to ensure that working practices are safe and staff confirmed this. Fire safety procedures and checks are in place and the records inspected were up to date. The registered manager said the fire risk assessment is currently being updated. All equipment and service maintenance checks have been undertaken as required. Accident reporting appears to be satisfactory and the registered manager audits accidents each month. The last environmental health officer’s report identified several issues in the kitchen. Minutes of meetings with the catering staff state the actions that are being taken. The chef on duty showed us around the kitchen and measures have been put in place for cleaning, storage and food labelling. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP27 OP35 Good Practice Recommendations The registered manager should undertake a review of the care staffing throughout the home and send a report to the Commission An inventory should be produced for the contents of the safe so that the people responsible know what is supposed to be in it. Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Kenwyn, Truro DS0000009256.V357504.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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