Care Home: Kestrel House

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What the care home does well Kestrel House offers residents a homely and comfortable place to live. Staff involved in the inspection said that they work with the residents and are able to offer the care they need. Residents were equally positive saying the staff are very good and offer the support they want. What has improved since the last inspection? Although the requirements from the last inspection were not fully met the deputy manager has looked in detail at the concerns raised. She has identified what action can be taken to address them, and a considerable amount of work has been done by all the staff working at the home. What the care home could do better: There continues to be some concerns about the support offered at the home, these have been included in the body of the report, and a requirement has been made regarding the homes capacity to meet the individual needs of people living there. Key inspection report Care homes for older people Name: Address: Kestrel House 220 Willingdon Road Eastbourne East Sussex BN21 1XR     The quality rating for this care home is:   one star adequate 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: Kathy Flynn     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Kestrel House 220 Willingdon Road Eastbourne East Sussex BN21 1XR 01323-431199 01323649420 potterde@bupa.com www.bupacarehomes.co.uk BUPA Care Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 54 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Kestrel House is owned and managed by BUPA. The accommodation comprises of forty-eight single bedrooms with ensuite facilities and three double rooms. There is ample communal space. Kestrel house is situated on the A22 and just over a mile from Eastbourne town centre. Care Homes for Older People Page 4 of 24 Over 65 54 0 0 6 1 0 2 0 0 9 Brief description of the care home There is car parking on site at the front of the home and a small garden and patio area is situated to the rear and side of the home. Copies of inspection reports and the homes Statement of Purpose are available in the reception area of the home. Details of the fees charged can be obtained from the home. Additional charges are made for hairdressing, toiletries, chiropody, newspapers and outside activities. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection was carried out by two inspectors on the 28th January and included a review of pre admission assessments, care plans, staff records and training, medication records, activities, and menus. There were 22 residents at the home during the inspection. 8 residents were involved in the inspection and three visitors to the home were happy to discuss the support provided. The deputy manager and the staff on duty discussed the care and support they provide at the home. The reader should aware that the Care Standards Act 2000 and the Care Homes Regulations 2001 use the term service user to describe those living in care home Care Homes for Older People Page 6 of 24 settings. However for the purposes of this report those living at Kestrel House will be referred to as residents. Care Homes for Older People Page 7 of 24 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 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Statment of Purpose provides information about the home to enable prospective residents and their representatives to decide if the home can meet their needs. Assessments are completed to ensure the home can meet the needs of people that are offered a place. Evidence: The homes Statement of Purpose and Service Users Guide were reviewed and updated during the inspection, and containts clear information about the services offered. Pre admission assessments are completed before people are admitted to the home, the deputy manager confirmed that this is to ensure that the home can meet their individual needs. Residents involved in the inspection said that they chose to come to Kestrel House, they discussed the support they wanted during the assessment and agreed that the Care Homes for Older People Page 10 of 24 Evidence: home could meet their needs. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system provides staff with information about the needs of people living in the home. Policies and procedures are in place with regard to medication to protect residents. Evidence: The home uses the Quest care planning system, which when used correctly enables staff to clearly show how they are meeting the needs of people living in the home. Six care plans were examined and found to contain risk assessments including Waterlow, moving and handling, nutrition, falls, a map of their life with details of their interests, how the home meets their religious needs, a health and safety assessment of the residents rooms and records of the support offered. The information in the care plans is much more detailed, They are easier to read and give a piture of their individual needs and show how the home is meeting them, and there is evidence of regular reviews of care that involve the residents and/or their representatives. Care Homes for Older People Page 12 of 24 Evidence: However there was conflicting information regarding one residents needs in his care plan, decisions had been made for a resident with a dementia type illness without their consent, and the home continued to offer a resident support when they could not meet her specific needs. It was noted at the last inspection that even if the home identifies the residents needs, it may not take action such as tranferring them to an appropriate setting, and therefore may not promote and maintain the residents health. This continues to be a concern. Policies and procedures are in place for the ordering, storage and administration of medicines, medication adminstration record charts (MAR) were viewed and found to be completed appropriatley. It was noted that the medicine trolley was left outside a residents room unlocked while medication was being administered. This is not a safe practice and the nurse involved advised that action would be taken to address this. Staff were noted to treat residents with respect, and communication between them was relaxed and friendly. Staff spoken with felt that they could provide the care and support the residents need and want, and residents said that the staff are helpful and look after us very well. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities are provided for residents who are able to participate in them, the food at the home is good, choices are offered at each meal, and special dietary needs are met. Evidence: The activity coordinator has developed a programme of activities for resdients to take part in if they wish. They include games and quizes, specific celebrations such as Burns day, as well as outside entertainers. During the inspection there was an activity committee meeting in the morning and movement to music in the afternoon. The coordinator advised that one to one activities are offered to people who prefer to remain in their rooms, although these should be developed further to ensure they are based on their preferences. The provision of activites for people with a dementia type illness was identifed as something the home would address as part of their improvement plan. However this has been delayed and the home has yet to evidence that they offer appropriate activities. Care Homes for Older People Page 14 of 24 Evidence: Visitors are welcome at any time, and those involved in the inspection said that the staff are more supportive and offer the care that the residents and relatives ask for. Residents are encouraged to make choices about how they spend their time, and those involved in the inspection said that they can decide where they spend their time, if they want to join in activities and where they eat their meals. The food at the home is good, the menu shows that choices are available and residents can change their mind if they prefer something else. Special dietary needs are provided for and staff are available to assist residents. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to enable people to raise any concerns they may have, and training in adult protection is provided for staff to protect residents. Evidence: The homes complaints procedure is available to residents and visitors in the Statement of Purpose and is also on display in the entrance area. Residents involved in the inspection said that they would talk to the staff or the nurses if they had any concerns. Training in adult protection is provided for staff, those involved in the inspection have attended this and were able to demonstrate an awareness of abuse and what action they would take if they have any concerns. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Kestrel House offers residents a homely environment, and infection control training is provided for staff to protect residents. Evidence: Kestrel House offers people living there a comfortable environment, there are lounges and dining rooms on each floor and the large garden to the rear are wheelchair accessible. Residents rooms have ensuite facilities and they are encouraged to personalise them with small pieces of furniture, ornaments and pictures, and to ensure their health and safety the rooms are individually assessed. There is an ongoing repair and maintenance programme at the home, and a number of rooms including the dining room have been redecorated. Training in the control of infection is provided for staff and those involved in the inspection have attended this and are aware of the homes policies with regard to the use of gloves and aprons. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are in place to protect residents, and training is provided for staff to enablet them to offer appropriate care and support. Evidence: There were 22 residents in Kestrel House during the inspection and the deputy manager advised that there were a sufficient number of staff working to meet their needs. Although a member of staff who was on the rota was not working and staff were moved from the other floor to cover. It was not clear if this is normal practice at the home or if additional staff are brought in to ensure the needs of the residents are met. It was noted that at lunch time staff were not available to give out meals on one floor, and the chef served the meals and took them to the residents rooms to ensure they did not have to wait. Recruitment procedures are in place. Four staff files were viewed and found to contain the relevant information including application forms, references and Criminal Record Bureau (CRB) checks. However two did not have full employment histories, although they are discussed at interview, and it was unclear when references were received. This information should be available so that there is a clear audit trail as part of the quality assurance system. All new staff are expected to complete induction training in line with Skills for Care Care Homes for Older People Page 18 of 24 Evidence: and there are opportunities for them to work towards National Vocational Qualifications (NVQs). The home does not meet the required 50 of staff with NVQ level 2 or equivalent. The training programme at the home includes the mandatory requirements fire training, food hygiene, moving and handling, safeguarding adults and infection control. Additonal training to meet the specific needs of residents is also provided including dementia care, however one of the staff spoken with during the inspection did not know which residents have a dementia type illness. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and safety of residents is promoted through the training programme for staff and ongoing maintenance of the home. Evidence: There has been a significant period of change in the management of the home and the home did not have a manager in place at the time of the inspection. We have been informed by the Responsible Individual that a manager has been appointed since the inspection. The deputy manager was appointed in November 2009 and is supported by the manager of the sister home in Eastbourne, and a number of managers from BUPA. She is a registered nurse, has considerable experience of supporting older people in a care home setting, and confirmed that she is working towards addressing all the issues raised at the last inspection. The deputy manager had an awareness of the Mental Capacity Act and no applications Care Homes for Older People Page 20 of 24 Evidence: have been made under Deprivation of Liberty. This was discussed and agreed further advice and guidance would be sought with regard to Deprivation of Liberty. As part of the quality assurance system the regional manager from BUPA visits the home to do Regulation 26 visits monthly. The records were viewed and it was noted that the system uses a tick box method which does not clearly show any feedback from residents, visitors or staff. We have been advised since the inspection that Regulation 26 reports now include more detailed information. Residents involved in the inspection said that the staff are very good and they felt that they are offered the support they want. Staff spoken with said that they can meet the residents needs, and feel they work together with the residents to provide the support that they want. The home does not take responsibility for residents finances, although some money may be kept in the home for their use. Records were viewed and found to be appropriate. The staff training programme and ongoing maintenance of the home protects the residents health and safety. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 That the home only admits and continues support for service users whose individual needs the home can meet. That the home promotes and makes proper provision for the health and welfare of service users. 08/03/2010 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 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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