Care Home: Kingfisher House

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What the care home does well People told us that they are happy with how the home supports them to meet their personal hygiene needs, this including input that is appropriate to people`s cultural needs. People have access to a range of health and social care professionals and this ensures that the appropriate advice is sought to meet their health needs. The home is sensitive to people`s cultural and religious needs so that they are supported to live their lives pursuing what is important to them. People are supported to keep in touch with their families and friends so that they do not lose relationships that are important to them. There is a robust system for checking that people`s money is held at the home in a safe manner. People told us: Staff " look after as individuals", "always very clean" and " always give privacy, staff are good". "carers are carers" and the "girls (staff) are very good" and that staff "treat you well" "Debbie Green here alot, a lot better you can talk to Debbie she will try to get sorted out" and "She (Debbie Green) is approachable and can go in and see and talk to, last manager could not pin down". "if you want to go out they let you with someone with you". What has improved since the last inspection? Assessments of people`s needs are now more robust, this meaning people can be more confident that their care and support needs will be met. Communication between Nurses and care staff has improved meaning that the staff response to people`s needs is better. Management of medication has improved and as a result is safer. Staffing numbers have increased and the allocation of staff to units within the home is now more robust. This means that people living at the home can be more confident that they will get assistance with personal care more promptly. This also means that their dignity is preserved. There are also pendants available in the lounges so that people are able to summon assistance. There are more robust vetting procedures for new staff meaning that people can be more confident that the staff looking after them are safe. The management are now more proactive in raising safeguarding alerts with statutory authorities. Staff training is improving and staff have received input in a number of areas in respect of how to work safely since our last visit. The homes management is now more accessible to people living at the home, and their representatives. There is noted improvement in the provision of some activities and stimulation to the point that people told us they want more. The homes activity co-ordinator has clear plans in place to improve the stimulation available to people living at the home, this on an individual and group basis. What the care home could do better: The home needs to promote the fact that information about the service is available in differing languages and formats. People`s views as to menu provision needs to be canvassed to ensure the food choices provided met with their expectations and needs. The management need to ensure all complaints received at the home are fully documented so that is clear what action is taken to respond to every concern or complaint raised. In addition when complaints are received, and the resolution of a complaint investigation is delayed, the complainant should be informed of this delay to counter any feelings of possible dissatisfaction. There are some areas of the home, that management have identified need redecoration such as bedrooms and corridors. In addition the removal of dirty soap trays/dishes in en suites, the fitting of better lighting (also in en suites) and risk assessment of unsecured wardrobes would make the home safer. Key inspection report Care homes for older people Name: Address: Kingfisher House 171 Yardley Green Road Bordesley Green Birmingham West Midlands B9 5PU     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: Jonathan Potts     Date: 2 4 0 6 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 31 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 31 Information about the care home Name of care home: Address: Kingfisher House 171 Yardley Green Road Bordesley Green Birmingham West Midlands B9 5PU 01217530333 01217714190 kathryn.rafter@mha.org.uk www.mha.org.uk Methodist Homes for the Aged 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 38 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 who can be accommodated is: 38 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 38 Date of last inspection Brief description of the care home Kingfisher House provides general nursing care for up to thirty eight older people. It is managed by Methodist Homes for the Aged, which is a nationwide charity. The aim of the home is to improve the quality of life for older people based on Christian values. However their services are open to all older people assessed as needing them regardless of their cultural background or faith. Care Homes for Older People Page 4 of 31 Over 65 38 0 1 2 0 1 2 0 1 0 Brief description of the care home The home is located in a residential area within the boundary of Heartlands Hospital. It is close to shops and public transport links. Ample off road parking is provided for vehicles at the front of the home. There is a secure garden that is suitable for all people to use. The home is a non-smoking environment. The home is purpose built and all bedrooms are located on the ground floor. They all offer single accommodation and all but two have en suite bathroom facilities consisting of a toilet, wash basin, and walk in shower facility. In addition, assisted baths and showers are available for all people to use. Corridors are spacious and allow people to move around freely with any mobility aids required. The home has transfer hoists to meet the assessed needs of people living there. The home offers communal dining and lounge areas. A separate room is allocated as a hair dressing salon. There is also a separate multi faith/prayer room. Kitchen and laundry facilities are based on site. The home employs one activity coordinator who works on a part time basis. In the reception area there is information that may be of interest. This includes our last inspection report, the statement of purpose, and service user guide. Details of fees charged to live at the home are not included in the service user guide and this will prevent people from having this information. Items excluded from the accommodation fee include chiropody, toiletries, hairdressing, and newspapers. Care Homes for Older People Page 5 of 31 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: Our surprise visit to Kingfisher House was carried out on the 24th June 2010. The visit involved one inspector. We arrived at 9.45am and left at 7.15pm. Our visit followed consideration of all the information we have received about the service since our last key inspection. This included information sent to us by the care provider in the form of improvement plans and information from different organizations. We have assessed the homes performance against key standards and looked at outcomes for people living at the home. This was carried out by us talking to a number of people living at the home and their relatives. We also spoke to management and staff about the service and how they meet the needs of people living at the home. We also looked at care plans, medical records and daily notes for a number of people that live at the home. We also looked around the building and sampled a number of management records. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? Assessments of peoples needs are now more robust, this meaning people can be more confident that their care and support needs will be met. Communication between Nurses and care staff has improved meaning that the staff response to peoples needs is better. Management of medication has improved and as a result is safer. Staffing numbers have increased and the allocation of staff to units within the home is now more robust. This means that people living at the home can be more confident that they will get assistance with personal care more promptly. This also means that their dignity is preserved. There are also pendants available in the lounges so that people are able to summon assistance. There are more robust vetting procedures for new staff meaning that people can be more confident that the staff looking after them are safe. Care Homes for Older People Page 7 of 31 The management are now more proactive in raising safeguarding alerts with statutory authorities. Staff training is improving and staff have received input in a number of areas in respect of how to work safely since our last visit. The homes management is now more accessible to people living at the home, and their representatives. There is noted improvement in the provision of some activities and stimulation to the point that people told us they want more. The homes activity co-ordinator has clear plans in place to improve the stimulation available to people living at the home, this on an individual and group basis. 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 31 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 31 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. People can make informed decisions about whether thy wish to live at Kingfisher House. The way in which the staff ensure they can meet peoples needs is now more robust, this meaning people can be more confident that their care and support needs will be met. Evidence: We looked at the homes statement of purpose and service user guide, which is available in the homes foyer. We saw that there is a copy available in a large print format. Management told us that these documents can be produced in other formats and languages on request. A statement to this fact is not however included in the documents or displayed where the information is available. The display of brief information to this fact, preferably in different languages, would be advisable so that people can see and are aware that this service is available to them. We also noted that there is a need to update some of the contact details in these documents so that they carry our correct contact details as in the national helpline number. Care Homes for Older People Page 10 of 31 Evidence: Information about the provider and the services they offer we saw is also available on their website which provides a link to our website and the latest report for Kingfisher house. People we spoke to told us that they were able to make a decision about moving into the home, and felt they had sufficient information available. This was due to having spent time at Kingfisher previously in some cases. We are aware that information is distributed in the form of a Welcome to your new home guide. We looked at the pre admission assessments for two people and found that these have improved with information now well recorded. There is clear recording of decisions made as to whether the home is able to meet the needs of the individual, this as they are identified in the assessment. We saw clear evidence that people and their relatives are involved through the staff going to visit them at their home or hospital prior to admission. The manager overseeing the home told us how she has worked with the nursing staff to improve the pre admission assessment process since our last visit to the home. Based on what we saw assessments of need by the homes staff are far more concise and detailed than those we saw previously. Intermediate care is not provided at the home. Care Homes for Older People Page 11 of 31 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. Improvements in staff communication and deployment have improved the success with which peoples health and personal care needs are met. People can now be more confident that they will be supported in a way that promotes their privacy and dignity. Evidence: We saw that assessments of peoples individual physical, emotional, and social care needs are undertaken on admission to the home, and are reviewed periodically throughout their time there. Care plans are derived from this information. These are individual plans written with the involvement of people and their representatives about what people can do for themselves, and in what areas they require support. We found that the vast majority of care plans were personalised, included peoples preferences regarding their daily lives and identified what the person could and couldnt do for themselves. They also gave instructions for staff about the support to be provided. It was evident from our discussions with people living at the home and their visitors that people are involved in writing and reviewing these. This is important in that people are encouraged to maintain their independence and means that their Care Homes for Older People Page 12 of 31 Evidence: preferred routines can be maintained whilst living at the home. There is scope to develop the plans in such as pictorial formats to assist with communication and involvement of people and the manager is considering ways in which this maybe implemented. We saw that care plans are supported by risk assessments that show consideration is given to supporting individuals to take responsible risks, and have access to independence. We saw that moving and handling assessments identified the specific support and equipment required for each person. Care records identified that staff support people to have regular baths and showers based on their preferences. People told us the staff look after as individuals, always very clean and always give privacy, staff are good. We saw that people are clean, hair is neatly styled and people are wearing clothing appropriate to their age, gender, culture, and the time of year. We spoke to a number of people about how quickly staff responded when they wanted assistance, and they told us that this is fairly quick (one person told us that sometimes about five minutes dependent on how busy the staff are). When asked no one said that any wait for assistance caused them any difficulties. We saw that staff are available in the communal living areas during the time we spent at the home. At the time of our last visit we identified issues around poor communication between the staff, this having an impact on the care and support people received. We spoke to the management and they told us how they have worked to remedy this, with changes in work routines so as to allow nurses more time working with carers. The method of handover is also strengthened this encouraging the passage of information. Decisions as to how staff are allocated are documented as we saw, so that the areas people are responsible for on any given day can be tracked. Staff we spoke to told us that the team work and communication between themselves and the nursing staff was improving with nurses getting first hand information and interacting more with carers. The staff told us issues raised by care staff are now actioned quicker than previously. We saw that people can retain their own doctor on admission to the home, if the doctor is in agreement. In addition we saw that advice can be sought as needed from a range of other health and social care professionals. We saw that staff follow instructions made by professionals and this promotes peoples health. The home employs a private physiotherapist two days a week for the benefit of the people living at the home. There is a good system in place for the management of medication and we saw that Care Homes for Older People Page 13 of 31 Evidence: records in relation to this are well maintained as was verified by visits to the home from pharmacists. The home had a visit from primary care trust pharmacist in May this year with comment made impressed with the obvious hard work that has gone into improving the medication management processes in a relatively short space of time. This was reflected by comments from the local pharmacy who stated many improvements have been made recently - much better. There have been some issues in the past few months with medication that the manager told us about, this reflected by comment from a relative. The manager told us how these are being remedied, this in part through improving staff communication. Throughout our visit we observed staff supporting people in a respectful manner, and this will ensure that their dignity is maintained. Changes have targeted improvement in peoples dignity, such as with the monitoring of the rota by managers to ensure that there are female carers available so that people do not have to have male carers, where they want females (this an issue at the time of our previous visit). People we spoke to told us that they have access to privacy with personal care always in private and staff knocking doors to bedrooms. We saw peoples self esteem is promoted with staff helping people to wear such as jewelery and preparing their hair appropriately. We were told that the diverse staff groups means there are staff available to assist with such as haircare in an appropriate manner. Care Homes for Older People Page 14 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is developing the way stimulation and activity is provided so that it meets diverse individual and group needs of the people living at the home. People have differing degrees of satisfaction with the current catering provision. Evidence: Discussion with a number of people living at the home showed us that they had flexible routines, with them telling us that they could get up when they wished to and retire to bed when they wanted, one telling us they liked to stop up late and watch the TV. We saw that there are activity boards throughout the home displaying photographs of recent activities and events. We discussed the homes provision of activities with the activity co-ordinator, who currently works at the providers home next door and Kingfisher house. From discussion she acknowledged that there was work to be done to improve the current activities programme, but enthusiastically told us how they are working toward improving this provision. To assist with this task the hours available for her in the home have increased to 18.75 hours per week where as it was previously 14 hours. Care Homes for Older People Page 15 of 31 Evidence: There is now 20 additional hours available for use in supporting 5 younger adults that live at the home with activities. They also told us that they could be flexible with the use of their hours between Kingfisher house and the home next door. They told and showed us how they are currently drawing together a four week activity plan, that would cover group activities such as music and movement class, chairobics, reflexology, ball games, arts and crafts and quizzes as examples. We saw how the organiser has set out clear instructions for each activity for staff to follow to carry out the planned sessions. We also heard that the activity organiser is co-ordinating the staff development of individual profiles for each person living at the home, this drawing on a daily living skills assessment that identifies what that individual is able to do successfully and where they may need support. This is then or will be used to formulate an individual plan for a persons individual activities. We looked at one that was complete for one of the people living at the home that we spoke to, and saw how it captured activities that reflected her abilities and culture. These plans are still in the process of completion but will provide a good base and clear guidance for staff so that they can provide people with the stimulation and activities they want and enjoy. People we spoke to told us that they have enjoyed recent group activities one of particular note the beach day where staff brought the beach (sand and water) to the home so that people could feel these and reminisce about past holidays. Numerous photos we say displayed show people enjoying themselves on this activity. One relative told us about some Al Johnson singers that came and how they noticed the more mentally frail people living at the home lighting up when they sang and interacted with them. People also told us about trips out of the home for such as shopping and cinema trips, one saying If you want to go out they let you with someone with you. There is also music therapy available (through the homes music therapy co-ordinator) that provides a way in which people with dementia or other disabilities can express themselves, an example the use of drums so a person who had limited difficultly communicating could vent their feelings. Based on what we heard from people they are positive about recent activities at the home and would like to see more. It is hoped that the planning and implementation of revised group and individual activity programmes by the homes staff will ensure peoples expectations in respect of stimulation and activity are met. Religious worship services are held at least weekly at the home, this through the homes Chaplaincy service. The statement of purpose states that the home aims to Care Homes for Older People Page 16 of 31 Evidence: improve the quality of life of older people based on Christian concern and that people of all faiths are welcomed. There is a multi faith/prayer room at the home. In addition, staff can help make arrangements for people to worship at a local place of their own choice if preferred. This means that people have the opportunity to worship and practice their own faith, and pursue what is important to them. People are encouraged to maintain contact with their family and other people important to them. People told that there is an open visiting policy and that they can meet with their visitors in private if they wish. We saw people had access to their rooms with visitors if they wanted privacy, one person telling us that the staff always ask do you want to go into your room. In addition, we saw that some people go outside of the home with their friends and family, at any time that they choose. One relative met with during the visit told us that visitors are able to make themselves drinks in the kitchenette area, and we saw others doing so. From discussions with people living at the home and from our observations, we saw that people are offered a choice of meals with staff seen to ask people what they wanted to eat from the menu. We heard mixed views about the quality of the food however some people saying they liked the meals and the choices where as some commented as to limited choices, although there was acknowledgment that this had improved recently. We hard that there was too much mash, too many crumbles and not enough rice puddings and that the vegetables are too hard. There was also reference to an individual having soup in a feeder that due to thick lumps could not be taken this way. People did tells us that there are foods available that reflect cultural needs and that there are three choices of main meal available every day (as we saw displayed on the menu). We did note that the dining areas where people eat are attractively set out, with tablecloths and flowers and the provision of printed menus on tables (although the day we visited was the first day this was done so we heard from relatives). We also saw and heard that people have the choice of where and when they wish to eat. We discussed the above issues with the manager who said that since a recent hospitality audit they are working on improving the catering at the home. Ways in which this is to be done include the increased cover in the kitchen (now has staffing in the afternoon until 4pm as opposed to 2pm). The manager also stated that they are considering the use of pictorial menus that would assist with choices. It was suggested to the manager that a fact finding mission in respect of peoples views about the catering would help clarify who had concerns, as some people living at the home are happy with the meals they have. Use of a questionnaire after meal times is one Care Homes for Older People Page 17 of 31 Evidence: possible way of capturing peoples views more accurately. Care Homes for Older People Page 18 of 31 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. People living at the home are now more confident that outcomes will improve as a result of raising concerns, although there is scope to further build on improvements in this area. The home has improved the way it protects people from harm, and reporting concerns where there is potential abuse. Evidence: An easy to read complaints procedure was on display in the home and is included in the service user guide. Some people told us that it was difficult to access the previous manager but that things had improved since new management took over. One relative told us that the manager made an effort to come round and speak to people and asked if things are alright. The relative said that she was made to feel that the manager did want to hear what they had to say. A number of people living at the home also said that they could speak to management or staff and had confidence that they would try to address any issues raised. One relative told us that they had written in to complain about an issue and despite receiving written confirmation of receipt they had not received any further response, leaving they feeling dissatisfied. We looked at the complaints register held at the home and found that there are still some complaints that we know the home has received earlier this year that are not included. When asking the manager about the complaints they gave us detailed feedback as to what they had done and we had confirmation from some people we spoke to that the one matter was resolved. We did however see that there was good Care Homes for Older People Page 19 of 31 Evidence: recording in respect of those complaints in the register, this including clear detail of any actions taken in respond to the issues raised, this to the benefit of the people living at the home. Since our last visit we have seen evidence of the homes management raising safeguarding referrals appropriately, this in respect of concerns as to other providers. We saw that the home has taken appropriate actions and the manager of the unit was attending a safeguarding meeting with other agencies on the day we visited the home. From the practices of the current management team since our last inspection we can see that they are now following the comprehensive safeguarding policy that is in place and are now also following local multi agency guidelines about how to manage investigations into these. This has demonstrated that the management have listened to and address the concerns about management of safeguarding issues raised at the time of our last visit, this meaning that investigations are no longer delayed by the home not reporting issues. This means that peoples rights to protection from abuse are being promoted. We saw evidence that staff have received safe guarding training since the time of our last inspection, this through a computer based training package that involves a test of their knowledge. Discussion with the management team also showed that they have a very good understanding of safeguarding vulnerable people. we saw from sampling recent recruitment checks for new staff that these have improved and now better protect people living at the home. Care Homes for Older People Page 20 of 31 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. People are provided with a homely and generally clean living environment that meets with peoples expectations. Evidence: Whilst we saw that there are areas that are in need of redecoration and refurbishment, we saw that some recent redecoration of the home has taken place, this meeting with the approval of people we spoke to who felt it had improved this area of the home, making it bright and cheerful. We were told of the plans to link Kingfisher House with the providers other home next door through a link way, with the plan that it will contain a range of communal facilities that may include a shop, cafe and hairdressing room. As part of this work it is planned to refurbish corridors and bedrooms in the house to bring them up to a better standard. We saw that the staff have put together a sample board to help people have involvement in the choice of decor such as carpets and curtains. We sampled the areas of the home relevant to the people case tracked. The home is divided into three self contained units however people are able to move freely around the home as they wish. All accommodation is located on the ground floor for ease of access for the people living there. Each unit has its own lounge and dining areas and we found that these had been decorated and furnished in homely styles. Care Homes for Older People Page 21 of 31 Evidence: All bedrooms offer single occupancy and all but two of these has an en suite toilet and walk in shower facility. In addition communal assisted toilet, bathing and shower facilities are accessible to all people living at the home. We looked at the bedrooms of people case tracked and saw that they have personalized their bedrooms to reflect their age, gender, interests and culture. People met during the visit stated that they were happy with their rooms. People have the option of having a key for their bedroom door so that they can keep their personal items private and secure, although those people we spoke to said that they had no interest in this facility. Peoples choices regarding key holding we saw are documented. There is equipment available to assist staff to deliver personal care to people living at the home in a safe manner. We saw that there is a rolling programme of replacing specialist equipment, including beds in order to improve the quality of peoples lives. We had concerns at the time we last visited that people in the lounge had no means of summoning assistance from staff whilst in the communal lounge and dining areas. It was pleasing to see that this issue has been addressed through the purchase of a pendant alarm that can be used to summon assistance and can be positioned in different areas of the home unlike a fixed call point. We saw a number of peoples rooms and noted that the wardrobes we saw to be unsecured. This presents a potential risk of them falling forward if used by people to steady themselves. The potential for this should be risk assessed, and where necessary wardrobes secured. We also noted that the lighting in some of the en suites could be better, this so to make for a brighter area due to the lack of natural light. It was pleasing to see that the handyman fixed a non working extractor fan promptly when this was reported to him. The manager also reported the lighting in en suites to the companys maintenance section before we left. We found that the home was overall clean and fresh throughout our visit, and people commented on the fact that there is never any unpleasant odors in the home. A four star food hygiene rating was awarded at the last environmental health inspection, this meaning people can be confident that food is prepared in a hygienic manner. We did however note that the soap dishes we saw in peoples en suite bathrooms are seemingly encrusted with old soap and present a surface that would be difficult to clean and has the potential to harbor bacteria, this an issue that was raised by one relative. The manager reported this matter to the maintenance on the same day of our visit. We also noted one mobile hoist with areas of rust. Care Homes for Older People Page 22 of 31 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. Staff in the home are now better trained and are now available in sufficient numbers so as to ensure people living at the home receive prompt support when needed. Evidence: In addition to care staff, administration, cleaning, maintenance, laundry, and catering staff are employed so that people living at the home receive some support in these areas. In addition there is a team of dedicated volunteers who spend their time improving the quality of the lives of people living at the home. The provider has responded to the concerns raised at the time of our last visit and staffing levels have increased, this meaning there is now better cover on the house units. The creation of new posts has meant that the home has used a agency staff to quickly increase the number of staff available although the use of these staff is now decreasing as posts are occupied by permanent staff. The views of some people we spoke to indicated that the saw the agency staff as not as committed as the permanent staff. We also heard that the carers are carers and the girls (staff) are very good and that staff treat you well from people living at the home and their relatives. The freeing up of nurse time has also allowed them more time to work alongside carers (this as management and staff we spoke to told us) and has also helped improve communication between nurses and care staff. Care Homes for Older People Page 23 of 31 Evidence: We asked people about the availability of staff in the communal areas and they told us that staff are usually available and they do not have to wait long for assistance. Some people we spoke to told us that staffing levels had improved, especially during late evening and night. This was also confirmed by staff we spoke to. We sampled the recruitment files of two staff members who had recently come to work at the home. These included all the information required including professional references from previous and last employers. The improvement in the homes recruitment practices means that people can have more confidence that people employed by the home are suitable to work with them. We saw that staff do not start working for the agency until satisfactory vulnerable adults checks have been obtained, this in order to protect people living there. We saw that new workers complete induction training including an introduction into health and safety matters, and practical work. This is in order to gain the skills and knowledge in preparation for providing care and support to people living at the home. Staff we met during the visit told us that they are very pleased with recent training they have received which they said conveyed very strong messages about values in care in a very enjoyable way. They also told us about the training they have received through the companys electronic learning this including safeguarding of vulnerable adults and safe working practices. We looked at the homes training planner and some certificates from training and this showed us that staff training is progressing well in mandatory areas such as health and safety, food hygiene and infection control. Other training the home is making available to staff includes care planning, health and personal care as well as a seven week dementia care training programme facilitated by external trainers. The majority of staff employed at the home are trained to a National Vocational Qualification Level 2 in care (NVQ 2) and most are working toward NVQ 3. This should mean that they have some of the skills and knowledge required to provide care and support in a competent manner. Records identified that staff meetings are held regularly, these now in smaller groups to allow people a better chance to speak up and have the opportunity to be involved in the running of the home. Care Homes for Older People Page 24 of 31 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 change of management at the home has promoted more openness and respect, better systems for the safeguarding of people, and a service that is more responsive so as to better meet the needs of people living at Kingfisher House. Evidence: We saw the homes certificate of registration on display in the foyer, this the current copy that reflects the service provided by the home. Since our last visit to the home the registered manager has left, and the home is now managed by Debbie Green, the registered manager from Herondale, another of the providers homes next door to Kingfisher. Ms Green told us about the company plans to physically link these two homes later this year and at that point combine the two into one larger service. This will mean that the homes current management arrangements will become more permanent with Debbie Green managing the home with the support of a deputy, with care manager allocated to each side of the home. Care Homes for Older People Page 25 of 31 Evidence: Comments we heard from people we spoke to showed confidence in the new management arrangements with comments such as Debbie Green here alot, a lot better you can talk to Debbie she will try to get sorted out and She (Debbie Green) is approachable and can go in and see and talk to, last manager could not pin down. Others also commented that whilst they felt there was still room for improvement the home was improving and the service getting better. We spoke to the management team and found that they are all knowledgeable as to the needs of individuals living at the home as well as the wider issues in respect of where the home needs to improve. It was pleasing to see that most of the issues we raised during our visit are ones the manager was already aware of and was able to give a verbal update on progress in addressing these matters. An example of this was comments we received about less availability of managers on a weekend. Debbie Green said that they are currently looking at a three week rota system which with improvement this availability. One of the key areas where the home needed to improve at the time of our last visit was in respect of staff communication. Feedback we have received from people living at the home, relatives and staff has shown us that work has improved how staff communicate, this through the way differing grades of staff now work together and including senior carers in the morning hand overs with managers and nurses. This has improved outcomes for people living at the home and based on the comments from care staff, their morale. The manager is looking to continue this development with senior staff currently undertaking roles and responsibility training that will prepare them to be the lead in key areas (such as hydration - promotion of fluid intake and dignity in care). There are regular quality monitoring visits at the home, these carried out by the companys board members and other managers. These visits are in addition to the service managers visits to the home. Following the issues raised related to quality monitoring at the time of our last visit to the home the company has revised its standards and values audit system, and an audit of the home by the companys quality monitoring section is due later this year. The manager told us how they are looking to involve people in the home and their relatives in the next audit process so that they can better capture their views and have a more independent view. Meetings with people living at the home are planned to recommence, but these are to be on a house basis so that the management can capture issues pertinent to the home and the individual unit. The manager also said that smaller groups will give the chance for more people to air their views as the full house meetings were seen to be too large. We saw at the time of our last key inspection in January that there was a robust Care Homes for Older People Page 26 of 31 Evidence: system in place for the safekeeping of small amounts of money held on behalf of people living at the home. Receipts were available and this means that it was possible to establish what peoples money had been spent on. From records sampled we identified that regular checks are taken on equipment to ensure that it is safe to use. We saw that a fire drill had been undertaken recently so that people were aware of the actions to be taken in the event of a fire. We saw that accident forms are completed and that the manager regularly audits these. There are now post accident monitoring systems in place that we looked at and tracked from two specific accident reports. These showed us that the home has a robust way to monitor and respond to issues that may lead to accidents and any potential injuries that follow them. Follow up for the two examples we looked at included input from the companys physiotherapist. Care Homes for Older People Page 27 of 31 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 28 of 31 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 1 The contact information for CQC in the homes statement of purpose and service users guide should be current and up to date. To ensure information is on clear display in appropriate languages. This would ensure that potential users of the service are aware that information about the home is available in a range of formats and languages. To further explore the views of people living at the home as to their satisfaction with the menu and food provision, this possibly with the use of a short post meal time questionnaire on a targeted time limited basis. The management should ensure that all complaints received are recorded in the homes complaints register, and where there is a delay in investigating any complaints the complainant is informed of this in writing. To risk assess the wardrobes in bedrooms that are unsecured in regard to the potential risk of their falling forward. To consider improving the lighting in en suite bathrooms. 2 1 3 15 4 16 5 19 6 25 Care Homes for Older People Page 29 of 31 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 7 26 To address issues identified in respect of infection control management such as the soap dishes in bedrooms that are unfit for purpose, and the areas of rust on the one hoist. To continue with the plans to increase the availability of managers within the home over weekends. 8 31 Care Homes for Older People Page 30 of 31 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. © 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. 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