Care Home: Kestrel House Lodge Care Home

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What the care home does well The care plans were written in plain language, easy to understand and considered all areas of the individuals life including health, personal and social care needs. Areas where individuals are encouraged to be independent were identified and the support that staff would need to take was clearly stated. The care plans seen by the inspector showed a real understanding of individual care issues and the amount of help that each individual needed without taking away the choices that they could make. The care plans seen were sensitively written and easy to follow. In each care plan seen by the inspector records were completed and evaluations made. Any changes in the individuals conditions were noted and an action point was made for follow up of treatment and referral for implementation of the organizations policy to rectify and monitor the situation. At this care home there was good evidence of the key worker system in practice as the key worker built up a one to one relationship with the individual and was able to write the care plans in an interesting and supportive manner that would benefit the outcomes of care for that individual when followed. Attention was given to ensure that the privacy and dignity needs of the individual was met by the staff when escorting people to the toilet areas, moving and handling or when addressing different individual people at the care home. What has improved since the last inspection? Care plans have been improved and there is evidence of the individual being involved wherever possible. There is better use of the organizational policies and procedures. Changes in the individual`s needs is reported and monitored by the organizations managers through their reporting systems. Staff at the care home have a monitoring system in place to ensure that medications are better managed. Documentation for staff records has been improved. What the care home could do better: The acting manager is to become registered by the Care Quality Commission. In this way the people living at the home, staff and family members will feel that there is continued daily management support. Key inspection report Care homes for older people Name: Address: Kestrel House Lodge Care Home St Thomas` Avenue Kirkby In Ashfield Nottingham NG17 7DX     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: Lesley Allison-White     Date: 2 1 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Kestrel House Lodge Care Home St Thomas` Avenue Kirkby In Ashfield Nottingham NG17 7DX 01623757204 01623750512 kestrel.lodge@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Keslaw Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 33 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: That service users shall not be accommodated in the home unless they come within one or other of the following categories :- OP (Old age, not falling within any other category) Aged 60 years and above - restricted to 5 service users That the category of service users to be included on the register shall be OP (Old age, not falling within any other category) 33 That within this number, a maximum of 5 service users can be included aged 60 years and over The total number of people to be accommodated in the Kestrel Lodge Care Home , St Thomas Avenue, Kirkby in Ashfield, Nottinghamshire, shall not exceed 33 at any one time Date of last inspection Brief description of the care home Kestrel House Lodge is a purpose-built home close to Kirkby town centre and is located on a quiet residential avenue. Most of the bedrooms are single, although two doubles Care Homes for Older People Page 4 of 24 Over 65 33 0 Brief description of the care home are available for those who choose to share. Accommodation is on two floors and there is a passenger lift to the first floor, as well as a staircase for those who are able and prefer to use this. There are pleasant gardens to the rear, which are enclosed, and there are car parking spaces to the front of the property. The home is close to Kirkby town centre and is located on a quiet residential avenue. The weekly fees for the home range between £355.00 - £392.00 The information about fees was provided by, the acting manager on 21st April 2009. Additional Charges are for hairdressing, Chiropody, Toiletries and Magazines/newspapers. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by the Care Quality Commission is on outcomes for the people who use the service and their views of the service provided. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This Key unannounced inspection took place on a week day. All the key standards were inspected and the previous requirements and recommendations were examined. There were twenty people living at the care home and this included one person in hospital. The primary method of inspection used is case tracking. This involves speaking with the people who use the service provided, looking at two peoples care plans and Care Homes for Older People Page 6 of 24 making observations. The inspection focused on checking existing records kept by Kestral House Lodge Care Home, looking at their service history and the Annual Quality Assurance Assessment (AQQA).(This is in formation about the service), completed by the acting manager for the service. This was a satisfactory inspection. The acting manager was present throughout this inspection. 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 Care Homes for Older People Page 8 of 24 order line 0870 240 7535. Care Homes for Older People Page 9 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 10 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. Individuals are provided with information about the service and are provided with an assessment to ensure that their needs will be met prior to decing if they wish to stay at the care home. Evidence: Two people were case tracked and the inspector spoke with five other people. This included a new person and their family member who were visiting the home for the day with the intention of seeing if the care home would be right for them. They both enjoyed the meal offered to them. A respite room is also made available for people who wish to stay for short periods of time. In both care records there was a pre-assessment. This included dietary needs and preferences, moving and handling needs, social needs and emotional needs. An action Care Homes for Older People Page 11 of 24 Evidence: plan was provided for the staff so that they would know what to do if certain assessments required further care to meet the needs of the individual. A copy of the Service User Guide and Statement of Purpose was available in individual bedrooms. This is information about the home that acts as a guide for all new individuals to have. New family members were aware of the Service User Guide also. In the foyer there are many brochures to explain aspects of care or medical conditions for any one to read. Standard 6 intermediate care is not offered at this care home. Care Homes for Older People Page 12 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals have a health care plan that gives a comprehensive overview of their general health needs and acts as an indicator to changing needs. Choices are supported by the staff and individulas are encouraged to remain as independent as they can be. Evidence: People case tracked showed that they were involved with the apsects of their care plan. The care plans were written in plain language, easy to understand and considered all areas of the individuals life including health, personal and social care needs. The care plans also included a risk assessment. Areas where individuals are encouraged to be independent were identified and the support that staff would need to take was clearly stated. For example reason for helping X, stated due to Xs reduced mobility X feels unsteady on standing at the sink to have a wash therefore X will require staff to bring a warm soapy flannel so that X can have a wash. X is able to wash her own hands and face but will require assistance to wash other areas. For drying the care plan said X can wash their hands and face Care Homes for Older People Page 13 of 24 Evidence: but requires staff to wash the hard to reach areas. X is able to make their own choices on clothes to wear each day, staff will need to get items of clothes out so that X can make their mind up on what they prefer to wear. etc etc. Staff will need to help with fastening buttons and zips due to X having arthritis in both hands. Choices were clearly shown throughout the process of giving X assistance. In this care plan there was a referral to the choice that X made. X preferred to have a bath rather than a shower. The carer wrote Staff to ensure that the bathing policy is followed when assisting X to have a bath.The care plan explains before assisting X in the bath all X belongings for bath time are in the bathroom ready for when X gets into the bathroom so that X would not have to be left alone at any time. Staff to fill bath to a level that X prefers ensuring that the temperature of water is safe and and comfortable. The care plans seen by the inspector were written in this way. They were clear, showed a real understanding of the individuals care issues and the amount of help that each individual needed without taking away the choices that they could make. The care plans seen were sensitively written and easy to follow. In each care plan seen by the inspector records were completed and evaluations made. Any changes in the individuals conditions were noted and an action point was made for follow up of treatment and referral for an implementation of the organizations policy to rectify and monitor the situation. At this care home there was good evidence of the key worker system in practice as the key worker built up a one to one relationship with the individual and was able to write the care plans in an interesting and supportive manner that would benefit the outcomes of care for that individual when followed. The medications of the two people seen and satisfactory. Another persons medication was also checked as they were on a controlled drug and this was appropriately managed by the care home and was satisfactory. A controlled drug is a drug that receives careful monitoring. Individuals have access to health and remedial services. Attention was given to ensure that the privacy and dignity needs of the individual was met by the staff when escorting people to the toilet areas, moving and handling, or when addressing different individuals at the care home. Care Homes for Older People Page 14 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. Maintaining independence for individuals through the key worker system is actively encouraged and the lifestyles match peoples expectations. Evidence: Routines at the home are planned around the individuals needs and wishes. The approach by the staff is flexible and friendly towards the individuals at the home. Different people said that their families and friends were made welcome when they came to see them. Individuals are actively encouraged to take control of their lives through the residents meeting and within the care choices that they make each day. They chose when to go to bed, when to have a bath or type of wash to have. Other choices include what clothes they may wish to wear or what areas they can manage when having a wash or when to see the hairdresser or take part in an activity. The key worker system is operated well and individuals who spoke with the inspector spoke about the staff as being like good friends to them. 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. Systems are in place to ensure that individuals rights are respected. Evidence: The Care Quality Commission has not received any complaints about Kestrel House Lodge Care Home. Individuals that spoke with the inspector felt that they were able to express any concerns that they may have. For those that could express an opinion they said that they would go to the staff or members of their family. Individuals living at the home are protected from abuse by involving the individual in the planning of care and the review process whenever possible. They are also protected through staff training in abuse awareness as part of the organizations regular updating. The inspector spoke with two staff members. The staff members were able to describe their induction process and training received whilst working at the care home. They felt able to ask for help and to recognize when a situation needed referring to senior staff. There are policies and procedures for dealing with complaints and protection. This protects the people who live at the care home. The complaints book was checked and there was one complaint this has been dealt with by the service. The complaints procedure is displayed in the hallway. 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. The home is kept clean, safe and tidy. Evidence: On entering the building the hallway is bright and pleasant. An information stand can also be found in the hallway. It includes the Service User Guide and the Statement Of Purpose. This is information about the home. Other information displayed includes the Employers Liability certificate and the most recent copy of the registration certificate for care from the Care Quality Commission (CQC)(previously known as the Commission for Social Care Inspection,(CSCI). The previous inspection report is also to be found in this area. The organization also provides information leaflets for people to take away and read about conditions that people can have they include advice on hearing loss, advice on continence and advice on diabetes for example. The home is a well maintained, safe and clean place to live in. There are a number of baths and shower facilities and toilets strategically placed around the home. The inspector saw the two bedrooms of the individuals case tracked and the admissions/respite room. Each room was clean and well presented with individual items in them making the rooms comfortable and homely. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the care home feel that their needs are met by the staff. The recruitment process is satisfactory also. Evidence: The staff training matrix shows that half the care staff have received training for dementia and that further staff will be provided with this training as the needs of the people who live at the care home continues to change. Pressure areas are identified by the staff. The company has a policy for alerting other agencies. This can include people such as the District Nurses. The internal policy for alerting the risk monitoring reporting system is then commenced. This identifies other areas to consider in the care provided such as nutritional assessment, weight and food intake charts for increased monitoring by the staff and managers. There is evidence of basic training such as fire training, food hygiene, health and safety and infection control. Specific training for staff who give medications is provided. Many staff have received equality and diversity training and some staff have received challenging behaviour training as the needs of the individuals who live at the home changes. As part of the homes ongoing training programme the home should further enhance their skills by introducing training for staff with regards to the Mental Capacity Act. Care Homes for Older People Page 18 of 24 Evidence: As the changing needs of the people who live the home increases it will be important for the staff at the home to monitor these needs and to seek further professional advice as required. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interest of the people who live there. Evidence: People who spoke with the inspector said that they felt happy to live, visit or to work at care home. Visitors said that they were made to feel welcome. The provider does a quality review of the service and has various monitoring systems in place. This is to ensure that the needs and values of the people who live at the home are met and that they can remain actively involved in life at the home. The finances of the two people case tracked was satisfactory. Each having weekly transaction sheets to track how their money was being spent. Their money was spent on hairdressing, chiropody or to buy a family member a Christmas present. Money is held in a group but there are individual accounts for each person. The money is stored within a locked safe. The inspector asked to see evidence of supervisions taking place for staff. One record Care Homes for Older People Page 20 of 24 Evidence: had evidence of recent supervisions and the other did not. Supervisions enable staff to give their views and assess their own performance and training needs. The Annual Quality Assessment completed by the home and sent into the Commission in January 2009 stated that health and safety meetings are held quarterly and the minutes of these are reviewed by the regional manager along with any outstanding maintenance issues. On inspection it was also confirmed by the acting manager that health and safety within the home was being met. The acting manager explained that she has was unable to commence registration procedures with CQC as her own organization has to approve their managers before they apply. The acting manager said that she was permitted to do so now and has commenced the process to be registered with the Commission. In this way the home can be said to be meeting the needs of the individuals who live there. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 31 Individuals are required to be Registered with the Commission as soon as it is possible. 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. 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