Care Home: Kingfisher Residential Care Home

What the care home does well Staff were observed to speak to people in a respectful manner. A timely response has been received from the Acting Manger and Responsible Individual to any concerns raised by Inspectors. What the care home could do better: Given the continued low occupancy it is of concern that more improvements have not been made. There is evidence that there have been some attempts to address requirements made through inspection, though the low number of people living in the home at present should have given sufficient time to work on and improve practices and the record keeping that supports people`s care. It is of particular concern that inspectors found it necessary to highlight areas where people`s basic needs were not being met and had to prompt further advice from health professionals. The lack of understanding of the importance of managing the staff rota in a way that ensures staff are not working excessive hours is of concern because of the potential risk that this poses to people using the service. Random inspection report Care homes for older people Name: Address: Kingfisher Residential Care Home 43 - 45 Marshalls Road Raunds Wellingborough Northamptonshire NN9 6ET zero star poor service 03/06/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Kathy Jones Date: 2 6 0 8 2 0 1 0 Information about the care home Name of care home: Address: Kingfisher Residential Care Home 43 - 45 Marshalls Road Raunds Wellingborough Northamptonshire NN9 6ET 01933623028 Telephone number: Fax number: Email address: Provider web address: kingfisher.r.h@hotmail.co.uk Name of registered provider(s): Name of registered manager (if applicable) Kingfisher Residential Home Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 27 Number of places (if applicable): Under 65 Over 65 27 dementia Conditions of registration: 0 No one falling within category DE(E) should be admitted to The Ferns Care Home where there are 27 persons within the category of DE(E) already accommodated The 5 persons identified in correspondence dated 2nd December 2004 who fall within the category of OP may continue to be accommodated at The Ferns Date of last inspection Brief description of the care home Kingfisher Care Home is registered to provide personal care to 27 older people, most of who have needs relating to dementia. The home is privately owned and is situated in the market town of Raunds, Northamptonshire, close to a range of local amenities. The Care Homes for Older People Page 2 of 11 0 3 0 6 2 0 1 0 Brief description of the care home home is on two floors and has a passenger lift and a stair lift. Single bedrooms and double rooms are provided, and there are four separate lounge/dining rooms. All of the roome are of domestic size. The homes statement of purpose and service user guide (which provides information on the range of facilities and services available at the home) is made available to prospective residents and their representatives. The range of fees as from 1st April 2009 is £355 to £381 per week. The actual fee is dependent on the persons assessed needs and the type of room occupied. Additional costs would include external services such as chiropody and hairdressing. Care Homes for Older People Page 3 of 11 What we found: The purpose of this inspection was to check compliance with statutory requirements, some which we found had not been met within the required timescales at our inspection in June 2010 and some new ones that were issued as a result of the findings of the inspection in June 2010. Compliance with the requirements was checked through looking at a sample of records, observations of the care and support that people were receiving and talking to the Acting Manager and Staff. The quality rating in June 2010 remained at 0* poor. As a result, since the inspection in June 2010 we have met with the Responsible Individual and have requested action and improvement plans. Information received in the plans has been considered as part of this inspection. At the time of this inspection there were ten people living at Kingfisher Residential Care Home. One person who was in hospital at the time of our inspection in June 2010 had moved to a nursing home as they were assessed as requiring nursing care. The numbers remained at ten as another person had been admitted on a privately funded basis. Northamptonshire County Council (NCC) stopped any further placements at Kingfisher Residential Home in December 2009 as a result of their concerns. They also have a policy not to place people in 0* poor, rated services. Inspections in January and June 2010 identified a quality rating of 0* poor and no further placements have been made by NCC. A requirement to update the statement of purpose was outstanding at the last inspection. We found that this has now been updated, however advice was given that it should accurately describe what is in place at the present time rather than what the service is aiming to do. Review of care records for a recent admission identified that an assessment of the persons needs had been carried out to establish the level of support and assistance they need. Due to the nature of the building and staffing levels which mean that there are not staff in all parts of the building all of the time, advice was given to assess any risks relating to this including if the person is able to use a call bell to summon any necessary assistance. Risk assessments continue to be very general with a standard format where peoples names are inserted, however there was an improvement in that those on file related to the correct person. The particular risks that had been identified in June 2010 and had led to us making a requirement were no longer applicable, however advice was given to continue to look more broadly at risks relating to individuals. We checked a sample of peoples care plans and were informed that the Acting Manager is continuing to work on these. The plans included information about peoples daily routines, such as when they needed assistance with toileting or where they were assessed as being at risk of pressure ulcers, when they needed repositioning or bed rest to reduce the risk. Inspectors observed three people over a six hour period. These people are unable to mobilise independently and are reliant on staff for assistance. During this observation period, people were assisted with drinks and meals, though they were not assisted from their chairs, either for re-positioning, bed rest or to be taken to the bathroom. Care Homes for Older People Page 4 of 11 Although there was no evidence that peoples assessed needs were not being kept under review we were concerned that record keeping, particularly relating to advice given by health professionals was poor. For example, although Inspectors were informed that the diet and the way someone was assisted with feeding was based on professional advice, there was no record of this. Inspectors advised that further advice should be sought and that increased monitoring be put in place. Confirmation was received following the inspection that the General Practitioner had been contacted and a revised care plan had been introduced. People were given assistance where required with their meals, though the practice of serving meals to those people all at the same time needs to be reviewed as staff are unable to assist all those that need help at the same time. Practices need to be reviewed to ensure that everyone has access to a hot meal. In all but one instance staff sat with people and assisted them appropriately with their meal. A member of staff said that all prescribed medication was in stock and a sample check confirmed this. Records were in place confirming that medication had been administered as prescribed. Records were in place of medication received and carried forward to the next cycle as part of an audit trail, however a sample check of records against medication in stock identified discrepancies with quantities for two medications. Staff thought the reason for the discrepancy may be that relatives had brought additional prescribed medication from home. This would indicate poor recording practices which should have been identified through medication audits. The Acting Manager said that medication audits have been taking place but have not been recorded. We were informed that new regular medication audits are due to be carried out by a member of staff who some of the management tasks have been delegated to. Staff were not aware of the outcome of some blood tests for someone. We asked the Acting Manager to contact the hospital for the results to ensure that the prescribed medication dosage remains correct. We were unable to access updated training records due to a computer breakdown, however we spoke with staff who confirmed that they had received additional training which included first aid and a session titled Advanced dementia. The dementia training was a 4.5 hour session which gave some examples of how to interact with people with dementia. Staff said they found this useful in helping them to respond to people with dementia. Inspectors observed three people during a six hour period, during which they did not take part in any activities, though on one occasion a staff member did sit and talk to two of the people who responded positively to this. A member of staff is employed specifically to assist people with activities. On the day of inspection this member of staff worked with a small number of people in the activities room. The Acting Manager sent us an updated training matrix as requested following the inspection. This shows that in addition to the dementia care training, health and safety training took place in June 2010 and medication training was due to take place the day after the inspection. As Kingfisher Residential Care Home provides care for people with dementia, advice was given to try and identify some more in depth dementia care courses for at least some of the staff. The Acting Manager advised that the Responsible Individual has now taken over the responsibility for arranging staff training. Care Homes for Older People Page 5 of 11 Staff recruitment was discussed with the Acting Manager who advised that they are waiting for the necessary references and checks for several potential new staff. A new member of staff that has been employed is related to the Acting Manager. Advice was given that the Responsible Individual take responsibility for overseeing and approving the recruitment in this case. We were concerned at the inspection in June 2010 about the induction process for new staff and gave advice about the need for implementing a more formal process for induction and assessing peoples competence. One new member of staff had started work since the inspection in June 2010. We found that the same basic in house induction records were being used, though the one for this member of staff was not dated. In June we were informed that staff were expected to work some shadow shifts without pay prior to starting work and forming part of the staff rota. There was no evidence of this new member of staff working any shadow shifts. The staff rota identified that the manager was on the rota as working a 9am-5pm shift, followed by a night shift the same day, followed by another 9am-5pm shift and a night shift again the following day. The night shift starts at 9pm and finishes at 7am. We have discussed our concerns about the lack of adequate time off between shifts with the Acting Manager and also the Responsible individual and advised that this should be reviewed taking account of the health and welfare of service users and the manager and employment legislation. Some of the service users require two staff to attend to their needs through the night and there are normally two waking staff on duty through the night. However when we raised concerns about the lack of time between shifts, we were told that if the shifts fall during the week then the manager sleeps and is woken to assist staff through the night. The Responsible Individual has confirmed that where there are insufficient staff, the agency staff are available, it is therefore unclear why such excessively long shifts would be worked except in an emergency. We checked the storage of chemicals as we had found chemicals left outside on our last inspection. There is a locked cupboard which is used for storage of items such as cleaning materials, however some poor practices continue in that a container of fence preservative was being used as a door stop for the managers office. The environment continues to show signs of wear and tear. A sheet was covering part of the wall in the dining room, which the Acting Manager advised was covering a damp area that they were waiting to have investigated by their insurers. We found that the ramp to the front door was wet and very slippy and brought this to the immediate attention of the manager. During the inspection in June 2010 we found that a protection plan drawn up by Northamptonshire County Council Safeguarding team and sent out with a letter dated 11th May 2010 had not been added to the persons care file. The fact that this still was not in place on 26th August 2010 is a further example of the poor management of paperwork and information affecting people who use the service. At our inspection in January 2010 we found that we were not consistently receiving details of notifiable incidents as specified in the Care Homes Regulations 2001 and made Care Homes for Older People Page 6 of 11 a requirement about this. During the inspection in June 2010 staff told us about someone who had been admitted to hospital several times. The Acting Manager told us that she had not been aware it was necessary to notify us of this. During this inspection the Acting Manager told us that these had been sent retrospectively and showed us a copy of two notifications. Although a notification has been received, we have not received the retrospective ones. Advice was also given regarding the need to include more information about the particular incidents. No application for registration has yet been received from the Acting Manager who has been in post since November 2009. We were informed that the necessary documentation is in the process of being collated. Following our meeting with the Responsible Individual in June 2010 he has provided improvement plans and further information and clarification as requested. One of the major changes that he highlights is that he is now a hands on owner. The plan identifies that he has taken on some of the roles that the Acting Manager was carrying out and that an extra member of staff was to be employed to assist the manager. We contacted the Responsible Individual following this inspection to discuss the findings and confirmed some of the more urgent actions required to ensure peoples health and safety in a letter. This inspection was conducted under the Care Standards Act 2000. This legislation ceases on 30th September 2010 and is replaced on 1st October 2010 by the Health and Social Care Act 2008. As a result of this we wont be making any new requirements following this inspection. However Kingfisher Residential Care Home have made an application for their registration to be transitioned to the new legislation and we will consider the findings in relation to that application. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 7 of 11 Care Homes for Older People Page 8 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 18 13 Advice and protection plans provided by the local authority safeguarding team must be incorporated in peoples care plans. To safeguard people who use the service. 22/07/2010 2 33 24 The quality assurance system must be effective in maintaining compliance with regulations. To promote the health and well being of people using the service. 22/07/2010 Care Homes for Older People Page 9 of 11 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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